Heterogeneous TRAb trajectories after total thyroidectomy in graves’ disease with thyroid eye disease
Dong Wook Kim, Jae Sang Ryu, Suk Won Lee, Sungkeun Kang, Ji An Lee, Ji Ahn Park, Songyi Yang, Sunmi Park, Eun Jin Kim, Jin Kyong Kim, Sang Wook Kang, Jong Ju Jeong, Kee Hyun Nam, Woong Youn Chung, Young Suk Jo, Jandee LeeBackground
Long-term serologic and ophthalmic outcomes after total thyroidectomy in Graves’ disease (GD) with thyroid eye disease (TED) remain incompletely characterized.
Objectives
To characterize 3-year postoperative TSH receptor antibody (TRAb) trajectories and identify factors associated with persistent elevation.
Design
Retrospective cohort study.
Methods
We included 289 patients with ophthalmologist-confirmed TED who underwent total thyroidectomy from 2011 to 2022 at a tertiary center. Thyroid function, TBII-measured TRAb, thyroid-stimulating antibody, and ophthalmic outcomes were assessed preoperatively and at 3 months and at 1, 2, and 3 years. Patients were classified as immediate decline (ID), delayed decline (DD), or no decline (ND).
Results
Median TRAb decreased from 33.1 (IQR, 15.2-40.0) IU/L preoperatively to 7.15 (2.66-20.82) IU/L at 3 months and 2.29 (1.28-10.07) IU/L at 3 years (all q < 0.001). Mean CAS decreased from 0.6 ± 1.3 to 0.1 ± 0.5 at 3 months and remained near zero. Among 32 patients with active TED, mean CAS decreased from 3.8 ± 1.0 to 0.4 ± 0.9 at 3 months, and all achieved inactive TED by 1 year. Greater thyroid weight was associated with ND in the primary model (OR per 50-g increase, 1.50; 95% CI, 1.04-2.16; p = 0.031) and after additional adjustment for systemic corticosteroid exposure (OR, 1.49; 95% CI, 1.03-2.15; p = 0.036). However, this association was not robust in sensitivity analyses excluding patients with TRAb values above the assay reporting limit.
Conclusion
Postoperative TRAb levels generally declined but followed heterogeneous trajectories that may reflect persistent systemic TSH receptor autoimmunity; however, these trajectories appear to have limited utility for predicting ophthalmic outcomes in patients with predominantly longstanding, low-activity TED.