Heterogeneous TRAb trajectories after total thyroidectomy in graves’ disease with thyroid eye disease
Abstract
Background 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.
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BibTeX
@article{kim2026heterogeneous,
title = {{Heterogeneous TRAb trajectories after total thyroidectomy in graves’ disease with thyroid eye disease}},
author = {Dong Wook Kim MD and Jae Sang Ryu MD and Suk Won Lee MD and Sungkeun Kang MD and Ji An Lee BS and Ji Ahn Park MS and Songyi Yang BS and Sunmi Park PhD and Eun Jin Kim MD and Jin Kyong Kim MD and Sang Wook Kang MD, PhD and Jong Ju Jeong MD, PhD and Kee Hyun Nam MD, PhD and Woong Youn Chung MD, PhD and Young Suk Jo MD, PhD and Jandee Lee MD, PhD},
journal = {Therapeutic Advances in Endocrinology and Metabolism},
year = {2026},
month = oct,
doi = {10.1177/20420188261501576},
url = {https://doi.org/10.1177/20420188261501576},
note = {CC BY},
}
RIS
TY - JOUR
TI - Heterogeneous TRAb trajectories after total thyroidectomy in graves’ disease with thyroid eye disease
AU - Dong Wook Kim MD
AU - Jae Sang Ryu MD
AU - Suk Won Lee MD
AU - Sungkeun Kang MD
AU - Ji An Lee BS
AU - Ji Ahn Park MS
AU - Songyi Yang BS
AU - Sunmi Park PhD
AU - Eun Jin Kim MD
AU - Jin Kyong Kim MD
AU - Sang Wook Kang MD, PhD
AU - Jong Ju Jeong MD, PhD
AU - Kee Hyun Nam MD, PhD
AU - Woong Youn Chung MD, PhD
AU - Young Suk Jo MD, PhD
AU - Jandee Lee MD, PhD
PY - 2026
DA - 2026/10/24
JO - Therapeutic Advances in Endocrinology and Metabolism
DO - 10.1177/20420188261501576
UR - https://doi.org/10.1177/20420188261501576
AB - Background 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.
SN - 2042-0196
SN - 2042-0188
ER -