Background: TSH Receptor Autoantibodies (TRAbs) are largely pathognomonic for Grave’s Disease and are also thought to underly the pathogenesis of Grave’s Ophthalmopathy (GO). Total Thyroidectomy (TTx) is one of the oldest approaches for GO management, and it is thought to work by removing the target tissue for intrathyroidal autoantibodies. A decline in TRAb levels has been documented post Total Thyroidectomy (TTx) in GO patients, however with conflicting correlations with disease outcome. Hence, we aimed to determine whether the reduction in TRAb levels post-TTx could improve or stabilize GO.
Methods: We conducted a systematic review and meta-analysis using six publicly available electronic databases (Medline, Embase, Scopus, Cochrane, CINAHL and Web of Science). Our inclusion criteria identified GO patients undergoing TTx with measurements of both TRAb levels and progression of the disease using a validated scoring system. The random-effects model was used to calculate the pooled odds ratio (OR) and 95% confidence interval to compare the number of patients with normalized TRAb levels and the progression of GO between TTx and other interventions.
Results: A total of 13 studies encompassing data from 1050 GO patients met our eligibility criteria and were included in our systematic review. Furthermore, 5 of these studies (4 RCTs, 1 Cohort study) had comparable data that were suitable for a meta-analysis. The meta-analysis included 1 study with radioiodine ablation (RAI) group, 2 studies with subtotal thyroidectomy (STx) groups, and 2 studies with RAI post-TTx groups. We found that significantly more patients had normalized TRAb levels post-TTx as compared to other interventions (p=0.035). However, there was no significant difference in improvement, unchanging or worsening outcomes of GO post-TTx as compared with other intervention groups.
Conclusion: These results suggest that while TRAb levels decline more post-TTx, they may not predict added improvements to GO progression.