Clinical predictors of TRAb decline after total thyroidectomy in patients with Graves’ disease
Authors' conclusion
In this large post-operative cohort, younger age emerged as an independent predictor of accelerated TRAb decline after total thyroidectomy. Total thyroidectomy yields sustained TRAb decline and may promote immunological remission, particularly in younger patients, by removing the antigenic source before the establishment of long-lived plasma cells. These findings highlight age as a key determinant of TRAb kinetics and provide timelines for counselling and follow-up. Surgery may be especially valuable when a timely TRAb decline is required, such as in younger patients planning pregnancy or those with orbitopathy or antithyroid drug refractoriness.
Study context
- Population
- Patients with GD after total thyroidectomy
- Participants
- 1,516 patients
- Outcome
- Time to TRAb <10 IU/L (pragmatic fetal-risk threshold) and <2 IU/L (assay negativity)
Methodological detailsserial TRAb measurements, post-operative cohort
- Serial TRAb measurements
- Post-operative cohort
Main finding
As reported in the abstract
Median TRAb fell below 10 IU/L
within 2 years
Preoperative TRAb ≥ 10 IU/L: reached <10 IU/L within 5 years
84.8%
Preoperative TRAb ≥ 10 IU/L: reached <2 IU/L within 5 years
60.1%
Observational data: associations, not effects.
Further findings
Predictors of earlier TRAb decline (multivariable models)
- Younger age, lower preoperative TRAb and smaller thyroid weight independently predicted earlier decline
- Sex, BMI and smoking did not predict decline
Original publication
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