[ldquo]A clearer view?[rdquo] TED improvements after total thyroidectomy despite unhelpful TRAb clues

Reshma Rajeev; Gangadhara Sundar; Blanche Lim; Yuan Ngiam Kee; Kit Lee James Wai; Sujith Wijerethne; Rajeev Parameswaran

doi:10.1530/endoabs.117.P302

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Endocrine Abstracts (2026) 117 P302 | DOI: 10.1530/endoabs.117.P302

SFEBES2026 Poster Presentations Late Breaking (54 abstracts)

“A clearer view?” TED improvements after total thyroidectomy despite unhelpful TRAb clues

Reshma Rajeev ¹ , Gangadhara Sundar ² , Blanche Lim ² , Ngiam Kee Yuan ³ , James Wai Kit Lee ^3,4 , Sujith Wijerethne ^3,4 & Rajeev Parameswaran ^5,3,4

Author affiliations

¹Department of Surgery, New Cross Hospital, Wolverhampton, United Kingdom; ²Department of Ophthalmology, National University Hospital, Singapore; ³Division of Endocrine Surgery, National University Hospital, Singapore; ⁴Department of Surgery, Alexandra Hospital, Singapore; ⁵Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

Introduction: Thyroidectomy leads to reduction in thyroid-stimulating hormone receptor antibody (TRAb) in patients with thyroid eye disease (TED), however the association between TRAb decline and clinical improvement remains unclear.

Methods: Retrospective cohort study of patients undergoing total thyroidectomy for Graves’ disease with concurrent thyroid eye disease (TED) between 2020 and 2025 at a tertiary institution. Clinical data, orbital symptoms improvement and post-operative outcomes were analyzed to corelate the impact of TRAb on TED.

Results: Nearly167 patients (139F:38M) with a mean age of 44.7 (±14.7) years underwent thyroidectomy for Grave’s disease. Of these, 75 (45%) patients had concomitant TED, with severity as follows: mild – 36(48%); moderate 28 (37%) and severe in 11 (15%). Patients with TED had significantly higher mean TRAb levels compared to those without TED (23.5±10.3 vs. 18.1±12.5; p = 0.001), which dropped following surgery. Higher TRAb showed no significant correlation with the various parameters evaluated such as age, gender, race, TED severity, or the need for orbital decompression. However when patients were evaluated for symptoms improvement, 53 of 75patients (71%) experienced clinical improvement in TED symptoms, 13 of 75 (17%) showing no change in symptoms. A total of 9 patients (12%) required subsequent orbital decompression to improve their eye symptoms during the study period. The complications of thyroidectomy included the following: recurrent laryngeal nerve palsy - temporary in 4 (2.3%); permanent in 1 (0.5%); hypoparathyroidism – temporary in 39 (23.3%) and permanent in 13 (7.7%); and haematoma in 1 (0.5%).

Conclusion: Subjective improvements are seen in patients with TED undergoing thyroidectomy. The TRAb levels however do not appear to correlate with the clinical course of disease or severity though the TRAb levels were lowered with surgery. The efficacy of surgery in improving eye symptoms however require comparative studies with patients on medical therapy alone.