TSH receptor autoantibody levels post-total thyroidectomy in Graves’ ophthalmopathy: a meta-analysis,Langenbeck's Archives of Surgery

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TSH receptor autoantibody levels post-total thyroidectomy in Graves’ ophthalmopathy: a meta-analysis
Langenbeck's Archives of Surgery ( IF 2.1 ) Pub Date : 2023-10-23 , DOI: 10.1007/s00423-023-03153-3
Arsalan Anees ₁ , Femi E Ayeni _{1,

2} , Guy D Eslick ₃ , Senarath Edirimanne ₁

Affiliation

Background

TSH receptor autoantibodies (TRAbs) are pathognomonic for Graves’ disease and are thought to also underly the pathogenesis of Graves’ ophthalmopathy (GO). A decline in TRAb levels has been documented post-total thyroidectomy (TTx) in GO, however with conflicting correlations with disease outcomes. The aim of the study was to compare the effectiveness of TTx to other treatment modalities of Graves’ disease and examine whether the lowering of TRAbs is associated with GO improvements.

Method

We searched electronic databases including Medline, Embase, Scopus, and Web of Science until 31 September 2022 using a broad range of keywords. Patients with GO undergoing TTx with measurements of both TRAbs and progression of the disease using a validated GO scoring system were included. Fourteen studies encompassing data from 1047 patients with GO met our eligibility criteria. The PRISMA guidelines were followed, and five studies had comparable data that were suitable for a meta-analysis.

Results

The Cochrane Risk of Bias tool for RCTs showed low risk of bias across most domains. The pooled odds ratio showed that more patients significantly had normalized TRAb levels post-TTx as compared to other interventions (OR: 1.36, 95% CI: 1.02–1.81, p = 0.035). But, there was no significant difference in GO improvement post-TTx as compared with other intervention groups.

Conclusions

This meta-analysis shows that TRAb levels may decline largely post-TTx, but may not predict added improvements to the progression of GO. Thus, future studies with uniform designs are required to assess the minimal significant GO improvements.

中文翻译：

格雷夫斯眼病甲状腺全切除术后 TSH 受体自身抗体水平：一项荟萃分析

背景

TSH 受体自身抗体 (TRAb) 是格雷夫斯病的特征，并且被认为也是格雷夫斯眼病 (GO) 发病机制的基础。 GO 患者甲状腺全切除术 (TTx) 后，TRAb 水平有所下降，但与疾病结果的相关性相互矛盾。该研究的目的是比较 TTx 与其他格雷夫斯病治疗方式的有效性，并检查 TRAb 的降低是否与 GO 改善相关。

方法

我们使用广泛的关键词检索了截至 2022 年 9 月 31 日的电子数据库，包括 Medline、Embase、Scopus 和 Web of Science。纳入接受 TTx 的 GO 患者，并使用经过验证的 GO 评分系统测量 TRAb 和疾病进展。包含 1047 名 GO 患者数据的 14 项研究符合我们的资格标准。遵循 PRISMA 指南，五项研究具有适合进行荟萃分析的可比数据。

结果

用于 RCT 的 Cochrane 偏倚风险工具显示大多数领域的偏倚风险较低。汇总比值比显示，与其他干预措施相比，更多患者在 TTx 后 TRAb 水平显着恢复正常（OR：1.36，95% CI：1.02–1.81， p = 0.035）。但是，与其他干预组相比，TTx 后的 GO 改善没有显着差异。