Purpose

Thyroidectomy is generally reserved for patients with thyroid disease who fail to achieve stable medical control, but its effect on thyroid eye disease (TED) remains unclear. We evaluated ophthalmic and biochemical outcomes in TED patients who underwent thyroidectomy.

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Methods

This retrospective cohort included all patients evaluated at a multidisciplinary TED clinic from 2008–2024. Patients were stratified by thyroidectomy status. Demographic, clinical, ophthalmic, and thyroid laboratory data were compared using t-tests, chi-square tests, and non-parametric analyses; paired tests assessed within-patient changes in CAS, VA, IOP, proptosis, and thyroid function.

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Results

Among 369 patients, 11.7% underwent thyroidectomy (mean age 49.3±16.2 years; 61% female). Baseline BCVA was good (0.08±0.21 OD, 0.08±0.22 OS), color vision was normal, mean proptosis was 20.4±3.4 mm OD and 20.3±3.6 mm OS, and IOP was 15.8±3.2 mmHg OD and 16.1±3.5 mmHg OS. Thyroidectomy patients had significantly higher baseline TSI (p=0.026).In the overall cohort, CAS improved from ~1.4 to ~0.6 (p<0.001), VA remained stable, and IOP decreased modestly by ~1 mmHg per eye (p<0.001). T3, T4, and TSI decreased significantly (p<0.001, p=0.024, and p<0.001, respectively). Thyroidectomy patients received more intensive TED-directed therapies (e.g., IVGC, biologics and anti-thyroid treatments, radiation, and IOP-lowering treatments; all p<0.001) reflecting greater treatment needs. CAS improvement was greater in the thyroidectomy group, although this did not reach statistical significance (ΔCAS −1.50 vs −0.76; p=0.11).

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Conclusion

Thyroidectomy patients had higher TSI burden and required more intensive treatment, suggesting more aggressive TED. Comparable final outcomes and a trend toward greater CAS improvement suggest thyroidectomy may benefit selected harder-to-treat TED patients.

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Additional Authors

First name	Last name	Base Hospital / Institution
Yuval	Cabir	Tel Aviv University
David	Carmon	Wolfson Medical Center
Bar	Klain	Tel Aviv University
Elad	Alexander	Sheba Medical Center
Havi	Murad	Tel Aviv University
Nancy	Agmon-Levin	Sheba Medical Center
Tali	Cukierman-Yaffe	Sheba Medical Center
Ayelet	Priel	Sheba Medical Center
Ofira	Zloto	Sheba Medical Center
Daphna	Landau	Sheba Medical Center
Guy	Ben Simon	Sheba Medical Center

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