Graves' Disease

Anatomy of thyroid gland
1. 3 surfaces
  1. Anterolateral
  2. Posterior
  3. Medial
2. Anterior relations
  1. Skin
  2. Venous arch
  3. Sterohyoid and sterothyroid muscles
3. Medial relations
  1. Larynx and tracheal
  2. Pharynx
  3. esophagus
  4. cricothyroid muscle
  5. superior laryngeal nerve
  6. Recurrent laryngreal nerve
4. Posterior relations
  1. Parathyroid glands
  2. carotid sheath
  3. Ansa cervicalis
  4. sympathetic chain
5. Aterial supply
  1. Superior thyroid
  2. inferior thyroid
  3. Thyroidea ima
6. Venous drainage
  1. Superior thyroid
    1. Internal jugular
  2. Middle thyroid
    1. Internal jugular
  3. Inferior thyroid
    1. L Brachiocephalic
Causes of unintentional weight loss
1. Addison's disease (adrenal insufficiency)
2. cancer
3. A disease of the gut, such as a stomach ulcer, inflammatory bowel disease (IBD) or coeliac disease
4. Depression
5. Diabetes
6. Hyperthyroidism
Thyroid hormone
1. Synthesis
2. Transport
  1. Free
    1. Produce effect
  2. bound to protein
    1. TBG
    2. Albumin
    3. Transthyretin
3. Regulation
  1. The chief stimulator of thyroid hormone synthesis is thyroid-stimulating hormone from the anterior pituitary.
    1. thyroid-releasing hormone (TRH) from the hypothalamus stimulates TSH from the pituitary, which stimulates thyroid hormone release.
4. Action
Hyperthyroidism
1. types
  1. Associated with hyperthyroidism
    1. Primary
      1. Graves' disease
      2. Toxic multinodular goiter
      3. Hyperfunctional (toxic) adenoma
    2. Secondary
      1. Thyroid-stimulating hormone (TSH) adenoma of the pituitary gland
    3. tertiary
      1. Hypothalamic disease
  2. not associated with hyperthyroidism
    1. Subacute granulomatous thyroiditis
2. Symptoms
3. Causes
Pathogenesis
1. Defect in suppressor T cell function > emergence of CD4+ cells targeted to TSH receptors
  1. Intolerant CD4+ T cells stimulate B cells-->release Thyroid-Stimulating Immunoglobulin (TSI)
    1. Immunoglobulin (TSI) TSI binds and activates TSH receptors on thyroid> hyperactive thyroid gland
Immunology of Graves disease
1. Polymorphisms in CTLA4 that result in reduced in activity will have less inhibition of the CTLs and overstimulation that can result in them becoming autoreactive
Histologic findings
1. Lymphatic infiltrates and follicular hypertrophy, with little colloid present
Prognosis
1. Most patients become hypothyroid and require replacement
2. On occasion, hyperthyroidism returns because of persisting thyroid tissue
  1. Surgery or radioactive iodine ablation
Investigations
1. Blood sample
  1. increased serum fT3 and fT4
  2. decreased TSH
2. Radioactive iodine uptake
3. Ultrasound
Treatment

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Graves' Disease

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	Created by hamda ali about 7 years ago