This is a case study on Grave's Disease

1. Case Study - Grave’s Disease
By: Michael Petrich

2. Background
Carley, a 32 year old woman, has come in for her anxiety. Carley
says that she is experiencing: excess sweating, can feel her heart
beat faster than usual, and is also having diarrhea. It should be
noted that Sarah appears to have puffy eyes, high blood pressure,
and enlarged thyroid.

3. What is Your Initial Diagnosis of
Sarah?

4. What Tests Would You Run to
Confirm a Diagnosis?

5. Tests
• Blood sample
• Tests levels of thyroid stimulating hormone
• Tests levels of thyroid hormones
• Radioactive iodine uptake
• Measures the rate at which the thyroid takes up iodine
• Ultrasound
• High frequency sounds waves to produce an image

6. What Diagnosis Would You Give?

7. Grave’s Disease
Carley has Grave’s disease. This is most common is women under
40 and is usually genetic but can come from smoking. Grave’s
disease is caused by autoantibodies to the the thyroid stimulating
hormone receptors on follicular cells and mimicking the receptor
activation actions of the original thyroid stimulating hormone. The
resulting consequence is stimulation follicular cell growth (thyroid
enlargement) and increased production of thyroid hormones.

8. Stimulating Auto-antibodies

9. Symptoms

10. Thyroid Stimulating Hormone
Receptor
• The TSHR is a G-protein coupled receptor with seven transmembrane-
spanning domains
• TSH, acting via the TSHR, regulates thyroid growth and thyroid hormone
production and secretion. The TSHR undergoes complex post-translational
processing involving dimerization and intramolecular cleavage
• The latter modification leaves a two-subunit structural form of the receptor.
• Each of these post-translational events may influence the antigenicity of the
receptor

11. Disease State
• The majority of intrathyroidal lymphocytes are T cells but plenty of B cells
may be present in Grave’s disease
• In some areas, thyroid epithelial cell size correlates with the intensity of the
lymphocytic infiltrate, suggesting thyroid-cell stimulation by local B cells
secreting stimulating thyroid antibodies
• Graves disease carrier protein is a protein of as yet uncharacterised
function that belongs to the mitochondrial metabolite carrier family (which
includes the ADP/ATP translocator, the phosphate carrier and the
hydrogen ion uncoupling protein)
• The protein is recognized by IgG from patients with active Graves disease
• The predicted amino acid sequence is 348 residues

12. Treatments
• Radioactive Iodine Therapy
• Thyroid needs iodine to produce hormones, radioactivity
breaks down overactive thyroid hormone cells overtime.
• Anti-Thyroid Medications
• Interferes with the thyroid’s use of iodine to produce hormones
• Beta Blockers
• Don’t inhibit the production of hormones, but do block the
effect of hormones in the body

13. Citations
http://www.thyroidmanager.org/chapter/diagnosis-and-
treatment-of-graves-disease/
http://www.uptodate.com/contents/pathogenesis-of-graves-
disease
https://www.ebi.ac.uk/interpro/entry/IPR002167