Grave's disease

Question 1

Graves disease

Answer 1

Autoimmune disorder that causes hyperthyroidism

• Excess thyroid hormones

Question 2

Pathophys of graves disease

Answer 2

1. b cells produce antibodies against thyroid proteins such as thyroid stimulating immunoglobulin
2. TSI binds to TSH receptors on thyroid cells (imitating TSH)
3. thyroid cells stimulated to produce more T3 and T4
   • Thyroid hypertrophy and hyperplasia -> enlargement of thyroid
4. In response, follicular cells express molecules on surface that attract T cells
5. T cells bind to follicular cells and infiltrate thyroid tissue interstitium

Question 3

Pathophys Graves (eyes)

Answer 3

4. Fibroblasts around eyes and skin also stimulated by thyroid stimulating antibodies
   - –> Extracellular matrix production called Glycosaminoglycans
   - -> build up in tissues over time

•Inflammation and swelling around the eyes ‘Graves opthalmopathy’

• ‘Exphthalmos’
( bulging of eyeball) –> drys out eyes –> increases risk of corneal ulcers//damage to corne

• Weakens muscles that control upper eyelid movements

Question 4

Hyperthyroidism ( symptoms)

Answer 4

• excess thyroid hormone

• -> hypertrophy
• -> Goitre

• higher basal metabolic rate
–> weight loss

• body produces more heat
–> heat intolerance
(rapid heart rate, sweating, hyperactivity, anxiety, insomnia)

Question 5

Opthalmopathy ( symptoms)

Answer 5

•Inflammation and swelling around the eyes ‘Graves opthalmopathy’

• ‘Exphthalmos’
( bulging of eyeball) –> drys out eyes –> increases risk of corneal ulcers//damage to corne

• Weakens muscles that control upper eyelid movements

Question 6

Graves disease symptoms

Answer 6

• Opthalmopathy
• Dermopathy
• Hyperthyroidism

Question 7

Dermopathy ( symptoms)

Answer 7

1. Pretibial myxedema - leads to
   •Non pitting edema
   ( swelling)
   • Skin thickening

Question 8

Pretibial Myxedema

Answer 8

Lesions of wazy discolouration of skin
(orange peel)
• Caused by glycosaminoglycan build up)

Question 9

Thyroid storm

Answer 9

•life threatening complication
• State of severe hypermetabolism -> exaggerates normal symptoms of hyperthyroidism
eg. 
•Heat intolerance -> high fever
•Rapid heart rate - > cardiac arrythmia

Question 10

Causes of thyroid storm

Answer 10

occurs when

• Stops treatment
• Develops infection
• Has surgery

Question 11

Diagnosis of Graves disease

Answer 11

• Measuring blood levels of TSH, T3 and T4
• Measuring Thyroid stimulating antibodies
(cause of hyperthyroidism)
• Radioiodine scans and measurements ofiiodine uptake

Question 12

Treatment

Answer 12

• Beta blockers - treat immediate symptoms
• Antithyroid drugs - block thyroid hormone production and release
• Radioiodine therapy - partially/completely destroy thyroid function
• Surgery to remove thyroid/Goitre

Question 13

Graves opthalmopathy treatment

Answer 13

• Steroids, radiation therapy, surgery