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http://www.endocrinesurgery.net.au/graves-disease/
Leading cause of
hyperthyroidism in
developed countries (7080% of cases)
https://embryology.med.unsw.edu.au/embryology/images/thumb/0/02/Thyroxine.jpg/3
00px-Thyroxine.jpg
Epidemiology
Annual incidence in
developed countries
is 14/100,100
More common in
females (5:1 ratio)
http://p-fst1.pixstatic.com/506ad86bdbd0cb306c0018aa._w.1500_s.f
t_.
Iodine intake
Smoking
Psychic stress
Vaccines
ex: NY-ESO-1
HLA-DR3
HLA-DR4
HLA-DR9
HLA-DQ2
HLA-DQ3
HLA-A2
Symptoms of
Hyperthyroidism4
Nervousness
Palpitations
Heat Intolerance
Increased
appetite
Weight loss
Tremor of hands
http://cdn1.medicalnewstoday.com/content/images/articles/170/170005/symptomsof-graves-disease.jpg
Detecting GD in a Clinical
Setting4
*Hyperthyroidism*
Ophthalmopathy
Evidence of bruit
Goiter
Acropachy
Pretibial
myxedema
http://intranet.tdmu.edu.ua/data/kafedra/internal/meds/classes_stud/en/nurse/en/BS
http://www.nejm.org/na101/home/literatum/publisher/mms/journals/content/nej
m/2011/nejm_2011.364.issue-7/nejmicm1008597/production/images/medium/nejmic N-(4y)/3%20year/Spring%20semester/Health%20Alteration
%201%20Practicum/21.%20Assessment%20and%20Management%20of%20Patients
m1008597_f1.gif
Pretibial Myxedema
Endocrinology of GD Hyperthyroidism
AutoABS
Normal
Hyperthyroidism
http://classes.midlandstech.edu/carterp/Courses/bio211/chap16/chap16.htm
Pituitary gland
TSH
TSH receptor (TSHR)
Negative
feedback
control
Stimulates
hormone
synthesis
Stimulates
hormone
synthesis
Thyroid cell
Unregulated overproduction of
thyroid hormones
http://www.ihealthblogger.com/2013/06/graves-disease-symptoms-ca
uses-diet-treatment.html
Yersinia enterocolitica
Cross-reactingSequences
DAFGGVYS
Graves Disease
DALGNVTS
Origin of Peptide
Human thyroid stimulating
hormonereceptor
Yersinia enterocolitica outer
membraneprotein
http://www.sekisuidiagnostics.com/writable/products/images/320x/bacteria_copy2.jp
g
https://books.google.com/books?
id=d4l81P7ODcIC&pg=PA522&lpg=PA522&dq=Graves+Disease+molecular+mimicry+amino+acid+sequences&source=bl&ots=xGZpPskdCL&sig=gVj5KlQTntecgvRpEtNK8nP_VA&hl=en&sa=X&ved=0CDYQ6AEwA2oVChMIyP3C-dGVyQIVD_JjCh0gBQUq#v=onepage&q=Graves%20Disease%20molecular%20mimicry%20amino
Vaccine-Induced Molecular
Mimicry7
NY-ESO-1 vaccination
used in immunotherapy
for cancer patients
Shares 5 homologous
epitopes with the TSHR
Genetic susceptibility is
key
http://discovermagazine.com/~/media
/import/images/2/3/1/vaccine.jpg
Additional Manifestation of
Molecular Mimicry for GO & PM2,5
TSHR is expressed in specifc fbroblast cells
of the orbital/tibial regions
Primary Treatment
Focused on treating hyperthyroidism by:
1. Medication
2. Surgery
3. Radioactive Iodine
http://www.lifeextension.com/~/media/lef/images/magazine/mag2012/images/aug2
12_thyroid_08.ashx
Medication3,6
Beta blockers- symptoms unrelated to
the thyroid gland
Surgery
3,6
Thyroidectomysurgical removal of
the thyroid
Followed by
hormone
replacement
therapy
https://mdmedicine.fles.wordpress.com/2011/05/418516-thyroid-gland.jpg
Radioactive Iodine
3,6
Followed by hormone
replacement therapy.
https://edc2.healthtap.com/ht-staging/
user_answer/reference_image/7544/large
/Radioactive.jpeg?
1386669668
Orbital
decompression
surgery
http://iovs.arvojournals.org/article.aspx?articleid=2188086
References
1. Hiromastu Y, Wall JR, Kahaly GJ, Kakizaki H. 2015. Graves
orbitopathy. International Journal of Endocrinology 2015: 1-2.
References Continued
6. Streetman DD, Khanderia U. 2003. Diagnosis and treatment of
graves disease. The Annuals of Pharmacotherapy 37: 1100-1109.
Special
Acknowledgements
A special thanks to Dr. Jane Cases, M.D., Dr.
Douglas Virostko, M.D., and Drs. David and Brenda
Lozowski, D.O., for their valuable feedback and
input for Detecting GD in a Clinical Setting.
Multiple Choice
1. Why would being infected by Yersinia
enterocolitica increase a persons risk for
developing Graves Disease?
a) Extracellular domains of the bacterium bind to the TSHR.
b) The infection stimulates the synthesis of T3 and T4.
c) The antibodies produced against this bacterium have
cross-reactive AA sequences with the TSHR.
d) The infection causes increased blood flow to the thyroid
gland, creating an excess of TSHR receptors.
Multiple Choice
2a. Treatment of Graves Disease
focuses on the symptoms of the
disease rather than targeting the
antibodies causing the
overproduction of thyroid
hormones. Which of the following
scenarios make it difficult to
target the auto-ABs?
c) Radioiodine therapy
a) Thyroidectomy
b) The drug, MMI
Multiple Choice
3. Which element is essential to the
synthesis of thyroid hormones?
a) Chloride
b) Iodine
c) Nitrogen
d) Carbon
Multiple Choice
4. When testing for GD hyperthyroidism, a
blood test would check for low levels of _____
and/or high levels of _____.
a) thyroid stimulating hormone; T3 and T4
b) thyrotropin-releasing hormone; thyroid stimulating
hormone
c) T3 and T4; thyroid stimulating hormone
d) thyroid stimulating hormone; thyrotropin-releasing
hormone