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Flashcards in Grave's disease Deck (13):
1

Graves disease

Autoimmune disorder that causes hyperthyroidism
• Excess thyroid hormones

2

Pathophys of graves disease

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

5. In response, follicular cells express molecules on surface that attract T cells

6. T cells bind to follicular cells and infiltrate thyroid tissue interstitium

3

Pathophys Graves (eyes)

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

4

Hyperthyroidism ( symptoms)

• excess thyroid hormone
--> hypertrophy
--> Goitre

• higher basal metabolic rate
--> weight loss

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

5

Opthalmopathy ( symptoms)

•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

6

Graves disease symptoms

• Opthalmopathy
•Dermopathy
• Hyperthyroidism

7

Dermopathy ( symptoms)

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

8

Pretibial Myxedema

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

9

Thyroid storm

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


10

Causes of thyroid storm

occurs when
- Stops treatment
- Develops infection
- Has surgery

11

Diagnosis of Graves disease

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

12

Treatment

• 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

13

Graves opthalmopathy treatment

• Steroids, radiation therapy, surgery