Grave’s Disease

Pathology, Symptoms and Treatment

Renz L. Salumbre
 Introduction

• Thyrotoxicosis
• Hyperthyroidism
• Autoimmune Disorder
 Objectives
• To define Grave’s disease
• To enumerate the factors that
contributes to its cause
• To define the autoimmune
characteristic of Grave’s disease
• To describe available treatments
 Pathogenesis
• Genetics
• Familial predisposition
• Existing history of autoimmune
disorders
• Autosomal dominant
• CTLA-4, HLA, LYP
 Pathogenesis
• Genetics (cont...)
• Polygenic / complex disorder
• Abnormal production of
immunoglobulins is triggered by
an external factor and which the
immune system fails to to stop
because of an inherited defect
 Pathogenesis
• Stress
• Physical and psychological
• E.g. Nazi Prisoners
• State of immunosuppression
• Secondary complications of
cortisol and corticotropin-
releasing hormone
 Pathogenesis
• Overcompensation by immune
system follows
immunosuppression
• Greater immune activity
• Infection
• Pathogenic species that may
cause Grave’s disease e.g. Y.
enterocolitica
 Pathogenesis
• Infection (cont.)
• Thyroid gland infections
• Gender
• 5 Females : 1 Male
• Estrogen
• X chromosome
 Pathogenesis

• Diet
• Consumption of iodine-rich foods
 Autoimmune
Characteristics
• Grave’s
disorder
disease is an autoimmune

• T lymphocytes sensitized to
thyroid antigens
• B lymphocytes are stimulated to
produce Ab to the produced
antigen
• Directed against TSH receptor
(TSAb / TSI)
 Autoimmune
Characteristics

• thyroid gland growth and

increased rate of function
 Signs and
Symptoms
• Anxiety, irritability, difficulty in
sleeping, fatigue, rapid/irregular
heartbeat, tremors, perspiration,
heat sensitivity, rapid weight loss,
brittle hair and nails, frequent
bowel movement, goiter
• Irregular to light menstruation in
women
• Hypokalimia in Asian Males
 Signs and
Symptoms

• Important Manifestations of the

Disease
• Exophthalmos
• Thyroid Dermopathy
 Exophthalmos

• Grave’s ophthalmopathy
• Inflammation of the tissue around
the eye
• TSH-R
• links the thyroid and the eyes
found in the thyroid follicular
cells and orbital fibroblasts
 Thyroid
Dermopathy
• Thickening of the
skin on the lower
extremity
• Pretibial
myxedema
• Accumulation of
GAGs
 Signs and
Symptoms
• Thyrotoxic Crisis
• Thyroid storm
• Exacerbation of all symptoms
• Dangerous
• CNS and Gastrointestinal
Symptoms
 Diagnosis
• Physical Examination
• Obvious signs and symptoms
• Patient History
• Determine other members with
Grave’s Disease; physical
disposition
• Laboratory Tests
• High FT + Low TSH = Grave’s
4
Disease
 Treatment
• Antihyperthyroid Drugs
• Thionamides
• Radioactive Iodine Therapy
• Sodium iodide (I )
131

• Surgery
• Special cases
 Antihyperthyroid
Drugs
• Thionamides - PTU and
Methimazole
• Blocks T and T
4 3 production
• 2 Regimens:
• Tapering
•+ T 4
 Antihyperthyroid
Drugs
• Up to 2 years of treatment
• Regular check up
• Laboratory tests
• May cause allergic reactions
• Rashes and Agranulocytosis
Radioactive Iodine
Therapy
• Sodium iodide taken as a single
capsule
• 2 to 6 months
• Routine
• Precautionary measures
• Pregnant women
• Geriatric patients with other
conditions
 Surgery

• Situations where antihyperthyroid

drugs fail to act
• Radioactive iodine is not allowed
 Treatment for
Symptoms
• Beta-blockers for palpitations
• Propranolol and metoprolol
• Potassium chloride and
spironolactone for hypokalimia
• Glucocorticoids for exophthalmos