Grave’s disease

Disease Entity

1

Graves' disease is an  ……… disease and it’s the most common cause of ……….., which increases thyroid hormone levels.

Graves' disease is an  …(autoimmune)…… disease and it’s the most common cause of ……(hypothyroidism)….., which increases thyroid hormone levels.

2

You’re also more likely to develop Graves' disease if you have another autoimmune disease. (True or False)

True

3

Graves' disease is most common in women over the age of:

   A) 10  

   B) 20  

   C) 15  

   D) 19  

(B)

4

Graves' disease accounts for ………… of the hyperthyroidism cases.  

   A) 50%-60%  

   B) 70%-96%  

   C) 60%-80%  

   D) 20%-60%  

(C)

5

Why is Graves' disease more common in females? (Considering that it’s not fully understood 🙃) But there are two suggested reasons?

“Cancel” I will give you the 5 points as 🎁🤍

S&S

1

Mention some of the symptoms of Graves' disease that were mentioned in Reem’s case.

- weakness in her legs

- ⁠heat intolerance 

- ⁠Anxiety ( irritable)

- ⁠sweating 

- Increasing Heart rates 

- ⁠weight loss

2

(…….) weight and (…….) appetite in Graves' disease, and this is because of (…….).

(…Loss….) weight and (…Increase….) appetite in Graves' disease, and this is because of (…Elevated metabolism….).

3

With your beautiful words, explain the relationship between the sympathetic symptoms and Graves' disease?

Increased levels of Thyroid hormone activity will stimulate the sympathetic nervous system.

- Symptoms: 

  - Increased heart rate

  - Anxiety

  - Sweating

  - Tremors

+ Heightened metabolism leads to constant alertness.

4

What causes exophthalmos in Graves' disease?

- Retro-Orbital Fluid Buildup: Accumulation of fluid behind the eyes.

- Autoimmune Changes: Inflammation and degeneration of extraocular muscles.

5

Muscle weakness occurs in both hyperthyroidism (caused by Graves' disease) and in hypothyroidism. What are the different causes of both?

- Hyperthyroidism= catabolic effect on protein 

- ⁠Hypothyroidism = low of energy

Pathophysiology

1

The name of the hormone secreted by pituitary gland to stimulate the thyroid gland.

Thyroid stimulating hormone (TSH)

2

 The types of hyperthyroidism?

 Grave’s disease is found in which type?

Primary hyperthyroidism 

secondary hyperthyroidism 

Graves’ disease is the most common cause of primary.

3

Which of the following statements about the immune mechanism in Grave's disease is most accurate?

a) The disease is mediated by a Th1-mediated immune response.

b) TSI binds to the TSH receptor on thyroid cells, leading to uncontrolled thyroid hormone production.

c) The primary defect is in B cells, leading to reduced secretion of antibodies.

d) Cytotoxic T cells play a major role in the destruction of thyroid tissue.

(B)

4

Which of the following histopathological findings is most commonly associated with Grave’s disease?

A) Lymphocytic infiltration of the thyroid gland

B) Nodular goiter with fibrous tissue formation

C) Fibrosis and calcification of the thyroid tissue

D) Increased number of follicular cells with a scalloped colloid

answer: D) Increased number of follicular cells with a scalloped colloid

5

The Mutations that cause TSH-receptor antibodies.

HLA-DR3

HLA-B8

examinations & investigations

1

Examination finding on hands of a patient with Grave’s disease. 

Sweaty palms

Fine tremors

acropachy

2

Which of the following would be expected in the laboratory results of a patient with untreated Grave’s disease?

A) Elevated TSH, decreased T3 and T4
B) Decreased TSH, elevated T3 and T4
C) Normal TSH with elevated reverse T3
D) Elevated TSH, normal T3 and T4

B) Decreased TSH, elevated T3 and T4

3

The gold standard investigation used to diagnose Grave’s disease.

TSH receptor antibody (TRAb)

4

Which of the following patients is more likely to have uncontrolled Grave’s disease 

based on there labs

D4

Tala

5

The most likely cytokine to contribute to the infiltration of orbital tissues leading to exophthalmos.

Interleukin-6 (IL-6)

treatment & management

1

 The aim of the treatment

Reduce the levels of thyroxine
try to get the patient to euthyroid state

2

Match the types of thyroidectomy with their pictures.

E2

A —-> 3

B —-> 2

C —-> 1

3

The first-line treatment for Grave's disease in an adult with mild to moderate hyperthyroidism

Antithyroid drugs (ATDs)

4

Select from the following list

the Findings that could be a complication or an outcome of thyroidectomy as management of grave’s disease 

E4

B C D F H I

5

 3 indications of total thyroidectomy

1- Malignancies

2- Not responsive to medical management

3- Goiter with severe symptoms

4- history of thyroid cancer