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5.4: A Difficult Colleague, 28 year old female, Maternal grandmother…

- - - - Th1 cells release cytokines, inducing Ab class switching of B cells
        
        B cells produce TRAb
        
        TRAb mimics TSH; stimulates TSH receptors without being inhibited by negative feedback
        
        Continuous T4 & T3 release from thyroid
        
        Raised T4/T3 levels
        
        Sympathomimetic effects
        
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        Metabolic effects - increased turnover
        
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        Calorigenic effects
        
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        Propanolol blocks conversion of T4 to T3
        
        Negative feedback on TSH activated
        
        TSH release suppressed by thyrotropin in anterior pituitary gland
        
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        TFTs: low TSH, elevated FT4 and FT3
        
        Graves' disease
        
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        Follicular cell hyperplasia and hypertrophy
        
        Thyroid gland moderately enlarged
        
        Thyroid Uptake Scan: toxic goitre consistent with Graves' disease
        
        TRAb causes inflammation of extra-ocular muscles and orbital fat and connective tissue
        
        Proptosis/Exophthalmos
        
        Lid retraction
        
        Eyelids oedematous
        
        Gritty and puffy eyes
        
        Ophthalmology review
        
        Thyroid Abs: positive for TRAb