Grave's disease

What is the alternative name for Grave's disease?

Hyperthyroidism

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What is Grave's disease?

A condition due to an overactive thyroid gland caused by an autoimmune response leading to excess levels of thyroid hormone

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Who is most likely to suffer?

Females aged between 30-50 years

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How common is Grave's disease worldwide?

1 in 2000 people

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What are the 2 common physical symptoms?

Exophthalamos and goitre

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What 2 thyroid hormones are responsible?

Triiodothyronine (T3) and thyroxine (T4)

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Name 5 things the thyroid hormones control and regulate.

Increase metabolic rate of proteins and carbohydrates, increase heart and cardiac output, increase breathing rate, increase basal body temperature, potentiates effects of catecholamines, increase sympathetic response

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Name other symptoms of Grave's disease

Weight loss, muscle wasting, hand tremors, dermopathy, tachycardia, nail thinning

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Describes why exophthalmos occurs and its consequences

Fibroblasts in eyes express TSH receptor: inflammation of eye muscles, extra fat in orbitals = risk of optic nerve compression

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In a diagnostic test, what confirms the presence of the disease?

High levels of T3 and T4 but low levels of thyroid stimulating hormone

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Which hormone is released from the hypothalamus to control thyroid hormones?

Thyrotrophin releasing hormone

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Pharmacologically, what stimulates the thyroid glands to overproduce thyroid hormones?

Antibodies bind to GPCR simulating Gas (signalling cascade including cAMP) to cause cell differentiation and increased hormone synthesis in the thyroid gland

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Describe radioactive iodine therapy

Thyroid gland concentrates iodine which is radioactive and so breaks down thyroid cells, oral thyroid hormone replacement therapy given

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What are the 4 precautions for radioactive iodine therapy?

Not suitable for pregnant or nursing women, can increase exophthalamos, increased concentration of iodine in urine and can take anything from weeks to months to work

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Name 3 examples of anti-thyroid drugs

Topazole, propylthiouricil, methimazole

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How do anti-thyroid drugs work?

Prevents thyroid gland from utilising iodine to make thyroid hormones

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Name 2 examples of alternative anti-thyroid drugs

Amiodarone and propanolol

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What is the mechanism of action of Amiodarone in Grave's disease?

Inhibits conversion of T3 into active T4 or degrades hormones and excretes them as faeces

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What is the mechanism of action of propranolol in Grave's disease?

Rapidly blocks the effects of thyroid hormones e.g. muscle weakness, diarrhoea, sweating, tachycardia

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Briefly describe how surgery can be carried out treat Grave's disease patient

First a thyroidectomy is done then oral replacement of thyroid hormones are administered

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Which drug can be given to treat exophthalmos?

Prednisone (synthetic glucocorticoid and some mineralocorticoid activity)

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Give 4 alternative treatment methods for exophthalmos

Prism glasses, eye muscle surgery, orbital radiotherapy, orbital decompression surgery

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Grave's disease

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