Grave’s Disease : Definition, Etiopathogenesis, Symptoms, Treatment And MCQs for NEET, GPAT, CSIR NET JRF

‘’ The term grave’s disease is restricted to a syndrome marked by hyperthyroidism caused by hyperfunctioning diffuse hyperplastic goiter, sometime accompanied by infiltrative ophthalmopathy and infiltrative dermopathy.’’

1.] Grave’s disease is also known as Basedow’s disease.

2.] Grave’s disease is more common in age between 30 and 40 years.

3.] This disease has more prevalence among females then males.

4.] Perplexingly, this disease is also known as localized myxoedema.

5.] Grave’s disease is an autoimmune disease.

6.] Both Grave’s disease and Hashimoto’s thyroiditis have somewhat similar immunologic origins.

ETIOPATHOGENESIS :-

• The thyroid changes in the Grave’s disease are autoimmune in origin and is initiated by IgG antibodies.
• One class of TSH receptor autoantibodies is known as thyroid stimulating antibodies (TSAb) or thyroid stimulating immunoglobulin (TSI).
• In vitro, as evidenced by increased generation of cAMP they stimulate the function of thyroid cells.
• Another distinctive autoantibody binds to the TSH receptor and inhibits TSH binding, referred to as thyrotropin – binding inhibitor immunoglobulin [TBII].
• By binding to the TSH receptor, it mimics the action of TSH and therefore and both TSI and TSII are responsible for the hyperfunction of thyroid gland in Grave’s disease.
• Also, the pathogenesis of Grave’s infiltrative ophthalmopathy is also based on autoimmune origin. The evidence in support is the intense lymphocytic infiltrate around the ocular muscles and detection of circulating autoantibodies against muscle antigen that cross react with thyroid microsomes.

SYMPTOMS :-

Common signs and symptoms of grave’s disease include :

• Patient may have irritable nature and sometimes anxiety also.
• Sometimes involuntary and rhythmic contraction also occur in hands and fingers.
• Person will have moist skin and heat sensitivity.
• Weight loss.
• Enlargement of the thyroid glands (goiter).
• Change in menstrual cycles due to the hormonal changes in the body of women.
• Frequent bowel movements.
• Bulging eyes (grave’s opthalmopathy).
• Fatigue.
• Person will have thick and red skin (grave’s dermopathy).
• Patient will also have palpitations.
• Person will also feel sleep disturbances.

TREATMENT :-

Three treatment options are available for people with Grave’s disease :

^{The above image is taken for education purpose only from genomicmedicineuk.com}

MULTIPLE CHOICE QUESTIONS :-

1.] Myasthenia gravis is associated with?

a. Hypergammaglobulinemia

b. Thymoma

c. Squamous cell carcinoma

d. Hepatic adenoma

2.] An autoimmune disease if the thyroid tissue is called ?

a. Grave’s disease

b. Thyroiditis

c. Thyroid cancer

d. All of the above

3.] What are the functions of thyroid gland in the body ?

a. Control metabolism

b. Maintain internal homeostasis

c. Control breathing and heart rate

d. All of the above

4.] The causative for Grave’s disease is ?

a. Hyperactivity of islets of Langerhans

b. Hyperactivity of adrenal cortex

c. Hyperactivity of thyroid gland

d. Hyperactivity of adrenal medulla

5.] Which of the following feature is not typical for Grave’s disease ?

a. Hyperplasia of the follicles

b. Scalloping of the colloids

c. Irregular shaped follicles

d. None of the above

6.] The main hormone secreted by the thyroid gland is ?

a. T4

b. T3

c. Both (a) and (b)

d. TSH

7.] Grave’s disease is due to ?

a. Hyperactivity of adrenal cortex

b. Hypoactivity of thyroid gland

c. Hyperactivity of thyroid gland

d. Hypoactivity of Islets of Langerhans

8.] Which of this disease is not related to thyroid gland ?

a. Cretinism

b. Myxoedema

c. Goiter

d. Acromegaly

9.] Which of the following is true of Grave’s disease of the thyroid ?
a. It is a cause of opthalmoplegia

b. It causes large multi – nodular goiter

c. It is more common in males then females

d. None of the above

10.] In most adults, one radioactive iodine treatment is typically given for Grave’s hyperthyroidism ?

a. True

b. False

SOLUTIONS :-

1.] (b) Thymoma

2.] (a) Grave’s disease

3.] (d)

4.] (c) Hyperactivity of thyroid gland

5.] (a) Hyperplasia of the follicles

6.] (c)

7.] (c) Hyperactivity of thyroid gland

8.] (d) Acromegaly

9.] (a) It is a cause of opthalmoplegia

10.] (a)

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REFERENCES :-

1.] Textbook Of Pathology By Harsh Mohan; 7th edition; Page no. 796 – 797.

2.] Robbin’s Basic Pathology; 5th edition; Page no. 1129 – 1131.