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Sympathetic underactivity
2%
3/147
Anti-thyroglobulin antibodies
7%
11/147
Exophthalmos
69%
102/147
Increased TSH release
14%
20/147
Multinucleate giant cells present in the thyroid
3%
5/147
Select Answer to see Preferred Response
The presence of thyroglobulin-stimulating immunoglobulins in the serum indicates that the patient has Graves disease. Important hallmarks of Graves disease are hyperthyroidism, exophthalmos, and pretibial myxedema. Graves disease is an autoimmune disease whereby self-antigens from the thyroid activate the immune system. This leads to the formation of antibodies that stimulate the TSH receptor on thyroid cells (hyperthyroidism). Generated immune cells may also infiltrate and attack extraocular muscles and tissue leading to exophthalmos. Furthermore, pretibial myxedema (a type of edema in the legs with a "waxy" appearance) may result from immune cell infiltration in the shin region. Incorrect Answers: Answer 1: Hyperthyroidism is consistent with sympathetic overactivity, not underactivity. Answer 2: Anti-thyroglobulin (as well as anti-thyroid) immunoglobulins are more consistent with Hashimoto thyroiditis (hypothyroidism). Answer 4: Due to the high levels of thyroid hormones, TSH levels are expected to be low. Answer 5: Multinucleate giant cells are consistent with subacute thyroiditis.
4.3
(6)
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