Graves disease is a condition in which immune cells target and damage the thyroid gland, the tissues around the eyes, and the skin.
Mechanism
Synthesis from 4 studies
Antibodies bind to receptors on cells in the thyroid and around the eyes, making those cells swell with fluid and fat, attract immune cells, and turn into scar tissue. The same antibodies keep immune cells alive and making more antibodies, so the attack never stops. The body loses its ability to...
Most probable mechanism
Antibodies in the blood bind to two specific receptors on cells in the thyroid and around the eyes, causing those cells to swell, produce sticky goo, and attract immune cells. This makes the tissues expand and become inflamed, damaging the eye muscles and thyroid. The same antibodies also keep immune cells alive longer, so they keep attacking, and prevent the body from stopping the attack.
Autoantibodies bind to thyrotropin receptor (TSHR) and insulin-like growth factor-1 receptor (IGF-1R) on orbital fibroblasts and thyroid cells, forming a receptor complex
TSHR-IGF-1R complex activation triggers PI3K/Akt and MAPK/Erk signaling pathways in orbital fibroblasts and thyroid cells
PI3K/Akt signaling upregulates hyaluronan synthases and UDP-glucose dehydrogenase, increasing hyaluronic acid production and osmotic water retention
PI3K/Akt/mTOR signaling induces adipogenic differentiation in Thy-1-negative orbital fibroblasts, leading to lipid accumulation and fat expansion
TSHR activation upregulates miR-146a and miR-155, which suppress ZNRF3 and PTEN, enhancing PI3K/Akt signaling and fibroblast proliferation
IGF-1R signaling on autoreactive T cells activates PI3K/Akt, inhibiting pro-apoptotic proteins and preventing T cell death
IGF-1R signaling on B cells stimulates proliferation and immunoglobulin synthesis, increasing autoantibody production
Reduced regulatory T cell numbers and function fail to suppress autoreactive Th17 cells, permitting sustained inflammation
Epac1 deficiency in orbital fibroblasts permits TGF-β1-induced STAT3 phosphorylation, driving fibrosis and extracellular matrix deposition
CD8+ T cells infiltrate the thyroid gland and form spatial niches adjacent to thyrocytes, targeting tissue microdomains while sparing hormone-producing regions
Evidence from Studies
Supporting (4)
Community contributions welcome
Thyroid-stimulating immunoglobulins as a reliable predictive blood test for thyroid eye disease
Immune-parenchymal multicellular niches are shared across distinct thyroid autoimmune diseases
Pathogenesis of Thyroid Eye Disease
Contradicting (0)
Community contributions welcome
Gold Standard Evidence Needed
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