Figure 10-1. Stimulation of thyroid secretion by LATS-P, a form of TSI. The subject's thyroid iodine was labeled by administration of 131I, and serial observations were made on the appearance of 131Ilabeled hormone in blood (ordinate) over one month (abscissa). An infusion of 280 ml control plasma had no effect, but 280 ml plasma from a patient with Graves' disease (and without serum LATS activity) caused a marked stimulation of secretion of hormone from the thyroid. (D.D. Adams et al., J. Clin. Endocrinol. Metab., 39:826, 1974. Used with permission of the authors)
Figure 10-1.1 In this remarkable x-ray crystallographic study, an HLA Class I molecule is seen from above. The two interlocking subunits form an antigen binding cleft into which the peptide epitope must fit and remain if it is to be recognized by the T cell receptor (a). In (b), fortuitously, a peptide epitope is found occupying the cleft, fitting like the hot-dog in a bun.
Figure 10-2 Extreme thyroid hyperplasia in Graves' Disease, with tall cells, small follicles, scant and "scalloped" colloid. Figure kindly provided by Dr. Francis Straus.
Figure 10-3 Myocardial tissue from a patient that died of cardiac failure with extreme thyrotoxicosis, showing degeneration of myocardial cells, mononuclear and polymorphonuclear infiltration, and edema.
Figure 10-4. Classic severe Graves' ophthalmopathy demonstrating a widened palpebral fissure, periorbital edema, proptosis, chemosis, and conjunctival injection.
Figure 10-5. (a) This MRI image from a patient with Graves' ophthalmopathy provides a coronal view of the eyes. In this depiction the muscles appear white, and are enormously enlarged, especially in the left eye.
(b) In this transverse view the enlarged muscles are seen (appearing dark against the light fat signal) and the exophthalmos is apparrent.
a. Histologic appearance of extraocular muscle
b. Retrobulbar fat
Figures 10-6, a, b, and c
c. Lacrimal gland removed during a Kronlein procedure on a patient with severe exophthalmos.
Figure 10-7. Plummer's nail changes, showing thinning of the nail and marked posterior erosion of the hyponychium.
Figure 10-8. Remarkable "pretibial myxedema", also present on feet and hands, of a patient with Graves' disease and exophthalmos.
Figure 10-9. Congestive heart failure induced in an otherwise healthy young woman (a), which receded (b), and returned to normal (c), during and after therapy.
Figure 10-10. Clinical course of a patient who had transient exacerbation of Graves' disease on two occasions shortly following delivery.