Stimulation of thyroidal and extrathyroidal thyrotropin receptors

TSH receptor plays a pivotal role in the regulation of thyroid function and is intimately involved in the pathogenesis of common thyroid disorders. A lack of specificity and absence of down regulation upon stimulation renders the human TSH receptor susceptible to exogenous overstimulation, which forms the basis of hyperthyroidism in TSHoma, Graves' disease and gestational thyrotoxicosis. Further, TSH receptor activation in the absence of exogenous stimulators due to the expression of endogenously active mutant receptors has recently been described, and may in part account for hyperthyroidism in autonomously functioning thyroid nodules. Signal bifurcating by coupling of TSH receptor to different G proteins may be a likely mechanism to explain the multitude of distinct effects caused by TSH receptor activation including mainly hormone production and growth promotion. Also, TSH receptor appears to mediate immunological stimulation, its activation by TSH R Ab inducing expression of adhesion molecules and HLA class II antigens on thyrocytes. Increasing evidence suggests that TSH receptor is not restricted to thyroid and may be expressed in extrathyroidal tissues with a potential role in the pathogenesis of Graves' orbitopathy.