TSHR and autoimmune disease: In addition to TSHR signaling, the CD40—CD40L interaction has been implicated in GD as it has in other autoimmune diseases.[26] Anti-CD40L therapy has been considered for treatment of autoimmune diseases.[27] A single nucleotide polymorphism in the Kozak sequence of CD40 is associated with an increased risk for GD.[28] The serum level of soluble CD40L is elevated in active GD.[29] Furthermore, Hwang et.