TSHR and viral infectious disease: Several postulations on the mechanisms include surgery destroys thyroid cells causing increase in TSH receptor expression, surgery induces an immune system response, such as the stimulation of the antigen-presenting cells that control the activation of suppressor or regulatory cells, stress from general anesthesia, and surgery causes neuroendocrine fluctuations that disrupt immunological homeostasis as well as postoperative bacterial and viral infections increase the number of cluster of differentiation (CD)5+ B cells, which stimulate the TSH receptor antibodies leading to GD [10].