TSHR and hypothyroidism: Patients with Graves’ disease may naturally evolve to hypothyroidism over time due to the transition of TSH receptor antibody types from initial stimulating antibodies to blocking antibodies, or the gradual depletion of thyroid function due to chronic inflammatory processes (30); ii) in the early stages of Hashimoto’s thyroiditis, transient hyperthyroidism can occur as the immune system attacks thyroid cells, leading to a substantial release of THs into the bloodstream.