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10.1016/j.jpainsymman.2012.02.016 J Pain Symptom Manag

So it is likely that the truncated TSHR results in decreased cellular level of cyclic adenosine monophosphate (cAMP) that is required for rapid exocytosis of TG 19 , thus accumulated TG protein in the follicular cells suppresses its own expression by a negative feedback mechanism

As the condition progresses, softening and roughening of the articular cartilage on the underside of the patella occurs, and the syndrome is referred to as chondromalacia patella