Recently, we identified constitutively activating mutations at positions Asp-403, Glu-404, and Asn-406 in the third extracellular cysteine box (C-b3) of the thyroid-stimulating hormone receptor. We hypothesized that this region could act as a molecular interface between the extracellular and serpentine domain. In this study we present a model for properties of potential interaction partners for this region. Moreover, we show that Pro-400 and Pro-407 adjacent to this epitope are also important for stabilizing the partially active, basal conformation of the wild-type (WT) thyroid-stimulating hormone receptor. Furthermore, the mutation K291A in the second extracellular cysteine box (C-b2) was identified as a new constitutively activating mutation that releases the basal conformation of the WT receptor like the known tryptic cleavage in its close vicinity. Taken together, we provide an activation scenario at the C-b2/C-b3 unit. Three anchor fragments (anchors I-III) most likely constrain the basal conformation. The three anchor fragments are tightly packed. A disulfide bridge holds the C-b2/C-b3 portions in close positions. Independent of the type of conformational interference such as side chain modifications, tryptic cleavage, or hormone stimulation that act on the constrained C-b2/C-b3 WT conformation, it will always release one of the anchor fragments. Subsequently, this results in a conformational displacement of the C-b2/C-b3 portions relative to each other, inducing receptor activation.The human anterior pituitary releases the structurally related glycoprotein hormones (GPHs), 3 thyroid-stimulating hormone (TSH), follicle-stimulating hormone, luteinizing hormone, and chorionic gonadotropin. These large hormones (ϳ30 kDa) interact with the N-terminal extracellular domain (ECD) of their specific receptors (1, 2), TSHR, follicle-stimulating hormone receptor, and luteinizing hormone/choriogonadotropin receptor, which are members of the seven-transmembrane-spanning receptor family (3-7).The large N-terminal extracellular domain is a common structural characteristic of all GPH receptors. The N-terminal ECD of the TSHR (Met-1-Asp-410) can be subdivided into (all numbers are hTSHR specific): (i) the extreme N-terminal tail (including the signal peptide), (ii) the cysteine box 1 (C-b1; Cys-24-Cys-41), (iii) the 11 leucine-rich repeats (LRR; Pro-37-Tyr-279) and (iv) the hinge region (Pro-280-Asp-410), which can be subdivided further into (v) the central cysteine box 2 (C-b2; Pro-280-Cys-301), (vi) the cysteine box 2/3 linker region (C-bl; Asn-302-Ile-389), and (vii) the cysteine box 3 (C-b3; Cys-390-Asp-410) located close to transmembrane helix 1.In addition to the activation mediated by TSH, the receptor can be activated by constitutively activating mutants (CAMs) (8, 9), by mutants leading to promiscuous hormone interactions (10), tryptic action (11), and deletions in the ECD and serpentine domain (12)(13)(14). Several pathogenic gain of function mutants in the ECD of the TSHR characterized by increased constitutive ...