Autoimmune Diseases Pt 2

What is the main concern with Graves’ disease?

Stimulatory autoantibodies against TSH receptor mimic effect of TSH

What is the result of TSH receptor effects being mimicked in Graves’ Disease

stimulation of thyroid gland and release of high level of thyroid hormones and patients develop symptoms of hyperthyroidism

What are some symptoms of hyperthyroidism

enlarged thyroid, bulging eyes, heat intolerance, sweating, tremor, nervousness

What are factors in a “Thyroid storm?“

crisis with high fever, severe tachycardia, extreme restlessness

How can a “thyroid storm“ be caused

stress or infection

What can a “thyroid storm“ lead to

Death from heart failure, MI, organ failure

What are three ways to diagnose Graves’ disease

• Thyroid hormone (Thyroxine, T4 and triiodothyronine, or T3 markedly elevated)

• Thyroid-stimulating hormone (TSH

• Thyroid-stimulating antibodies

What are 3 treatment options for Graves’ disease

• Antithyroid drugs block iodine uptake and decrease hormones

• Surgery

• Radioiodine

What is the main concern of Myasthenia Gravis

Blockage of antibodies

What happens when antibodies are blocked in Myasthenia Gravis (3 things)

• Production of autoantibodies against acetylcholine receptor on the motor end plates of muscles

• Binding of acetylcholine prevents the receptor turnover may be accelerated.

• Patients show progressive weakening of muscles

What are 4 main clinical symptoms of Myasthenia Gravis?

• Progressive muscle weakness

• Muscle wasting may occur after years

• Remitting-relapsing disease occurs

• Myasthenic crisis

What are 5 examples of progressive muscle weakness

• difficulty chewing, swallowing, talking (Slurred speech)

• weakness of the eye muscles = double vision

• Drooping eyelids

• Difficulty breathing

• Weakness of body muscles leading to difficulty holding up arms

What is Myasthenic crisis

respiratory failure due to MG; aspiration pneumonia

How do you diagnose a patient with myasthenia Gravis (4)

• Clinical Picture

• Nerve Stimulation Test

• Anticholinesterase (edrophonium) test

• Thymoma

What is a Nerve Stimulation Test

evoked muscle action potential

What is an anticholinesterase (edrophonium) test

temporarily inhibiting the breakdown of acetylcholine; weakness gets better after injection and lasts for couple of minutes

What percent of patients with Myasthenia Gravis have Thymomas

15%

What are 4 treatments for Myasthenia Gravis

• Oral anticholinesterase inhibitor (Pyridostigmine)

• Plasmapheresis

• Thymectomy

• Immunosuppression

Whats the diagnosis for A 45- year old man presents to the ER with massive hemoptysis, respiratory failure, and acute renal failure. The patient deteriorates quickly and ddies overnight. Autopsy shows extensive bleeding into the lungs

Goodpasture’s syndrome

What is Goodpasture’s syndrome caused by

“destructive“ autoantibodies

What is the clinical picture for Goodpasture’s syndrome

• disease may be present years before patients seek medical attention

• disease affects lungs and kidneys

What are 2 symptoms that affects the lungs in Goodpasture’s syndrome

• coughing up of blood

• shortness of breath

What are 5 symptoms that affects the kidneys in Goodpasture’s syndrome

• rapidly progressive glomerulonephritis

• hematuria

• edema

• high blood pressure

• proteinuria

What is glomerulonephritis

a kidney disease that causes inflammation and damage to the glomeruli, which are the tiny filters in the kidneys that clean waste from the blood.

How do you diagnose Goodpasture’s syndrome (3)

• Kidney

• Anti-glomerular basement membrane antibodies (anti-GMB antibodies)

• anti-alveolar antibodies

What is a treatments for Goodpasture’s syndrome

immunosuppressive drugs

What are some immunosuppressive drugs

glucocorticoids and cyclosporine

What is the diagnosis of this case: You are at a UTSA football game. All of a sudden there is a lot of commotion around a young boy who seemingly is disoriented, has slurred speech, and shows noticeably deep but regular breaths. You notice that the boy smells funny (you cannot really place the smell, but it is a bit fruity, like an old apple). It turns out that this child had been extremely thirsty for weeks, urinated frequently, was tired, and did not feel well for the last day or two. The child is dehydrated by the “back of the hand” test.

Diabetes Mellitus Type 1

What autoimmune process causes Goodpasture syndrome?

Autoantibodies against type IV collagen in basement membranes bind to glomeruli and alveoli, activating complement and causing inflammation and tissue damage; immunofluorescence shows linear IgG and C3b along basement membranes.

What are three cell-mediated organ specific autoimmune diseases

• insulin-dependent DM/ type 1 diabetes

• Hashimoto’s disease

• Multiple sclerosis

How did old doctors diagnose Diabetes

Urine wheel

Diabetes comes from what greek word

Diabeinein meaning syphon, passing through

Mellitus means what? Why is it used in the naming convention?

honey; Urine tastes sweet

What is another name for Type 1 diabetes mellitus

Insulin dependent diabetes mellitus

What population does Type 1 diabetes mellitus affect

Young children

Which attack destroys pancreatic Langerhans islet cells that produce insulin

T lymphocyte-mediated autoimmune attack

When was the first insulin treatment processed?

1922

What is required to regulate glucose uptake in cells

Insulin

Lack of insulin leads to what (4)

• hyperglycemia in blood

• decreased protein synthesis

• acidosis

• ketone production from fatty acids

What are ketone bodies used for?

cell metabolism

What happens when ketones are made and used?

• ketoacidosis

• glucose spills into urine and takes water with it, leading to dehydration

What is ketoacidosis

ketones are acidic and increase the osmolarity of the blood and blood pH drops

What do cells do to balance a water loss and keep perfusing organs?

water goes from cells into the blood, which impairs cell function

What can happen if Type 1 diabetes is untreated

• diabetic ketoacidotosis

• coma

• death due to brain edema

What is the clinical picture for Type 1 diabetes mellitus

Classical triad and fatigue

What is the clinical triad for Type I Diabetes Mellitus

polydipsia, polyuria, polyphagia but loss of weight

What is polydipsia?

increased thirst

What is polyuria

Increased urination

What would a diagnosis look like for Type 1 diabetes

Glucose enhanced in blood and urine

What are the numbers for Fasting plasma glucose for indicators and prediabetes

> 125 mg/dL and then prediabetes is 100-125 mg/dL

What are the numbers for HbA1c for indicators and prediabetes

> 6.5% prediabetes is (5.7-6.4%)

What are the numbers for Oral glucose tolerance test for indicators of T1D

> 200 mg/dL two hours after 75 g oral glucose

What are the numbers for Random glucose for indicators of T1D

> 200 mg/dL

What is the treatment of T1D?

Insulin

What are three complications of T1D?

• Come and death

• Small vascular disease

• Large vascular disease

What are two Coma complications from T1D

• Diabetic Ketoacidotic coma

• hypoglycemic coma

What are three Small vascular disease complications from T1D

• diabetic retinopathy

• diabetic neuropathy

• diabetic nephropathy

What are three large vascular disease complications from T1D

• Coronary Artery Disease

• stroke

• peripheral vascular disease

What is peripheral vascular disease

diabetic foot

What disease is this: A 23-year old female college student presents to family physician after Thanksgiving holidays with chronic fatigue, cold intolerance, excessive sleepiness, muscle cramps, and constipation.

Hashimoto’s Thyroiditis

What is the most common cause of primary hypothyroidism in the USA?

Hashimoto’s thyroiditis

What is the most common cause of hypothyroidism worldwide

iodine deficiency

What causes Hashimoto’s disease? (2)

• Inflammation and Infiltration of thyroid by T cells and macrophages

• DTH type reaction and antibodies may also contribute

What is the typical presentation for Hashimoto’s disease

goiter and signs of hypothyroidism

What are 9 symptoms of Hashimoto’s thyroiditis/ Hypothyroidism

• cold intolerance

• hoarse voice

• decreased sweating

• depression

• memory loss

• sleepiness

• fatigue

• hair loss

• bradycardia

How is Hashimoto’s disease diagnosed?

• measure thyroid hormone levels

• anti-thyroglobulin antibodies

• anti-thyroid peroxidase antibodies

• thyroid ultrasound

• fine needle biopsy with histology

What is Hashimoto’s often initially misdiagnosed with

Depression

How is Hashimoto’s treated

by giving thyroid hormone