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Autoimmune diseases (I)

Introduction
Thyroiditis: Graves disease, Hashimotos
thyroiditis
Myasthenia gravis
Rheumatoid arthritis

Introduction
The immune system functions to protect the
host from invasion by foreign organism
However, this protective response can cause
damage to the host of it is directed against
the individuals own antigen.
These antigens are often referred as selfantigens, or autoantigens.

The immune system has developed a series of


checks and balances that enable it to
distinguish between dangerous and harmless
signals.
Therefore, it allow it to respond to foreign
antigens but not self antigens.
Self-responsiveness: a state of
unresponsiveness to self-antigen.
Autoimmune diseases occurred as a result of
loss of self-tolerance.

Thyroiditis: Graves disease


What is Graves disease?
- It is named for Robert Graves, an Irish
physician, who was the first to describe this
form of hyperthyroidism about 150 years ago.
- Graves disease is an autoimmune disease that
affects the thyroid.
- The thyroid is a small gland in the front of the
neck.

- It makes hormones called T3 and T4 that


regulate how the body uses energy
- The thyroid is a small gland in the front of
the neck.
- It makes hormones called T3 and T4 that
regulate how the body uses energy.
- With Graves disease, the immune system
makes antibodies that cause the thyroid to
make more thyroid hormone than your
body needs.

- Hence, Graves disease is a type of


hyperthyroidism.
- An overactive thyroid causes every function
of the body to speed up, such as heart rate
and the rate your body turns food into
energy.

What causes Graves disease?


- Many factors are thought to play a role in
getting Graves disease. These might include:
i. Genes
Many people inherit an immune system
that can cause problems. In Graves
disease, antibodies bind to the surface of
thyroid cells and stimulate those cells to
overproducce thyroid hormones.

ii. Gender
Sex hormones might play a role, and
might explain why Graves disease affects
more women than men.
iii. Stress
Severe emotional stress or trauma might
trigger the onset of Graves disease in
people who are prone to getting it.

iv. Pregnancy
Pregnancy affects the thyroid. As many as 30
percent of young women who get Graves
disease have been pregnant in the 12
months prior to the onset of symptoms. This
suggests that pregnancy might trigger
Graves disease in some women..
iii. Infection
Infection might play a role in the onset of
Graves disease, but no studies have shown
infection to directly cause Graves disease.

What are the symptoms of Graves


disease?
- Most people with Graves disease have
symptoms of an overactive thyroid, such as:
a) Goiter (enlarged thyroid)
b) Trouble sleeping
c) Irritability or nervousness
d) Heat sensitivity, increased sweating

e)
f)
g)
h)
i)
j)

Hand tremors
Rapid heartbeat
Frequent bowel movements
Weight loss without dieting
Fatigue or muscle weakness
Lighter menstrual flow and less
frequent periods

- Unlike other causes of an overactive thyroid,


Graves disease also can cause:
Eye changes.
For some people with Graves disease, the
tissue behind the eyes becomes inflamed
and swells. This can cause bulging or
discomfort in one or both eyes. Sometimes
it affects vision.

Reddening and thickening of the skin, often


on the shins and tops of the feet.
(pretibial myxedema)
This rare skin problem is not serious and is
usually painless. Most people with this skin
problem also have eye problems from
Graves disease.

How to diagnose Graves disease?


- Symptoms of Graves as mentioned above
(bothersome).
- Laboratory tests:
a) Thyroid function tests
- Determine the right amount of thyroid
hormone (T4) and TSH.
- A high level of thyroid hormone in the
blood plus a low level of TSH is a sign of
overactive thyroid.

b) Radioactive iodine uptake (RAIU)


- An RAIU tells how much iodine the
thyroid takes up.
- A high uptake suggests Graves disease
(thyroid uses it to make thyroid
hormone)
c) Antibody tests
- Look for antibodies that suggest Graves
disease.

Treatment
- There are 3 main treatments for Graves'
disease :
a) Antithyroid medicine
Methimazole
Propylthiouracil

b) RAI (Radioactive Iodine)


- With this treatment, you swallow a pill
that contains RAI, which is a form of
iodine that damages the thyroid by
giving it radiation.
- The RAI destroys thyroid cells so that
less thyroid hormone is made
c) Surgery
- Most or all the thyroid is removed.

Thyroiditis: Hashimotos thyroiditis


What is Hashimotos thyroiditis?
- Hashimotos thyroiditis is characterized by
the production of immune cells and
autoantibodies, which can damage thyroid
cells and compromise their ability to make
thyroid hormone.

- Hypothyroidism occurs as a result of


insufficient thyroid hormone produced,
which is not enough for the bodys needs
- The thyroid gland may also enlarge in some
patients, forming a goiter.

What is the cause of Hashimotos


thyroiditis?
- The immune system recognizes normal
thyroid cells as foreign tissue, and it
produces antibodies that may destroy these
cells.

What are the symptoms of Hashimotos


thyroiditis?
- The first sign of this disease maybe painless
swelling in the lower front of the neck.
- This enlargement may eventually become easily
visible and maybe associated with an
uncomfortable pressure sensation in the lower
neck.
- Left untreated, a person may begin to have
trouble swallowing or even breathing

- Other symptoms include:


a)
b)
c)
d)
e)
f)
g)

Sore muscles
Weight gain
Fatigue
Drowsiness
Forgetfulness
Puffy face
Constipation

How is Hashimotos thyroiditis


diagnosed?
- Performing a physical examination and can
recognize hypothyroidism by identifying
characteristic symptoms,finding typical
physical signs.
- Doing appropriate laboratory tests:

a) ANTITHYROID ANTIBODIES
- Increased antithyroid antibodies provide
the most specific laboratory evidence of
Hashimotos thyroiditis. (but no all
cases).
b) TSH (THYROID-STIMULATING HORMONE
OR THYROTROPIN) TEST
- Increased TSH level in the blood is the
most accurate indicator of
hypothyroidism

c) OTHER TEST
- Free T4 (thyroxine)
A low level of free T4 is consistent with
thyroiD hormone deficiency.
- Fine-needle aspiration of the thyroid
A good way to diagnose difficult cases
and a necessary procedure if a thyroid
nodule is also present. (not necessary
for all patients)

How is Hashimotos thyroiditis treated?


Thyroid hormone therapy.
-Treatment consists of taking a single daily
tablet of levothyroxine.
-Thyroid hormone acts very slowly in the
body, so it may take several months after
treatment is started to notice improvement
in symptoms or goiter shrinkage.

Myasthenia grevis
What is Myasthenia grevis (MG)?
- MG is an autoimmune disease that
weakens the muscles.
- This muscle weakness usually occurs during
periods of activity and improves after
periods of rest.

- MG is not contagious, or fatal, and does not


affect life expectancy.
- MG is not passed down through the family.
- A group of rare disorders called congenital
myasthenic syndromes (CMS) can produce
symptoms similar to MG.
- Unlike MG, these disorders are not autoimmune disorders but are caused by defective genes.

What is the cause MG?


- MG occurs when normal communication
between nerves and muscles is interrupted
at the neuromuscular junction.
- The interruption is due to antibodies that
prevent acetylcholine from reaching the
muscles by destroying or blocking the
receptors.

What are the symptoms of MG?


- MG can affect any muscle, but the muscles
that control eye and eyelid movement,
facial expression, and swallowing are most
often affected.
- In some people, the first symptom is
weakness of the eye muscles.
- Other symptoms include:

a)
b)
c)
d)

Drooping of one or both eyelids


Blurred or double vision
Problems walking
Weakness in arms, hands, fingers, legs, and
neck
e) Change in facial expression
f) Having a hard time swallowing
g) Trouble talking
h) Shortness of breath
(feeling like you cant get enough air)

How is MG diagnosed?
- MG is hard to diagnose because weakness is
a common symptom of many disorders.
- Performing some laboratory tests:

a) Antibody blood tests


- Most people with MG have abnormally
high levels of acetylcholine receptor
antibodies.
b) Edrophonium test
- When this drug is injected into someone
with MG, his or her normally weak eye
muscles will get stronger for a few
minutes.

c) Nerve conduction test/repetitive


stimulation
- With this test, a nerve linked with a specific
muscle is stimulated to see if the muscle
action is weakened.
d) Single fiber electromyography (EMG)
- In this test, single muscle fibers are
stimulated by electrical impulses.
- Muscle fibers of people with MG do not
respond to repeated electrical stimulation as
well as muscles that function normally

e) Computed tomography (CT) or magnetic


resonance imaging (MRI)
- This test can show if you have an
abnormal thymus gland or a thymus
gland tumor.

How is MG treated?
Treatment for MG may include:
a) Medications
Cholinesterase inhibitors: pyridostigmine
- These drugs help improve nerve signals to
muscles and increase muscle strength.
Immunosuppressive drugs
- Frequently used to suppress the production
of abnormal antibodies

b) Thymectomy
- This is the surgical removal of the thymus
gland, which is abnormal in most persons
with MG.
c) Plasmapheresis (Acute Weakness)
- This procedure removes abnormal
antibodies from the blood.
- This provides relief from MG symptoms in
many patients for a few weeks

b) High-dose intravenous immuneglobulin


(Acute Weakness)
- This treatment keeps the immune system
from damaging the nerve-muscle
junction for a short time.
- This provides relief from MG symptoms in
many patients for weeks to months

Rheumatoid Athritis
What is Rheumatoid Athritis (RA)?
- RA is an inflammatory disease affecting
about 2.1 million people.
- It causes pain, swelling, stiffness, and loss
of function in the joints.

- Several features make it different from


other kinds of arthritis
Eg: Generally occurring in a symmetrical
pattern.
- The disease often affects the wrist joints
and the finger joints closest to the hand.
- It can also affect other parts of the body
besides the joints.
- Like some other forms of arthritis, RA occurs
much more frequently in women than in
men.

What is the cause RA?


- In RA, white blood cells move into the
synovium and release protein.
- Protein released in the synovium cause it to
become think and cause damage to the
bone, ligaments, and cartilage of the joint.
- This happens over months and years.
- The joint then first loses its correct
alignment and its function.

What are the symptoms of RA?


- Symptoms first begin in the small joints of the
fingers, wrists and feet.
- Often accompanied with warm, swollen and
tender joints that are painful and difficult to
move.
- Joints of both sides of the body (symmetrical)
are typically affected.
- People with RA often experience fatigue, loss
of appetite and low-grade fever.

- Nodules may form under the skin, often


over the bony areas exposed to pressure
(such as the elbows)
- Over time, damage to the cartilage and bone
of the joints may lead to joint deformities.

How is RA diagnosed?
- A diagnosis of rheumatoid arthritis can
generally be made following a thorough
medical history. (Children of parents who have
RA are more likely to have it)
- Physical examination, looking for:
i. Distribution of joints affected
ii. Joint swelling,warmth and range of motion
iii. Presence of nodules under the skin :

- Imaging studies used to detect the degree of


joint involvement or joint damage:
i. X-rays
ii. Sonograms
iii. Magnetic Resonance Imaging (MRI)
- A blood test can indicate the presence of an
antibody called rheumatoid factor, which is
found in 80 percent of people with RA.

How is RA treated?
- Currently, there is no cure for RA.
- The goals of treatment of RA are to reduce
joint pain and swelling, relieve stiffness and
prevent joint damage.
- Treatment plans often include a
combination of rest, physical activity, joint
protection, use of heat or cold to reduce
pain, and physical or occupational therapy.

- Many people with RA take nonsteroidal


anti-inflammatory drugs (NSAIDs) to help
reduce joint pain, stiffness and swelling.
- Low doses of corticosteroids such as
prednisone may also be used to relieve
joint pain, stiffness and swelling and to
reduce the risk of joint swelling.