The Aspects of Graves Disease - Essay Example

Grave’s Disease The proper functioning of the human body is dependant upon the normal working of the systems of the human body. The endocrine systemis an important system vital for leading a normal life. Any pathologic condition affecting the endocrinology of the body usually does not only produce local effects but it is a cause of many systemic disturbances affecting the efficient working of the body. This paper will particularly focus upon the immunopathological condition of the endocrine system known as Grave’s disease. This disease which affects the thyroid gland produces a wide range of effects on the human body. This paper will encompass all the aspects of Grave’s disease describing it as an immunological disorder with its causes and the body wide effects. Grave’s disease has been given the name after the scientist Robert Graves who actually found out about this condition (American Thyroid Association). This disease which is considered to be the most common reason leading towards hyperthyroidism has a genetic predisposition. That is people within the same family have high chances of having the disease. The disease also has a gender deviation with the females being seven times more affected than the males. This disease occurs between the age groups of 20 and 40. According to statistics, in the United States 1.5 to 2.0 percent of the females suffer from the condition (Kumar et al 2005). The gland that is affected by Grave’s disease is the thyroid gland. This endocrine gland which is present in the neck secretes the thyroid hormones which are triiodothyronine T3 and thyroxine T4. Thyroid stimulation hormone TSH is a hormone of the anterior pituitary gland which binds to specific receptors on the thyroid gland and triggers the release of the thyroid hormones. Graves’s disease alters the functioning of the gland and disturbs the synthesis of the thyroid hormones which have major functions in the body (Guyton et al 1996). Grave’s disease is basically an autoimmune disorder. In this disorder certain antibodies are developed in the body against the thyroid gland. Particularly these antibodies are formed against the TSH receptor (LEVINSON, W. 2008). Though a proper reason for the development of these antibodies has not been concluded but it is believed that due to the release of certain antigens from the thyroid cells of a person during his life results in the formation of antibodies against the gland or it may also be due to decreased activity of the protective mechanism of the T helper cells.. Another cause for this disease which has been presented by Robert Graves as well is that the condition can be led to because of extreme stress. But this is also not a much proved cause. The antibodies which are formed are known as thyroid stimulating immunoglobulin (TSI), thyroid growth stimulating immunoglobulin (TGI) and TSH binding inhibitor immunoglobulin (TBII). The Thyroid stimulating immunoglobulin (TSI) antibodies bind to the receptors on the thyroid gland where under normal conditions TSH binds and stimulate the secretion of the thyroid hormone. The TSI antibodies have a very long lasting effect of about 12 hours as compared to the 1 hour effect of the thyroid stimulating hormone of the anterior pituitary. The TGI antibodies also function on the same TSH receptor but their function is basically the dividing of the follicular epithelial cells. The TSI antibodies prevent the binding of the TSH to its receptor on the thyroid gland. While bound to the receptor to block the effect of TSH they actually lead to the increased secretion of the thyroid hormone. But in certain instances they also suppress the activity of the thyroid gland. These antibodies account for the excessive secretion of the thyroid hormone (Kumar et al 2005). The thyroid hormone has an effect of negative feedback on the thyroid stimulating hormone. So irresponsive of the fact that the thyroid hormone is released in Grave’s disease because of the autoimmune antibodies, there is always suppression in the secretion of thyroid stimulating hormone from the anterior pituitary because of the presence of increased thyroid hormone in the blood (Ganong 2005). Thyroid hormone is essential for the carrying out of normal body processes. But an increase in the hormone due to the disease can have many adverse effects. The basal metabolic rate of the body can increase 60 to 100 percent more than normal and this can account for the increased sweating and decreased tolerance to heat. The thyroid hormone stimulates the central nervous system but increased quantities can lead to psychological issues and nervousness. The muscles become weak because of the increased catabolism of proteins (Guyton et al 1996). The increased quantities lead to an increase in the GIT motility leading to diarrhea and the increased metabolism is the cause of weight loss which may be of varying degrees. (Metso et al 2008) The main clinical manifestations of Grave’s disease are hyperthyroidism and there are pathologies of the eyes and skin. These are particularly known as infiltrative opthalmopathy and infiltrative dermopathy. In the case of pathology of the eyes the patient presents with exopthalmos which is the protrusion of the eyeball because of the increased activity of the sympathetic nervous system due to its overstimulation by the thyroid hormone. This effect on the eyeball is because of an autoimmune response of the T cells against the TSH receptor which is present in the preadipocyte fibroblasts in the eyes. Because of this autoimmune effect the retro orbital space becomes occupied with T cells and adipocytes, the extra ocular muscles became edematous and there is deposition of Glycosaminoglycans in the extracellular space. All of these reasons lead to the protrusion of the eyeball. Hence the patient presents with exopthalmos (Kumar et al 2005). This exopthalmos can be very serious as the person is unable to close his eyelids completely even during sleep. This can lead to an ulcer of the cornea and make the patient’s eye susceptible to infections. Because of the protrusion the optic nerve also becomes stretched and this can greatly affect vision. A person might also suffer from blurred vision (Guyton et al 2005). The skin pathology particularly affects the area of the tibia bone that is the shins. The skin around the shins becomes red but it is not tender on touch. The skin is thickened there with raised lymphocytes and the presence of glycosaminoglycans (Kumar et al 2005). Morphologic changes in the structure of the thyroid gland take place because of Grave’s disease. Due to the hyperactivity and increased stimulation of the thyroid gland, the gland becomes enlarged. This enlargement is a diffuse symmetrical one (Metso et al 2008). As the thyroid hormone increases the activity of the heart muscle, hypertrophy of the heart muscle is observed. This hypertrophy and increased activity provides reason for the ischemic changes in the heart. Due to increased antibodies and lymphocytes there is hyperplasia of the lymphoid tissue of the body (Kumar et al 2005). Diagnostic tests include the presence of antibodies in the blood and the raised levels of the thyroid hormones. The TSH concentration is also important to rule out the hyperthyroidism resulting from pathologies of the anterior pituitary gland. The basal metabolic rate can also be checked because it is always raised in the case of Grave’s disease because of the hyperthyroidism (Guyton et al 2005). Grave’s disease is a pathological condition of the thyroid gland. It not only effects the gland itself but it disrupts major physiological processed of the body. Grave’s disease puts a person at a very high chance of developing hypothyroidism at some late stage in life because of the inflammation and destruction of the cells of the gland (American Thyroid Association). Medical and surgical intervention can help a person overcome most of the symptoms associated with the disease. (Word Count: 1238) Bibliography: GANONG, W. F. (2005). Review of medical physiology. New York, McGraw-Hill Medical. GUYTON, A. C., & HALL, J. E. (1996). Textbook of medical physiology. Philadelphia, W.B. Saunders. KUMAR, V., ABBAS, A. K., FAUSTO, N., ROBBINS, S. L., & COTRAN, R. S. (2005). Robbins and Cotran pathologic basis of disease. Philadelphia, Elsevier Saunders. LEVINSON, W. (2008). Review of medical microbiology and immunology. New York, McGraw-Hill Medical. METSO S, JAATINEN P, & SALMI J. (2008). Graves disease. The New England Journal of Medicine. 359, 1408-9. Patient’s Resource, American Thyroid Foundation(http://www.thyroid.org/patients/brochures/Graves_brochure.pdf) Read More