BNURS20 Nursing

Graves disease or hyperthyroidism is a kind of autoimmune disease that results from the over-production of the thyroid hormones in response to auto-antibodies or long acting thyroid stimulating (LATS) antibodies. In normal cases, the secretion of the thyroid hormones from the thyroid glands occurs in response of Thyroid Stimulating Hormone (TSH), which is secreted from the anterior pituitary gland. Secreted TSH hormone binds to the TSH receptors of the thyroid gland, leading to the secretion of thyroid hormones, thyroxine (T4) and tri-iodothyronine (T3). However, in the diseased condition, the auto-antibodies bind mimics the structural integrity of the TSH and binds specifically to the TSH-receptors. TSH-receptors also mistakenly recognise these LATS antibodies as TSH and activations the pathway of thyroid hormone secretion. But the over stimulation occurs because the binding of the LATS antibodies are are negatively regulated via feedback inhibition as in case of the TSH and this lead to prolong secretion of T3 and T4 and thereby leading to the generation of hyperthyroidism or grave’s disease (Falgarone et al., 2013).

The main risk factor behind the development of hyperthyroidism is genetic-predisposition or previous family cases of auto-antibody related disorders. The birth of the auto-antibodies generally takes place via spontaneous mutation or via the connection behind the genetic history and hence previous family history is extremely significant in the development of the disease (Chu et al., 2013).

Isabella’s blood reports give a clear interpretation about the link of the hyperthyroidism with her current condition.

Isabella’s TSH level is under the normal range which signifies that her TSH secretion have not encountered any malfunctioning. If TSH is normal then T3 and T4 concentration in the blood will also be normal as the secretion of TSH and thyroid hormones are inter-related. However, the case of Isabella is different. Her T3 and T4 concentration is extremely high. It signifies that the secretion of T3 and T4 is taking place beyond the influence of TSH and that is auto-antibodies for the TSH-receptors or the LATS antibodies. Thus the condition of Isabella can be directly linked with the hyper-thyroidism or Grave’s disease. The symptoms of Isabella also gives indication towards the possible occurrence of hyperthyroidism like weight loss and increased appetite (Menconi, Marcocci & Marinò, 2014).

Digestion starts from the mouth itself via the action of the salivary glands. Teeth break down the food into smaller particles. Thus the main structure of the digestive system include mouth, salivary gland, parotid gland, pharynx, oesophagus, stomach, liver, pancreas, gall bladder, duodenum, small intestine, large intestine (colon), appendix and ileum (Sherwood, 2015).

The main function of the digestive system is metabolism (mostly catabolism) in order to provide nutrition. The process of digestion initiates from mount with the help of the salivary juices secreted from salivary glands. Teeth also take an important part in digestion via breaking down the food in to smaller particles and making it ready to be processed inside the stomach. Inside the stomach, there are several other digestive juices, which facilitate the process of digestion (Sherwood, 2015).

Human beings fall under the category of holozoic nutrition. Here, the food is broken down into smaller fragments which is being absorbed into the body via large intestine and thus helps in providing nutrition (Sherwood, 2015).

Immune system is the defence system of the body that protects the body against the invasion of harmful pathogen (bacteria and viruses). Immune system is divided into innate and adaptive immunity. The first hand defence against the infection is provided by innate immunity. Adaptive immunity comes into action when there is an antigenic challenge. Adaptive immunity mainly surfaces after five to six days of preliminary exposure of antigen. The immune response to the second round of infection takes place via the action of memory T-cell and B-cell and the reaction is instant and more effective. The main components of innate immunity are skin or the mucosal surfaces that provide barrier against infection it falls under anatomical barrier. Whereas, body temperature, phagocytic barrier fall under physiological barriers. Adaptive immune response is subdivided into humoral and cell-mediated immune response. However, only humoral immunity is transferred with antibody (Rotte & Bhandaru, 2016).

Rheumatoid arthritis is caused by a group of auto-antibodies known as rheumatoid factors. Rheumatoid factors have reactive determinant against the Fc region of IgG. Classic rheumatoid factor is IgM.  Auto-antibodies bind to the circulating IgG forming IgG-IgM complexes that are deposited over joints. The disease is manifested via chronic inflammation of joints while affecting respiratory and cardio-vascular function (Gibofsky, 2012).

The immediate treatment of the grave’s disease is surgical removal of the thyroid gland (thyroidectomy) from the body and which will be followed by external supply of thyroid hormones in order maintain the hormonal equilibrium (Annerbo, Stålberg & Hellman, 2012).

References

Annerbo, M., Stålberg, P., & Hellman, P. (2012). Management of Grave’s disease is improved by total thyroidectomy. World journal of surgery, 36(8), 1943-1946. (https://link.springer.com/article/10.1007/s00268-012-1617-x) Question no.: 9, 10

Chu, X., Shen, M., Xie, F., Miao, X. J., Shou, W. H., Liu, L., … & Hua, Q. (2013). An X chromosome-wide association analysis identifies variants in GPR174 as a risk factor for Graves’ disease. Journal of medical genetics, 50(7), 479-485. (https://www.ncbi.nlm.nih.gov/pubmed/23667180) Question no. 3

Falgarone, G., Heshmati, H. M., Cohen, R., & Reach, G. (2013). Mechanisms in endocrinology: role of emotional stress in the pathophysiology of Graves’ disease. European Journal of Endocrinology, 168(1), R13-R18. (https://www.eje-online.org/content/168/1/R13.short) Question no. 3

Gibofsky, A. (2012). Overview of epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis. The American journal of managed care, 18(13 Suppl), S295-302. (https://europepmc.org/abstract/med/23327517) Question no.: 8

Menconi, F., Marcocci, C., & Marinò, M. (2014). Diagnosis and classification of Graves’ disease. Autoimmunity reviews, 13(4), 398-402. (https://www.sciencedirect.com/science/article/pii/S1568997214000251) Question no.: 4

Rotte, A., & Bhandaru, M. (2016). Overview of Immune System. In Immunotherapy of Melanoma (pp. 113-142). Springer International Publishing. (https://link.springer.com/chapter/10.1007/978-3-319-48066-4_5) Question no.: 7

Sherwood, L. (2015). Human physiology: from cells to systems. Cengage learning. (https://books.google.co.in/books?hl=en&lr=&id=_i5BBAAAQBAJ&oi=fnd&pg=PT8&dq=Human+physiology:+from+cells+to+systems&ots=YySoPCe6dT&sig=wK9wYDynWFVVtYo_uB12YJvrh8Q&redir_esc=y#v=onepage&q=Human%20physiology%3A%20from%20cells%20to%20systems&f=false) Question no. 5, 6