Tiredness Flashcards
Causes of tiredness and fatigue
Insomnia
Unhealthy lifestyle
Stress, depression, bereavement
Hormonal changes (puberty, pregnancy or menopause)
Illness (glandular fever, COVID)
Chemotherapy and other medical treatments
Tiredness because of waking up at night (gasping, snorting, choking)
Sleep apnoea
Tiredness with lack of energy, noticeable heartbeats, shortness of breath and pale skin?
Iron deficiency anaemia
Tiredness, thirst, polyurea and noturea, weight loss?
Diabetes
Chronic tiredness, hard to stay still, nervous, anxious and irritable, muscle weakness?
Hyperthyroidism
Extreme fatigue for more than 3 months, problems with thinking, memory and concentration, flu-like symptoms?
ME or CFS
Things to help with tiredness?
Improve diet and exercise
Consistent sleep pattern
Good sleep routine
Relaxing sleep area
Makes tiredness worse
Smoking, alcohol
Caffeine or exercise before sleep
Smartphones and screens before bed
What percentage of patients who present with fatigue have a diagnosis made?
66%
What percentage of patients who present with fatigue receive diagnosis through blood tests?
Less than 10%
Possible causes of fatigue?
Anaemia, sleep apnoea, hypothyroidism, coeliac disease, CFS, diabetes, glandular fever, depression, restless legs, anxiety.
Malignancy, long COVID, pregnancy, stress, hyperthyroidism, vitamin D deficiency, Addison’s
Relevant blood tests for to check for hypothyroidism, anaemia, diabetes and renal function.
FBC - anaemia
Vitamin D
Thyroid function test - hypothyroidism
Urea and electrolytes - renal function
HbA1C - diabetes
Primary hypothyroidism bloods?
High TSH, low T3 and T4
Hypothyroidism symptoms
Bradycardia, cold intolerance, dry skin, fatigue, weight gain, constipation
Enlarged thyroid, dry hair, depression, brittle nails, infertility…
T4 production physiology?
- TSH binds to TSH-R on follicular cells - causes production of thyroglobulin and thyroperoxidase.
- Iodide enters colloid through Na+/I- cotrsnsporter.
- TPO and H2O2 catalyse iodination of iodide and reaction between TG and iodine.
Reactions produce MIT and DIT. - Coupling reactions between MIT and DIT with help from TG form T3 and T4.
Most common autoimmune hypothyroidism?
Hashimoto’s thyroiditis.
Which antigen is considered foreign by immune cells in Hashimoto’s and what is the name of the antibodies?
Antigen - TPO
Antibody - anti-TPO
Properties of adaptive immune system?
Specificity
Memory
NK both adaptive and innate
Which cells are looking for the foreign antigens and in what order are other cells activated?
Antigen presenting cells find foreign antigen
APC present to T cells
T cells present to B cells
Where are MHC I and II located?
MHC I on self cells
MHC II on APC
Reactions between APC and T cells?
APC presents MHC II to TCR on CD4 cells
B7 ligand on APC also detected by CD28 receptor on T cell
B7 only present on APC when it is present with infected cell
How do activated T cells find specific B cells?
T cell will use TCR to find specific MHC II on B cell.
B cell will then use CD40 receptor to find CD40L on T cell.
These 2 reactions lead to co-stimulation of B cells so activation, maturity and proliferation to produce antibodies (anti-TPO)
CD40L only present on T cells with infected material
Why don’t innate immune cells attack host cells?
Because they look for PAMPs (pathogen associated molecular patterns)
Examples of PAMPs?
Peptidoglycan
Lipopolysaccharides
Mannan
Flagella proteins
Why don’t NK cells attack host cells?
They look for MHC I cells because they are present on all host cells
If no MHC I, NK will go to action
What is central tolerance?
When B cells (in bone marrow) and T cells (in thymus) come into contact with self antigens.
If they react too strongly to these antigens, they undergo apoptosis (negative selection).
If they don’t react at all to these antigens, they undergo apoptosis.
We want a response but a WEAK response - positive selection.
What are Treg cells?
Matured in thymus
If they come across a self cell, they dampen immune response.
How can autoimmunity happen?
Genetic mutations can influence maturation of T cells in the thymus
Molecular mimicry - if the body is trained to remember a certain antigen that looks very similar to a self antigen, it can attack the self antigen.
An increase in dietary ______ can worsen autoimmune thyroiditis
Iodine
