Autoimmune diseases, part 2

By Alan Koenigsberg, M.D.

Autoimmune disorders are extremely complex and sometimes difficult to understand and appreciate. Many people who are affected with these conditions seem to be completely “normal” on the outside and yet are suffering pain internally, as well as other discomforts.

Many of these conditions affect the lubricating linings of various organs, such as the pericardium surrounding the heart, synovial capsules of the joints and linings of the lungs, and cause seriously painful conditions internally.

Other afflictions can destroy cells that produce insulin, for example, which is what causes type 1 diabetes and causes a permanent lack of insulin, which can result in death if not treated.

When autoimmune diseases affect the brain, we can find multiple sclerosis, which causes damage to various and random areas of the brain, resulting in any kind of dysfunction imaginable, depending on what portion of the brain is affected.

Parkinson disorder is another autoimmune brain disease which affects the cells in the mid-part of the brain that produce a neurotransmitter, dopamine, which in that area helps coordinate movement and speech. 

Staring with type 1 diabetes, this tends to have inherited tendencies and can show up early in life, with fatigue, excessive thirst, excessive urination, weight loss, blurry vision and fatigue. A simple blood glucose test can help diagnose the condition. Lifelong insulin injections are needed, as there is not yet a viable pancreas transplant widely available.

Advances in long-acting insulins have made treating this condition less arduous, as well as continuous glucose monitors which one can stick to the under surface of the arm and have helped monitor and treat this illness.

Untreated or poorly treated diabetes, whether type 1 or type 2, can lead to four main complications — heart attack, blindness, kidney failure and leg amputation — so neither condition should be taken lightly.

With recent estimates suggesting that as much as one-third of the adult United States population may have prediabetes, screening for this condition makes sense.

Treatment for type 1 diabetes includes daily insulin, whether manually, by subcutaneous injection or by insulin pump, which is worn on a belt and replenished every few days with fresh insulin. Regular follow-ups with an endocrinologist are essential to provide optimal results.

Learning to eat in a healthy manner is an integral part of this condition and may take some getting used to.

Hashimoto’s disease is an autoimmune disease that attacks the cells of the thyroid gland in the front part of the neck, which results in little to no production of the thyroid hormone. 

Thyroid hormone is the hormone that regulates our body’s metabolism and affects every single cell throughout the body. Low thyroid may affect our cognition and make it difficult to think and concentrate; may cause depression, weight gain, high levels of lipids, as our metabolism has slowed down; and may cause fatigue, excess sleeping and a general slowing down of our body, including delayed reflexes.

The treatment for this condition is fortunately readily available and fairly straightforward. An endocrinologist will prescribe thyroid hormone, a pill which can be taken each morning. It may take some time to find the optimal level of thyroid hormone, but once done, it’s fairly stable. The treatment generally is for a lifetime, as the condition is lifelong.

It is of note that many people may have mildly low levels of thyroid and while not frankly ill, may benefit from low-dose thyroid replacement. This is called subclinical hypothyroidism and I have seen and treated this disorder many times in my practice.

Next week, we’ll move on to discuss lupus, multiple sclerosis and rheumatoid arthritis.

Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas. He can be reached at

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