Autoimmune thyroiditis( Hashimoto's thyroiditis) - Causes, symptoms and treatment. MF.

Autoimmune thyroiditis is one of the most common thyroid diseases( every 6-10 woman over 60 years old suffers from this disease).Often this diagnosis causes patient anxiety, which leads them to an endocrinologist. I want to immediately reassure: the disease is benign and if you follow the recommendations of your doctor, then there is nothing to be afraid of.

This disease was first described by the Japanese scientist Hashimoto. Therefore, the second name of this disease is Hashimoto's thyroiditis. Although in fact, Hashimoto's thyroiditis is just one of the types of autoimmune thyroiditis.

What is autoimmune thyroiditis? Autoimmune thyroiditis is a chronic disease of the thyroid gland, as a result of which destruction( destruction) of thyroid cells( follicles) occurs due to the effect of antithyroid autoantibodies.

Causes of autoimmune thyroiditis

What are the causes of the disease? Why does it arise?

1. At once it is necessary to note, that your fault in occurrence of disease is not present. There is a hereditary predisposition to autoimmune thyroiditis. Scientists have proven this: found genes that cause the development of the disease. So, if your mother or grandmother suffers from this disease, you too have an increased risk of getting sick.

2. In addition, the onset of the disease often contributes to the stress of the day before.

3. The dependence of the frequency of the disease on the patient's age and sex is noted. So in women it is much more common than in men. According to different authors, women 4-10 times more often put this diagnosis. Most often autoimmune thyroiditis occurs in middle age: from 30-50 years. Now often this disease occurs and at an earlier age: autoimmune thyroiditis also occurs in adolescents and children of different ages.

4. Pollution of the environment, poor environmental situation in the place of residence can promote the development of autoimmune thyroiditis.

5. Infectious factors( bacterial, viral diseases) can also be triggering factors for the development of autoimmune thyroiditis.

The most important system of our organism is the immune system. It is she who is responsible for the recognition of foreign agents, including microorganisms, and does not allow their penetration and development in the human body. As a result of stress, with the existing genetic predisposition, in a number of other reasons the immune system fails: it starts to confuse "one's own" and "another's".And begins to attack "his".Such diseases are called autoimmune diseases. This is a large group of diseases. In the body cells of the immune system - lymphocytes produce so-called antibodies - these are proteins that are produced in the body and directed against their own body. In the case of autoimmune thyroiditis, antibodies to thyroid cells are produced - antithyroid autoantibodies. They cause the destruction of thyroid cells and, as a consequence, hypothyroidism may then develop - a decrease in thyroid function. Given this mechanism of disease development, there is also another name for autoimmune thyroiditis - chronic lymphocytic thyroiditis.

Symptoms of autoimmune thyroiditis

What is the clinical picture of the disease? What symptoms of the disease should lead you to an endocrinologist?
Immediately it should be noted that autoimmune thyroiditis often occurs asymptomatically and is detected only when the thyroid gland is examined. At the onset of the disease, in a number of cases throughout life, the normal function of the thyroid gland, the so-called euthyroidism, can be maintained, a condition where the thyroid gland produces a normal amount of hormones. This condition is not dangerous and is the norm, only requires further dynamic observation.

Symptoms of the disease occur if as a result of the destruction of thyroid cells there is a decrease in its function - hypothyroidism. Often at the very beginning of autoimmune thyroiditis, there is an increase in thyroid function, it produces more than normal hormones. This condition is called thyrotoxicosis. Thyrotoxicosis may persist, or it may go into hypothyroidism. Symptoms of hypothyroidism and thyrotoxicosis are different.

Symptoms of hypothyroidism are:

Weakness, memory loss, apathy, depression, low mood, pale dry and cold skin, rough skin on the palms and elbows, delayed speech, facial swelling, eyelids, overweight or obesity, chilliness, cold intolerance, decreased sweating, increase, swelling of the tongue, increased hair loss, brittle nails, swelling on the legs, hoarseness, nervousness, menstrual irregularities, constipation, joint pain.

Possible symptoms of hypothyroidism

Symptoms are often nonspecific, occur in a large number of people, may not be associated with thyroid dysfunction. However, if you have most of the following symptoms, you need to examine thyroid hormones.

Symptoms of thyrotoxicosis are:

Increased irritability, weight loss, mood swings, tearfulness, heart palpitations, a feeling of heart failure, increased blood pressure, diarrhea( loose stools), weakness, propensity to fracture( bone strength decreases), fever,intolerance to hot climate, sweating, increased hair loss, menstrual irregularity, decreased libido( sexual desire).

Symptoms of hyperthyroidism

It also happens that with autoimmune thyroiditis with symptoms of thyrotoxicosis, tests show a decreased function of the thyroid gland, therefore it is impossible to diagnose exclusively by external symptoms even an experienced doctor. If you notice these symptoms, you should immediately contact an endocrinologist for examination of thyroid function.

Complications of autoimmune thyroiditis

Autoimmune thyroiditis is a relatively harmless disease only if the normal amount of hormones in the blood is maintained - the state of euthyroidism. Hypothyroidism and thyrotoxicosis are dangerous conditions that require treatment. Untreated hyperthyroidism can cause severe arrhythmias, lead to severe heart failure and cause myocardial infarction. Severe untreated hypothyroidism can lead to dementia( dementia), common atherosclerosis and other complications.

Diagnosis of autoimmune thyroiditis

In order to identify the presence of autoimmune thyroiditis, it is necessary to undergo a survey that includes examination of an endocrinologist, hormonal examination, ultrasound of the thyroid gland.

The main research is:

1. Hormone examination: the determination of TSH, free fractions of T3, T4,
T3, T4 are elevated, TSH is lowered - indicates the presence of thyrotoxicose
T3, T4 are lowered, TSH elevated is a sign of hypothyroidism.
If T3 sv, T4 sv, TTG is normal - euthyroidism is a normal function of the thyroid gland.
Your hormonal examination can be commented in more detail by a doctor endocrinologist.

2. Determination of the level of antithyroid autoantibodies: antibodies to thyreperoxidase( AT-TPO or antibodies to microsomes), antibodies to thyroglobulin( AT-TG).
In 90-95% of patients with autoimmune thyroiditis, the increase in AT-TPO is determined, in 70-80% of patients, the increase in AT-TG is determined.

3. It is necessary to perform ultrasound of the thyroid gland.
For autoimmune thyroiditis is characterized by a diffuse decrease in the echogenicity of thyroid tissue, there may be an increase or decrease in the size of the thyroid gland.

In order to accurately diagnose autoimmune thyroiditis, 3 main components are needed: a decrease in the echogenicity of thyroid tissue and other signs of autoimmune thyroiditis by ultrasound of the thyroid gland, the presence of hypothyroidism, and the presence of autoantibodies. In other cases, in the absence of at least one component, the diagnosis is only probable.

Treatment of autoimmune thyroiditis

The main goal of the treatment is to maintain a stable euthyroidism, that is, a normal amount of thyroid hormones in the blood.
If there is euthyroidism, treatment is not carried out. Regular examination is shown: hormonal examination T3 sv, T4 sv, TTG control once every 6 months.

In the stage of hypothyroidism, levothyroxine( L-thyroxine, Eutirox) is prescribed is the thyroid hormone. This drug is prescribed in order to make up for the amount of thyroid hormones that the body lacks, since hypothyroidism is characterized by a decrease in its own production of hormones by the gland. Dosage is selected individually by a doctor endocrinologist. Begin treatment with a small dose, gradually it increases under the constant control of thyroid hormones. Choose a maintenance dose of the drug, against the background of which the normalization of the level of hormones is achieved. Such therapy with levothyroxine in a maintenance dose, usually, is taken for life.

In the stage of thyrotoxicosis, the doctor decides on the treatment. Drugs that reduce the synthesis of hormones( thyreostatics) usually with this disease are not prescribed. Instead, symptomatic therapy is performed, that is, medications are prescribed that reduce the symptoms of the disease( reduce the palpitation, heartbeat).Treatment is selected individually.

Treatment with folk remedies

It should be cautioned against self-treatment. The right treatment can only be prescribed to you by a doctor and only under the systematic control of hormone tests.
In autoimmune thyroiditis, immunostimulants and immunomodulators, including natural origin, are not recommended. It is important to observe the principles of healthy eating: eat more vegetables and fruits. If necessary, during periods of stress, physical and emotional stress, during illness, you can take multivitamin preparations, for example, Vitrum, Centrum, Supradin, etc. Better yet, avoid stress and infection altogether. They contain vitamins and microelements necessary for the body.

Prolonged intake of excess iodine( including taking baths with iodine salts) increases the frequency of autoimmune thyroiditis, as the amount of antibodies to thyroid cells increases.

Recovery prognosis

The prognosis is generally favorable. In the case of the development of persistent hypothyroidism - lifelong treatment with drugs levothyroxine.
Dynamic monitoring of hormonal parameters should be performed regularly every 6-12 months.

If ultrasound of the thyroid gland revealed nodal formations, then it is necessary to consult with a doctor-endocrinologist.
If the nodes are more than 1 cm in diameter or they grow in dynamics, in comparison with the previous ultrasound, it is recommended to perform a puncture biopsy of the thyroid gland, in order to exclude the malignant process. Control of ultrasound of the thyroid gland once in 6 months.
If the nodes are less than 1 cm in diameter, then it is necessary to perform ultrasonography of the thyroid gland once every 6-12 months to exclude the growth of the nodes.

Doctor's consultation on autoimmune thyroiditis:

Question: In the analyzes, a significant increase in antibodies to thyroid cells is determined. How dangerous is an autoimmune thyroiditis if thyroid hormones are normal?
Answer: A high level of antithyroid antibodies can occur even in healthy people. If the thyroid hormones are normal, then there is no cause for concern. This is not required treatment. It is only necessary to monitor the thyroid hormones once a year, if necessary, ultrasound of the thyroid gland.

Question: How to make sure that the function of the gland returned to normal during the treatment?
Answer: It is necessary to assess the level of T4 sv, T3 sv - their normalization indicates the elimination of hormonal disorders of the gland. TSH should be evaluated no earlier than a month after the start of treatment, as its normalization is slower than the level of hormones T4 and T3.

Doctor endocrinologist Artemieva M.S.