Chronic autoimmune thyroiditis With the thyroid gland Among the associated disorders, one of the most common conditions is
As the name suggests, this is an autoimmune disease in which the malfunctioning immune system produces antibodies against thyroid cells.
Antibodies They are products of the immune system that are normally produced to detect and destroy foreign bodies (viruses, bacteria, parasites, etc.) that have entered the body.
As a result of the attack on its own structures, in this case specifically on the thyroid gland, its hormone-producing cells are damaged, a deficiency of these hormones develops, and the accompanying symptoms occur. Hypothyroidism.
Chronic autoimmune thyroiditis It is also referred to by other names, such as Hashimoto's thyroiditis (The disease was first described by Japanese physician Faraku Hashimoto in Germany in 1912) or Chronic lymphocytic thyroiditis.
Distribution
According to statistics, the disease is much more common in women than in men.
1000 cases of the disease are recorded per 0,8 people each year.
And in the case of women, this figure is 1000 out of 3,5.
The risks and frequency of disease occurrence increase with age.
causes
The causes of autoimmune thyroiditis are still not fully understood.
Based on the data comparison, it determines the development of the disease by 79% geneticsThe remaining 21% is due to the influence of sex hormones and provoking environmental factors (such as viral infection, stress, radiation, etc.).
Autoantibodies are produced against various structural components of the thyroid gland.
Among them, the most common Anti-thyroperoxidase antibodies (Anti-TPO) And Anti-thyroglobulin antibodies (Anti-TG).
Rarely, there are cases when the full picture of autoimmune thyroiditis is clinically expressed, although the presence of autoantibodies is not confirmed by laboratory tests. In this case, the presence of other unknown antibodies is likely.
It is worth noting that the number of antibodies detected is not positively correlated with the severity of the disease. That is, high antibody levels do not mean that the damage process is more aggressive, and a low level does not guarantee that the condition will not be severe.
Manifestation of the disease
The clinical manifestations of Hashimoto's thyroiditis can be quite diverse, depending on the nature of the disease.
Option 1:
There is often a situation where elevated antibody levels are detected in the laboratory, although the gland is still producing its hormones in sufficient quantities and, therefore, the hormonal levels are normal.
A condition where the thyroid gland function is normal, Euthyroid We call.
It is impossible to predict how long the euthyroid state will last against the background of elevated antibodies. This period may be quite long or may not lead to functional disorders at all.
In such cases, we say that it has increased. Hypothyroidism – That is, the risks of developing thyroid dysfunction and deficiency of its hormones.
At such times, as a rule, ultrasonography already reveals changes characteristic of an autoimmune process in the structure of the thyroid gland. Heterogeneity.
Option 2:
If the antibodies are more aggressively affecting the gland and the damage process is severe, the gland may be temporarily paralyzed in the initial stage. Hyperfunction Signs appear. This happens in about 5% of cases.
This occurs as a result of damage to the stores of thyroid hormones in the gland and their sudden release into the bloodstream.
This phase Hashish toxicosis It is called by its name and lasts for about 1-2 months.
The gland may be enlarged at this stage of the disease due to the active inflammatory process.
This period is transient, and when the damage to the gland cells reaches a level where the hormones it produces are no longer sufficient for the body, it sets in. Hypothyroidism phase, which can manifest in subclinical or full clinical form.
Subclinical hypothyroidism During this time, the TSH level is high, meaning the level of gland stimulation is increased, but FT4 remains within the normal range.
Clinical hypothyroidism In time, along with the increase in TSH, the FT4 level also decreases more than normal.
Often, the discovery of chronic autoimmune thyroiditis coincides with the phase of hypothyroidism, i.e., this is the manifestation of the disease. Third option.
Ultrasonographic image
The radiological manifestations of Hashimoto's thyroiditis are also diverse and depend on the stage of the disease and the severity of the process.
The thyroid gland under this diagnosis is usually characterized as follows: the structure of the organ is heterogeneous, a cloud-like structure may be observed, as well as nodular formations, both small and large in size, which are rarely cystic, that is, with purulent contents. The blood supply to the gland is increased.
As for the size of the gland, in the initial stage, the gland may be enlarged, and later, as the process progresses chronically, it may shrink and become atrophic.
Sometimes, so-called reactive visible lymph nodes with a normal structure are observed in the neck area, which can be explained by a reaction to the inflammatory process caused by autoantibodies in the thyroid gland.
Symptoms
The disease progresses very slowly, usually over years. Symptoms only begin to appear when the body is already deficient in hormones.
Symptoms of both subclinical and clinical hypothyroidism may include the following:
- Skin: dryness, peeling, mucosal edema, pallor
- Hair: slow growth, increased hair loss, brittle, split ends. Alopecia areata or diffuse alopecia areata is possible.
- Slowing of the heart rate – bradycardia, accompanied by general weakness and decreased muscle strength.
- Constipation and difficulty gaining or losing weight.
- Intolerance to cold
- Decreased energy, drowsiness
- Depression
- joint and muscle pain
- Hearing impairments
- Memory loss
- Excessive menstrual bleeding.
Comorbid conditions that can be caused by Hashimoto's thyroiditis and hypothyroidism include:
- Increased prolactin levels
- Cholesterol level increase
- Anemia.
Diagnosis
The following tests are performed to diagnose chronic autoimmune thyroiditis:
Immunological research – To detect specific autoantibodies: Anti-TPO, Anti-TG.
Hormonal research – To assess the functional state of the thyroid gland: TSH, FT4.
Instrumental research – To assess the structure and size of the thyroid gland and detect focal lesions: ultrasonography (ultrasound).
These indicators With anamnesis (This is a history of the development of the disease, compiled by the doctor based on the patient's testimony.) As a result of the comparison, a diagnosis is made and an appropriate treatment and/or monitoring plan is selected.
Treatment
Developing a treatment strategy depends on various factors.
If we are experiencing functional insufficiency of the thyroid gland (hypothyroidism), replacement treatment is prescribed to restore the euthyroid state. With thyroxine preparations, which, due to the chronic nature of the disease, must continue throughout life.
Unfortunately, there is no treatment that would reduce the number of antibodies or protect the thyroid gland from their effects at this time.
Therefore, if the gland's function is preserved, we do not start treatment with drugs and establish a plan for periodic monitoring of hormone levels.
necessary Nodular formations Observe them if they exist and, if necessary, Aspiration biopsy Conducting.
Co-occurrence with other autoimmune diseases
Autoimmune diseases of different organs often coexist, which can be explained by the general genetic predisposition of the organism to autoimmune processes and/or common provoking environmental factors.
For example, Hashimoto's thyroiditis can develop in parallel with:
- Autoimmune gastritis – The presence of gastritis alongside thyroiditis is quite common, because during the formation process, the thyroid gland and the gastrointestinal system arise from the same structure and share many common features in their structure, so antibodies produced against the cells of one organ often damage the other as well.
- Alopecia – which refers to autoimmune damage to hair follicles and irreversible hair loss.
- Vitiligo is an autoimmune skin disease that causes the loss of skin pigment and the appearance of discolored patches.
- Rheumatoid arthritis is a chronic autoimmune disorder that primarily affects the joints, although other organs are often affected as well.
- Also: celiac disease, type 1 diabetes, Addison's disease, and more.
Hashimoto's thyroiditis and pregnancy
It is likely that the concomitant autoimmune processes (involving the reproductive organs) are the direct cause of the increased risk of early pregnancy loss in Hashimoto's thyroiditis. However, in such cases, subsequent pregnancies usually proceed normally.
Chronic autoimmune thyroiditis itself can become a factor preventing pregnancy if hormonal levels are not regulated. Therefore, women with this diagnosis should carefully plan their pregnancy under the supervision of an endocrinologist.
Author: Elga Giorgadze (Endocrinologist)
English version summary
Autoimmune Thyroiditis
Chronic autoimmune thyroiditis is one of the most common conditions in thyroid disorders group.
As the name suggests, this is an autoimmune disease in which the malfunctioning immune system produces antibodies against thyroid cells.
Antibodies are products of the immune system that are normally produced to detect and destroy foreign bodies (viruses, bacteria, parasites, etc.) that have entered the body.
As a result of the attack on its own structures, in this case specifically on the thyroid gland, its hormone-producing cells are damaged, a deficiency of these hormones develops, and the accompanying symptoms occur.
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