Thyroiditis symptoms and treatment in women. Autoimmune thyroiditis: treatment, symptoms, causes

Chronic thyroiditis is a disease (in most cases very severe) which is characterized by its inflammation. In this process, the body's own antibodies damage or completely destroy the cells of the gland. As a rule, women who have crossed the 40-year mark are most affected by this disease. Behind last years It has been observed that the number of people suffering from this disease young and children increased.

Chronic thyroiditis: causes

There are several factors that provoke this disease:

viral infections;
exposure to radiation waves;
focal infections chronic, which include: sinusitis, otitis, tonsillitis, adnexitis and many others;
hereditary predisposition (the patient has relatives with diabetes, chronic thyroiditis etc.);
intake of iodine into the body in large volumes (500 mcg per day or more).

Chronic thyroiditis: symptoms

Very often this disease occurs without any noticeable changes in the patient’s body, but in most cases it is accompanied by the following symptoms:

There is a feeling of tightness and pressure in the neck.
Feeling of a lump in the throat.
Constant unmotivated fatigue and weakness.
Strong sensitivity thyroid gland and the appearance of pain during palpation.
In some cases, eye diseases may occur.
Chronic thyroiditis is manifested by increased blood pressure.
Cold intolerance.
The thyroid gland becomes very elastic and dense to the touch.
Constipation.
Swelling lower limbs and faces.
Gaining excess weight.
Muscle cramps.
The appearance of "bags" under the eyes.
When accompanied by hyperthyroidism, tachycardia and tremor of the fingers may be observed.

Chronic thyroiditis: treatment

IN currently medicines that would save the patient from this disease have not been invented. Therefore, the main methods of treating thyroiditis are aimed at eliminating the inflammatory process with non-steroidal drugs and stimulating work drug therapy prescribed immediately after the detection of the disease, even if this moment the organ is functioning well. One of the most known drugs, preventing the development of hypothyroidism, is the remedy "L-thyroxine". Its dosage is prescribed depending on the patient’s age and TSH level in the blood.

Chronic thyroiditis: treatment with folk remedies

Get rid of this disease Alternative medicine will also help. The most known means is which is prepared as follows:

take 30 pieces of green walnuts and chop them;
then they are mixed with a glass of honey and a liter of vodka;
the mixture is infused for 2 weeks (it is necessary to stir periodically);
after time, the tincture is filtered;
Take a tablespoon in the morning 30 minutes before meals.

Thyroiditis thyroid gland- a collective term. Various types inflammation of organ tissue combines under common name- thyroiditis of the thyroid gland. The reasons that cause inflammation can be different, the same applies to the symptoms of the disease, the nature of the course, which undoubtedly requires different approach in treatment.

In this article I will briefly but succinctly talk about each variant of thyroiditis of the thyroid gland. And you can find out more about them by following the links to articles that describe the main methods and treatment regimens.

All variants of thyroiditis of the thyroid gland can be divided into:

acute thyroiditis
subacute thyroiditis
chronic thyroiditis

Acute thyroiditis of the thyroid gland

Acute thyroiditis is often a surgical pathology requiring intervention from surgeons. This variant of thyroiditis, in turn, is divided into purulent and non-purulent.

Purulent thyroiditis, like any purulent inflammation, is caused by bacteria, mainly cocci (staphylococci, streptococci, etc.). But due to the widespread use antibacterial drugs this type of inflammation is quite rare.

If purulent thyroiditis develops, then it was preceded by some disease associated with the same pathogen. Very often there is a connection between acute purulent diseases“ENT organs” (sinusitis, otitis, tonsillitis, etc.). Chronic infections of the ENT organs, such as chronic pharyngitis, which, by the way, can be treated with cold, can also cause thyroiditis of the thyroid gland, not only acute, but also some forms of chronic, but more on that a little later. To prevent thyroiditis, timely sanitation of chronic foci of infection of the nasopharynx and tonsils by an ENT doctor is recommended.

The disease develops acutely. Increase in body temperature to 38-39 degrees with symptoms of intoxication. I am concerned about intense throbbing pain in the area of the projection of the thyroid gland, which radiates to the ear and lower jaw. The skin over the gland is red, swollen and very painful to the touch. Sometimes an abscess forms, which can open on its own outward or into the mediastinum.

In acute purulent thyroiditis, the function of the thyroid gland is never impaired, i.e. hormonal background unchanged. This type of thyroiditis must be treated with antibiotics to which this pathogen is sensitive. After recovery, a small scar forms, which does not interfere with normal operation thyroid gland.

Acute non-purulent thyroiditis resolves without the participation of bacteria. It is formed due to trauma, hemorrhage, or after treatment with radioactive iodine-131. But since the treatment method with iodine 131 has now been improved, such treatment complications are no longer observed.

Subacute thyroiditis of the thyroid gland

The cause of subacute thyroiditis of the thyroid gland is a viral infection. Usually 2-6 weeks after viral infection The first signs of thyroiditis appear. There has been a connection between subacute thyroiditis and the following viral infections:

infectious mumps (mumps)
adenovirus infection
some types of flu

It was found that women suffer from this variant of thyroiditis 4 times more often than men and more often at the age of 30-40 years. It is assumed that viruses have a direct destructive effect on the thyroid tissue, resulting in the release of a large number of colloid (contents of gland follicles), which is a depot of thyroid hormones.

Since a lot of colloid is sent into the blood, thyroid hormones have an intense effect on tissues and organs. Thus, signs of thyrotoxicosis appear: palpitations, sweating, trembling hands, anxiety and irritability. The more active the destruction process, the more colloid goes into the blood, the more intense symptoms thyrotoxicosis.

Usually, one lobe of the thyroid gland is first involved, then the process migrates to the second lobe. In subacute thyroiditis, in addition to the symptoms of thyrotoxicosis, there is pain in the thyroid gland of moderate intensity, less than in acute thyroiditis. The skin over the gland is usually unchanged, of normal color, but when palpating the gland it is painful.

Distinctive for this variant of thyroiditis are high ESR numbers in a general blood test, which can last a long time.

Treatment of thyrotoxicosis with thyreostatics is not carried out, since the reason is not the increased synthesis of thyroid hormones, but a massive release active forms thyroid hormone directly into the blood. This variant of thyroiditis of the thyroid gland is treated by prescribing glucocorticoids (prednisolone, hydrocortisone). There are various treatment regimens, the choice of which depends on the attending physician.

After the inflammatory process subsides, mild hypothyroidism may develop, which goes away on its own after a few months.

Subacute thyroiditis does not affect the functioning of the thyroid gland in any way in the future. With proper treatment, the disease goes away without a trace. More details about

Chronic thyroiditis of the thyroid gland

Chronic thyroiditis is considered the most common among thyroiditis. In this group there are also individual diseases, characterized by a slow inflammatory process:

autoimmune thyroiditis (Hashimoto's thyroiditis)
fibrous-invasive thyroiditis (Riedel's goiter)
postpartum thyroiditis
silent (hidden) thyroiditis
specific thyroiditis (tuberculous, syphilitic, fungal)

Autoimmune thyroiditis thyroid gland occupies a leading place in the structure of thyroid diseases. With this thyroiditis there is an autoimmune lesion of the entire thyroid tissue.

The cause of the autoimmune process is still not completely clear. It is known that there is a certain hereditary predisposition to autoimmune diseases at all. There is also a connection between the development of this process and chronic foci of infection in the body. This is most often chronic diseases upper respiratory tract(tonsillitis, sinusitis, adenoiditis, etc.), genitourinary system(cystitis, pyelonephritis), carious teeth.

The mechanism of autoimmune damage is very complex, but in short, immune cells, which are supposed to protect the body from infections, begin to mistake the components of the thyroid gland for foreign ones and actively destroy them. A similar mechanism exists in the development of diseases such as rheumatoid arthritis, pernicious anemia, type 1 diabetes mellitus, vitiligo.

Currently, no one in world medicine has learned to influence this process, and therefore we have to cope with its consequences. Consequence autoimmune thyroiditis is the development of hypothyroidism (decreased function) of the thyroid gland.

Young women are most often affected. The rate of development of hypothyroidism is individual. Only the carriage of antibodies without the development of hypothyroidism is possible. Hypothyroidism is treated by prescribing replacement therapy with thyroxine (thyroid hormone).

Postpartum thyroiditis develops some time after birth. Sometimes pregnancy is a trigger for the development certain diseases. But, fortunately, postpartum thyroiditis is temporary and goes away without a trace after a few months. With the development of severe hypothyroidism, temporary administration of thyroxine may be required, followed by trial withdrawal. Read on to find out more.

Riedel's goiter- a disease of the thyroid gland, which is characterized by rocky hardness of the thyroid gland. This is a very rare disease, approximately 0.98-0.05% of all cases of thyroiditis. Women are 2 times more likely to get sick, more often at the age of 50 years and older.

With this thyroiditis, growth occurs fibrous tissue inside the gland with the germination of blood vessels, nerves, and capsules, as a result of which it acquires a “woody” or “stony” density. To put it simply, the thyroid gland with this thyroiditis turns into one large scar.

The reason of that rare disease still not clear.

There is a feeling of a lump in the throat, a feeling of constriction with difficulty swallowing and breathing, and hoarseness. The gland is dense to the touch, does not move when swallowing, and is tightly fused to the surrounding tissues.

The disease develops slowly, over decades, and the result of the disease is hypothyroidism. Often combined with other sclerosing diseases (pulmonary fibrosclerosis, orbital fibrosclerosis, etc.).

There is no increase in antibodies. Diagnosis is carried out with thyroid cancer.

Riedel's goiter is treated surgically, by decompressing adjacent organs. Treatment with glucocorticoids is ineffective. But in rare cases spontaneous resorption of fibrous tissue is observed. Developed hypothyroidism is treated by prescribing thyroxine replacement therapy.

With warmth and care, endocrinologist Dilyara Lebedeva

Autoimmune thyroiditis is a pathology that mainly affects older women (45-60 years old). The pathology is characterized by the development of a strong inflammatory process in the thyroid gland. Occurs due to serious malfunctions immune system, as a result of which it begins to destroy thyroid cells.

The susceptibility of older women to pathology is explained by X-chromosomal disorders And negative impact estrogen hormones on the cells that form the lymphoid system. Sometimes the disease can develop in both young people and small children. In some cases, pathology is also found in pregnant women.

What can cause AIT, and can it be recognized independently? Let's try to figure it out.

What it is?

Autoimmune thyroiditis is an inflammation that occurs in the tissues of the thyroid gland, the main cause of which is a serious malfunction in the immune system. Against this background, the body begins to produce an abnormally large amount of antibodies, which gradually destroy healthy thyroid cells. Pathology develops in women almost 8 times more often than in men.

Reasons for the development of AIT

Hashimoto's thyroiditis (the pathology got its name in honor of the doctor who first described its symptoms) develops for a number of reasons. The primary role in this matter is given to:

regular stressful situations;
emotional overstrain;
an excess of iodine in the body;
unfavorable heredity;
the presence of endocrine diseases;
uncontrolled intake;
negative influence external environment(this could be a bad environment and many other similar factors);
unhealthy diet, etc.

However, do not panic - autoimmune thyroiditis is reversible pathological process, and the patient has every chance to improve the functioning of the thyroid gland. To do this, it is necessary to ensure a reduction in the load on its cells, which will help reduce the level of antibodies in the patient’s blood. For this reason it is very important timely diagnosis diseases.

Classification

Autoimmune thyroiditis has its own classification, according to which it occurs:

Painless, the reasons for its development have not been fully established.
Postpartum. During pregnancy, a woman’s immunity weakens significantly, and after the birth of a baby, on the contrary, it becomes more active. Moreover, its activation is sometimes abnormal, since it begins to produce an excessive amount of antibodies. Often the consequence of this is the destruction of “native” cells various organs and systems. If a woman has a genetic predisposition to AIT, she needs to be extremely careful and carefully monitor her health after childbirth.
Chronic. In this case we're talking about about genetic predisposition to the development of the disease. It is preceded by a decrease in the production of hormones in organisms. This condition is called primary.
Cytokine-induced. This type of thyroiditis is a consequence of taking medicines based on interferon, used in the treatment of hematogenous diseases and.

All types of AIT, except the first, are manifested by the same symptoms. The initial stage of development of the disease is characterized by the occurrence of thyrotoxicosis, which, if diagnosed and treated untimely, can develop into hypothyroidism.

Stages of development

If the disease was not detected in a timely manner, or for some reason it was not treated, this may cause its progression. The stage of AIT depends on how long ago it developed. Hashimoto's disease is divided into 4 stages.

Eutheroid phase. Each patient has its own duration. Sometimes a few months may be enough for the disease to enter the second stage of development, while in other cases several years may pass between phases. During this period, the patient does not notice any special changes in his well-being and does not consult a doctor. Secretory function is not impaired.
At the second, subclinical stage, T lymphocytes begin to actively attack follicular cells, leading to their destruction. As a result, the body begins to produce significantly less St. hormone. T4. Eutheriosis is maintained due to sharp increase TSH level.
The third phase is thyrotoxic. It is characterized by a strong surge in the hormones T3 and T4, which is explained by their release from destroyed follicular cells. Their entry into the blood becomes a powerful stress for the body, as a result of which the immune system begins to rapidly produce antibodies. When the level of functioning cells drops, hypothyroidism develops.
The fourth stage is hypothyroid. Thyroid function can recover on its own, but not in all cases. It depends on the form in which the disease occurs. For example, chronic hypothyroidism can last for quite a long time, moving into an active stage followed by a phase of remission.

The disease can be in one phase or go through all the stages described above. It is extremely difficult to predict exactly how the pathology will progress.

Symptoms of autoimmune thyroiditis

Each form of the disease has its own characteristics of manifestation. Since AIT does not pose a serious danger to the body, and its final phase is characterized by the development of hypothyroidism, neither the first nor the second stages clinical signs Dont Have. That is, the symptoms of the pathology are, in fact, a combination of those anomalies that are characteristic of hypothyroidism.

We list the symptoms characteristic of autoimmune thyroiditis of the thyroid gland:

periodic or constant depressive state(purely individual sign);
memory impairment;
problems with concentration;
apathy;
constant drowsiness or feeling tired;
a sharp jump in weight, or a gradual increase in body weight;
deterioration or complete loss of appetite;
slow heart rate;
chilliness of hands and feet;
loss of strength even with adequate nutrition;
difficulty performing ordinary physical work;
inhibition of the reaction in response to the impact of various external stimuli;
dullness of hair, its fragility;
dryness, irritation and peeling of the epidermis;
constipation;
decline sexual desire, or its complete loss;
violation menstrual cycle(development of intermenstrual bleeding, or complete cessation of menstruation);
swelling of the face;
yellowness of the skin;
problems with facial expressions, etc.

Postpartum, silent (asymptomatic), and cytokine-induced AIT are characterized by alternating phases of the inflammatory process. In the thyrotoxic stage of the disease, the manifestation clinical picture happens due to:

sudden weight loss;
sensations of heat;
increased sweating intensity;
feeling unwell in stuffy or small rooms;
trembling in fingers;
drastic changes in psycho-emotional state sick;
increased heart rate;
seizures;
deterioration of attention and memory;
loss or decrease in libido;
fatigue;
general weakness, which even proper rest does not help get rid of;
sudden attacks of increased activity;
problems with the menstrual cycle.

The hypothyroid stage is accompanied by the same symptoms as the chronic stage. Postpartum AIT is characterized by the manifestation of symptoms of thyrotoxicosis in the middle of 4 months, and the detection of symptoms of hypothyroidism at the end of 5 - at the beginning of 6 months of the postpartum period.

With painless and cytokine-induced AIT, no special clinical signs are observed. If ailments nevertheless appear, they are extremely low degree expressiveness. When asymptomatic, they are detected only during preventive examination in a medical facility.

What does autoimmune thyroiditis look like: photo

The photo below shows how the disease manifests itself in women:

Diagnostics

Before the first warning signs Pathology to detect its presence is almost impossible. If there are no ailments, the patient does not consider it advisable to go to the hospital, but even if he does, it will be almost impossible to identify the pathology using tests. However, when the first adverse changes in the functioning of the thyroid gland begin to occur, clinical trial biological sample will immediately reveal them.

If other family members suffer or have previously suffered from similar disorders, this means that you are at risk. In this case, it is necessary to visit a doctor and undergo preventive examinations as often as possible.

Laboratory tests for suspected AIT include:

general blood test, which determines the level of lymphocytes;
a hormone test required to measure serum TSH;
immunogram, which establishes the presence of antibodies to AT-TG, thyroid peroxidase, as well as to thyroid hormones of the thyroid gland;
fine-needle biopsy, necessary to determine the size of lymphocytes or other cells (their increase indicates the presence of autoimmune thyroiditis);
Ultrasound diagnosis of the thyroid gland helps to determine its increase or decrease in size; with AIT, a change in the structure of the thyroid gland occurs, which can also be detected during an ultrasound scan.

If the results ultrasound examination indicate AIT, but clinical tests refute its development, then the diagnosis is considered doubtful, and does not fit into the patient's medical history.

What will happen if left untreated?

Thyroiditis may be unpleasant consequences, which vary for each stage of the disease. For example, during the hyperthyroid stage, a patient may have a heart rhythm disorder (arrhythmia), or heart failure may occur, and this is already fraught with the development of such dangerous pathology like myocardial infarction.

Hypothyroidism can lead to the following complications:

dementia;
infertility;
premature termination of pregnancy;
inability to bear fruit;
congenital hypothyroidism in children;
deep and prolonged depression;
myxedema.

With myxedema, a person becomes hypersensitive to any changes in temperature downwards. Even a banal flu or something else infection, transferred at a given pathological condition, can cause hypothyroid coma.

However, there is no need to worry too much - such a deviation is a reversible process and can be easily treated. If you choose the right dosage of the drug (it is prescribed depending on the level of hormones and AT-TPO), then the disease will long period time may not remind of itself.

Treatment of autoimmune thyroiditis

AIT treatment is carried out only on last stage its development – at . However, in this case, certain nuances are taken into account.

So, therapy is carried out exclusively with overt hypothyroidism, when TSH level less than 10 mIU/l, and St. T4 is reduced. If the patient suffers from a subclinical form of pathology with a TSH of 4-10 mU/1 l and with normal indicators St. T4, then in this case treatment is carried out only in the presence of symptoms of hypothyroidism, as well as during pregnancy.

Today, the most effective in the treatment of hypothyroidism are medications based on levothyroxine. The peculiarity of such drugs is that they active substance as close as possible to the human hormone T4. Such drugs are absolutely harmless, so they are allowed to be taken even during pregnancy and breastfeeding. The drugs do not cause side effects, and despite the fact that they are based on a hormonal element, they do not lead to weight gain.

Levothyroxine-based drugs should be taken “isolated” from other medications, since they are extremely sensitive to any “foreign” substances. Reception is carried out on an empty stomach (half an hour before meals or the use of other drugs) with the use of copious amounts liquids.

Calcium supplements, multivitamins, iron supplements, sucralfate, etc. should be taken no earlier than 4 hours after taking levothyroxine. The most effective means based on it are L-thyroxine and Eutirox.

Today there are many analogues of these drugs, but it is better to give preference to the originals. The fact is that they are the ones who have the greatest impact positive action on the patient’s body, while analogues can only bring a temporary improvement in the patient’s health.

If from time to time you switch from originals to generics, then you must remember that in this case a dosage adjustment will be required active substance– levothyroxine. For this reason, every 2-3 months it is necessary to take a blood test to determine the TSH level.

Nutrition for AIT

Treating the disease (or significantly slowing its progression) will provide more good results if the patient avoids foods that cause harm thyroid gland. In this case, it is necessary to minimize the frequency of consumption of products containing gluten. The following are prohibited:

cereals;
flour dishes;
bakery products;
chocolate;
sweets;
fast food, etc.

At the same time, you should try to eat foods fortified with iodine. They are especially useful in the fight against the hypothyroid form of autoimmune thyroiditis.

In case of AIT, it is necessary to take the issue of protecting the body from the penetration of pathogenic microflora with the utmost seriousness. You should also try to clean it of pathogenic bacteria that are already in it. First of all, you need to take care of cleansing the intestines, because this is where active reproduction occurs harmful microorganisms. To do this, the patient’s diet should include:

fermented milk products;
Coconut oil;
fresh fruits and vegetables;
lean meat and meat broths;
different types of fish;
seaweed and other seaweed;
germinated cereals.

All products from the above list help strengthen the immune system, enrich the body with vitamins and minerals, which, in turn, improves the functioning of the thyroid gland and intestines.

Important! If there is a hyperthyroid form of AIT, it is necessary to completely exclude all foods that contain iodine from the diet, since this element stimulates the production of hormones T3 and T4.

For AIT, it is important to give preference to the following substances:

selenium, which is important for hypothyroidism, as it improves the secretion of hormones T3 and T4;
B vitamins, which help improve metabolic processes and help keep the body in good shape;
probiotics, important for maintaining intestinal microflora and preventing dysbiosis;
adaptogen plants that stimulate the production of hormones T3 and T4 in hypothyroidism (Rhodiola rosea, Reishi mushroom, ginseng root and fruit).

Treatment prognosis

What's the worst thing you can expect? The prognosis for treatment of AIT is, in general, quite favorable. If persistent hypothyroidism occurs, the patient will have to take levothyroxine-based medications for the rest of his life.

It is very important to monitor the level of hormones in the patient’s body, so once every six months it is necessary to take a clinical blood test and ultrasound. If during an ultrasound examination a nodular compaction is noticed in the thyroid area, this should be a good reason to consult an endocrinologist.

If, during an ultrasound, an increase in nodules was noticed, or their intensive growth is observed, the patient is prescribed a puncture biopsy. The resulting tissue sample is examined in the laboratory in order to confirm or refute the presence of a carcinogenic process. In this case, ultrasound is recommended to be performed every six months. If the node does not tend to increase, then ultrasound diagnostics can be performed once a year.

Thyroiditis of the thyroid gland is very common. In terms of prevalence, this violation is in second place after diabetes mellitus among the anomalies endocrine system. Autoimmune thyroiditis is the most frequent violation from this group. The first symptoms of the disease should encourage a person to consult a doctor who will select effective treatment. So what is thyroiditis?

Thyroiditis is an inflammation of the thyroid gland, which manifests itself in the form of pressure, pain in the neck, difficulty swallowing, and hoarseness. In acute inflammatory process there is a risk of an abscess.

As the anomaly develops, there is a risk of diffuse lesions organ. Initially, hyperthyroidism occurs, then hypothyroidism develops. These diseases require adequate therapy.

The basis of chronic and acute thyroiditis are various mechanisms. However, the key role is played by the appearance of inflammation, which affects the thyroid tissue. General group are divided into several collective categories, which characterize the main types of illness:

Acute thyroiditis. In this case, purulent thyroiditis may be observed or nonpurulent form pathology. However, the disease is often characterized by the appearance of local inflammatory foci in the tissues of the thyroid gland.
Subacute thyroiditis of the thyroid gland. The main symptom of this type is focal lesion body that has a long development.
Chronic thyroiditis. In this case, the provoking factors may be specific pathogens that lead to the development of the disease. These include syphilis and tubercle bacillus. Autoimmune thyroiditis may also appear.

Causes

Factors include any causes that lead to damage to the thyroid gland. The only exception is autoimmune thyroiditis, which has a different development mechanism. The main reasons include:

Transferred traumatic lesions organ. They can lead to hemorrhage in the gland tissue. The causes and characteristics of the injury are not particularly important.
Prolonged exposure to ionizing radiation. This may be due to the person's profession.
Viral infections. The development of acute thyroiditis is especially often associated with influenza, mumps or measles.
Damage to the follicles that are located in the structure of the gland. This process is the result of the action of antibodies, which have different structures. This reason usually provokes autoimmune thyroiditis of a chronic nature.
Bacterial microorganisms that become pathogens.
Development lymphoid infiltration. This becomes the reason gradual defeat organ parenchyma. As a result, chronic lymphocytic thyroiditis develops.

Autoimmune thyroiditis (AIT)- chronic inflammation thyroid tissue, which has an autoimmune genesis and is associated with damage and destruction of follicles and follicular cells of the gland. In typical cases, autoimmune thyroiditis is asymptomatic, only occasionally accompanied by an enlargement of the thyroid gland. Diagnosis of autoimmune thyroiditis is carried out taking into account the results clinical tests, Ultrasound of the thyroid gland, data histological examination material obtained as a result of a fine-needle biopsy. Treatment of autoimmune thyroiditis is carried out by endocrinologists. It consists of correcting the hormone-producing function of the thyroid gland and suppressing autoimmune processes.

ICD-10

E06.3

General information

Autoimmune thyroiditis (AIT)- chronic inflammation of the thyroid tissue, which has an autoimmune genesis and is associated with damage and destruction of the follicles and follicular cells of the gland. Autoimmune thyroiditis accounts for 20-30% of all thyroid diseases. Among women, AIT occurs 15–20 times more often than among men, which is associated with a violation of the X chromosome and the effect of estrogen on the lymphoid system. Patients with autoimmune thyroiditis are usually between 40 and 50 years of age, although Lately The disease occurs in young people and children.

Classification of autoimmune thyroiditis

Autoimmune thyroiditis includes a group of diseases that have the same nature.

Chronic autoimmune thyroiditis(lymphomatous, lymphocytic thyroiditis, obsolete - Hashimoto's goiter) develops as a result of progressive infiltration of T-lymphocytes into the parenchyma of the gland, an increase in the number of antibodies to cells and leads to gradual destruction of the thyroid gland. As a result of disturbances in the structure and function of the thyroid gland, the development of primary hypothyroidism (decreased levels of thyroid hormones) is possible. Chronic AIT has genetic nature, can manifest itself in familial forms and be combined with other autoimmune disorders.
Postpartum thyroiditis occurs most often and is most studied. It is caused by excessive reactivation of the body's immune system after its natural suppression during pregnancy. If there is an existing predisposition, this can lead to the development of destructive autoimmune thyroiditis.
Painless thyroiditis is an analogue of postpartum, but its occurrence is not associated with pregnancy, its causes are unknown.
Cytokine-induced thyroiditis may occur during treatment with interferon drugs in patients with hepatitis C and blood diseases.

Variants of autoimmune thyroiditis, such as postpartum, painless and cytokine-induced, are similar in the phases of the processes occurring in the thyroid gland. At the initial stage, destructive thyrotoxicosis develops, which subsequently turns into transient hypothyroidism, in most cases ending with restoration of thyroid function.

In all autoimmune thyroiditis, the following phases can be distinguished:

Euthyroid phase diseases (without thyroid dysfunction). May last for years, decades or a lifetime.
Subclinical phase. As the disease progresses, massive aggression of T lymphocytes leads to the destruction of thyroid cells and a decrease in the amount of thyroid hormones. By increasing production thyroid-stimulating hormone(TSH), which overstimulates the thyroid gland, the body manages to maintain normal T4 production.
thyrotoxic phase. As a result of increasing aggression of T-lymphocytes and damage to thyroid cells, existing thyroid hormones are released into the blood and the development of thyrotoxicosis. Besides, in bloodstream falls into destroyed parts internal structures follicular cells, which provoke further production of antibodies to thyroid cells. When, with further destruction of the thyroid gland, the number of hormone-producing cells falls below critical level, the T4 content in the blood decreases sharply, and a phase of obvious hypothyroidism begins.
hypothyroid phase. It lasts about a year, after which thyroid function is usually restored. Sometimes hypothyroidism remains persistent.

Autoimmune thyroiditis can be monophasic (have only a thyrotoxic or only a hypothyroid phase).

By clinical manifestations and changes in the size of the thyroid gland, autoimmune thyroiditis is divided into forms:

Latent(there are only immunological signs, no clinical symptoms). Gland regular size or slightly enlarged (1-2 degrees), without compaction, the functions of the gland are not impaired, sometimes moderate symptoms of thyrotoxicosis or hypothyroidism may be observed.
Hypertrophic(accompanied by an increase in the size of the thyroid gland (goiter), frequent moderate manifestations of hypothyroidism or thyrotoxicosis). There may be a uniform enlargement of the thyroid gland throughout its entire volume (diffuse form), or the formation of nodes may be observed (nodular form), sometimes a combination of diffuse and nodal forms. Hypertrophic form autoimmune thyroiditis may be accompanied by thyrotoxicosis in initial stage diseases, but usually thyroid function is preserved or reduced. As the autoimmune process in the thyroid tissue progresses, the condition worsens, the function of the thyroid gland decreases, and hypothyroidism develops.
Atrophic(the size of the thyroid gland is normal or reduced, according to clinical symptoms- hypothyroidism). It is more often observed in old age, and in young people - in case of exposure to radioactive radiation. The most severe form of autoimmune thyroiditis, due to the massive destruction of thyrocytes, the function of the thyroid gland is sharply reduced.

Causes of autoimmune thyroiditis

Even with hereditary predisposition, for the development of autoimmune thyroiditis, additional unfavorable provoking factors are necessary:

previous acute respiratory viral diseases;
outbreaks chronic infection(on the palatine tonsils, in the sinuses, carious teeth);
ecology, excess of iodine, chlorine and fluorine compounds in environment, food and water (affects the activity of lymphocytes);
long-term uncontrolled use of medications (iodine-containing drugs, hormonal agents);
radiation exposure, long exposure to the sun;
psychotraumatic situations (illness or death of loved ones, loss of work, resentment and disappointment).

Symptoms of autoimmune thyroiditis

Most cases of chronic autoimmune thyroiditis (in the euthyroid phase and the phase of subclinical hypothyroidism) long time is asymptomatic. The thyroid gland is not enlarged in size, is painless on palpation, and the function of the gland is normal. Very rarely, an increase in the size of the thyroid gland (goiter) may be detected; the patient complains of discomfort in the thyroid gland (feeling of pressure, coma in the throat), easy fatigue, weakness, joint pain.

The clinical picture of thyrotoxicosis in autoimmune thyroiditis is usually observed in the first years of development of the disease, has transitory nature and as the functioning tissue of the thyroid gland atrophies, it passes for some time into the euthyroid phase, and then into hypothyroidism.

Postpartum thyroiditis usually manifests as mild thyrotoxicosis at 14 weeks after birth. In most cases, fatigue, general weakness, and weight loss are observed. Sometimes thyrotoxicosis is significantly pronounced (tachycardia, feeling of heat, excessive sweating, tremors of the limbs, emotional lability, insomnia). The hypothyroid phase of autoimmune thyroiditis appears at 19 weeks after birth. In some cases, it is combined with postpartum depression.

Painless (silent) thyroiditis is expressed by mild, often subclinical thyrotoxicosis. Cytokine-induced thyroiditis is also not usually accompanied by severe thyrotoxicosis or hypothyroidism.

Diagnosis of autoimmune thyroiditis

It is quite difficult to diagnose AIT before the onset of hypothyroidism. Endocrinologists make the diagnosis of autoimmune thyroiditis based on the clinical picture, data laboratory research. Presence of other family members autoimmune disorders confirms the likelihood of autoimmune thyroiditis.

Laboratory tests for autoimmune thyroiditis include:

general analysis blood- an increase in the number of lymphocytes is determined
immunogram– characterized by the presence of antibodies to thyroglobulin, thyroid peroxidase, second colloid antigen, antibodies to thyroid hormones of the thyroid gland
determination of T3 and T4(total and free), TSH level in blood serum. An increase in TSH levels with normal T4 levels indicates subclinical hypothyroidism, elevated level TSH with a reduced concentration of T4 – about clinical hypothyroidism
Ultrasound of the thyroid gland- shows an increase or decrease in the size of the gland, a change in structure. The results of this study serve to complement the clinical picture and other laboratory results.
fine needle biopsy of the thyroid gland- allows you to identify a large number of lymphocytes and other cells characteristic of autoimmune thyroiditis. It is used when there is evidence of possible malignant degeneration of a thyroid nodule.

The diagnostic criteria for autoimmune thyroiditis are:

increased levels of circulating antibodies to the thyroid gland (AT-TPO);
detection of hypoechogenicity of the thyroid gland by ultrasound;
signs of primary hypothyroidism.

In the absence of at least one of these criteria, the diagnosis of autoimmune thyroiditis is only probabilistic. Since an increase in the level of AT-TPO, or the hypoechogenicity of the thyroid gland in itself does not yet prove autoimmune thyroiditis, this does not allow us to establish accurate diagnosis. Treatment is indicated for the patient only in the hypothyroid phase, therefore, as a rule, there is no urgent need to make a diagnosis in the euthyroid phase.

Treatment of autoimmune thyroiditis

Specific therapy for autoimmune thyroiditis has not been developed. Despite modern achievements medicine, endocrinology does not yet have effective and safe methods corrections autoimmune pathology thyroid gland, in which the process would not progress to hypothyroidism.

In the case of the thyrotoxic phase of autoimmune thyroiditis, the use of drugs that suppress the function of the thyroid gland - thyrostatics (thiamazole, carbimazole, propylthiouracil) is not recommended, since in this process there is no hyperfunction of the thyroid gland. At severe symptoms cardiovascular disorders beta blockers are used.

For manifestations of hypothyroidism, individually prescribed replacement therapy thyroid preparations of thyroid hormones - levothyroxine (L-thyroxine). It is carried out under the control of the clinical picture and TSH levels in the blood serum.

Glucocorticoids (prednisolone) are indicated only for simultaneous autoimmune thyroiditis with subacute thyroiditis, which is often observed in the autumn-winter period. To reduce the titer of autoantibodies, non-steroidal anti-inflammatory drugs are used: indomethacin, diclofenac. They also use drugs to correct immunity, vitamins, and adaptogens. In case of hypertrophy of the thyroid gland and pronounced compression of the mediastinal organs, surgical treatment is performed.

Forecast

The prognosis for the development of autoimmune thyroiditis is satisfactory. With timely treatment, the process of destruction and decrease in thyroid function can be significantly slowed down and long-term remission of the disease can be achieved. Satisfactory health and normal performance In some cases, patients persist for more than 15 years, despite short-term exacerbations of AIT.

Autoimmune thyroiditis and elevated titers of antibodies to thyroid peroxidase (AT-TPO) should be considered as risk factors for future hypothyroidism. In the case of postpartum thyroiditis, the likelihood of its recurrence after next pregnancy in women it is 70%. About 25-30% of women with postpartum thyroiditis subsequently develop chronic autoimmune thyroiditis with the transition to persistent hypothyroidism.

Prevention

If autoimmune thyroiditis is detected without dysfunction of the thyroid gland, it is necessary to monitor the patient in order to detect and timely compensate for the manifestations of hypothyroidism as early as possible.

Women who are carriers of AT-TPO without changes in thyroid function are at risk of developing hypothyroidism if they become pregnant. Therefore, it is necessary to monitor the condition and function of the thyroid gland both early stages pregnancy and after childbirth.

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