Autoimmune thyroiditis: symptoms, treatment. Treatment of autoimmune thyroiditis

The thyroid gland is an internal secretion organ, which is one of the most important regulators of metabolic processes occurring in the human body. This organ is very sensitive to internal and external influences. Disruption of the thyroid gland affects the condition of the skin, cardiac activity, weight, the ability to conceive and bear a child, the disease is visible by changes in the speed of thinking and behavioral reactions.

20-30% of thyroid diseases are caused by a pathology called “autoimmune thyroiditis.” Autoimmune thyroiditis of the thyroid gland is a chronic or acute inflammation of the tissues of the organ, which is associated with the destruction of the thyroid cells by the own immune system. More often, the disease develops in women and can be asymptomatic for a long time, so it is most often detected during a routine ultrasound examination and determination of the level of antibodies to gland peroxidase in the blood. Treatment of the pathology is selected by the endocrinologist, taking into account the stage and nature of the process. Autoimmune thyroiditis can be completely cured or controlled with constant use of medications, it all depends on the type of pathology. This disease has a benign course.

Etiology

The word “autoimmune” describes a situation in which inflammation is provoked by one’s own immune system, attacking an organ (in thyroiditis, the thyroid gland). What are the reasons for this immune behavior?

All cells in the body - both pathogenic and healthy - must identify themselves. For these purposes, a kind of “identification mark” is located on their surface, which is made of specific proteins. Such proteins are commonly called “antigens,” and proteins that are responsible for eliminating pathological proteins and secreted by the immune system are called “antibodies.” The cells of the immune system, which are transported through blood vessels, constantly check each cell for danger to the body precisely by reading autoantigens and checking them against the “list” of approved ones. When the immune system fails and ceases to perform this function normally (due to a violation of the quality of lymphocytes or a decrease in the number of “guardians”), tumors arise, because atypical cells begin to divide in any tissue.

Even before a person is born, lymphocytes undergo special training, resulting in a list of self-cell antigens that should not be attacked by producing antibodies. However, not all parts and organs of the human body normally possess permitted antigens. In such cases, the body blocks them with the help of special cells that do not allow lymphocytes to reach them. Such a barrier is present in the male genital organs, lens, and thyroid gland; This kind of protection also forms around the child growing in the uterus.

When the barrier around the thyroid gland is destroyed (temporary or permanent), autoimmune thyroiditis develops. The culprits in this situation are genes that give lymphocytes increased aggressiveness. In most cases, as mentioned earlier, women get sick, since estrogens, unlike male hormones, affect the immune system.

Statistics

Autoimmune thyroiditis covers a third of all thyroid pathologies and occurs in 3-4% of the population of our planet. Also, the incidence of the disease increases with age. Thus, this pathology can be found in every 6-10 women aged 60 years, while in children the incidence of the disease is 1-12 per 1000.

Classification of pathology

Hashimoto's disease, or chronic autoimmune thyroiditis. It is this pathology that most often appears simply as “autoimmune thyroiditis,” and it is this pathology that will be discussed further. The disease occurs due to genetic reasons. Its course is chronic, but benign. In order to maintain a normal quality of life, you need to constantly take medications as part of hormone replacement therapy.

Hashimoto's disease is also known as lymphomatous goiter because the thyroid gland increases in size due to swelling in response to a massive attack of tissue by lymphocytes. Quite often there is a combination of it with other diseases of autoimmune origin, if not in a specific patient, then in other family members. Thus, Hashimoto's thyroiditis can occur in combination with vitiligo, autoimmune inflammation of the liver, damage to the lining cells of the stomach, rheumatoid arthritis, and type 1 diabetes.

Postpartum thyroiditis: inflammation of the thyroid gland develops at 14 weeks after delivery. It is associated with the peculiarities of the reaction of the immune system; throughout pregnancy, the immune system is suppressed in order not to destroy the fetus (after all, the child is essentially a foreign agent), and when the child is born, the body can reactivate to an excessive degree.

A painless form of the pathology, this disease has a development mechanism similar to postpartum thyroiditis, but its causes have not yet been established.

Cytokine-induced form of autoimmune thyroiditis. It develops as a result of bombardment of the thyroid gland with substances-cytokines, which are present in the body in significant quantities during the patient’s treatment with interferon drugs - “Viferon”, injectable “Laferon” (usually some blood diseases and viral hepatitis C are treated in this way until it turns into cirrhosis).

Based on the degree of enlargement of the thyroid gland, another classification of autoimmune thyroiditis is distinguished. Thus, the disease may be:

Atrophic: the size of the thyroid gland is reduced, the amount of secreted hormones is reduced. Essentially, this is hypothyroidism due to autoimmune thyroiditis.

Hypertrophic: the size of the thyroid gland is increased either in some places (nodular thyroiditis) or completely (diffuse thyroiditis).

Latent: the organ may be normal or slightly enlarged. Hormone levels and thyroid function remain normal.

Causes of pathology

In order to start the process of development of autoimmune thyroiditis, the presence of only a genetic defect is not enough. A person can consider the following predisposing factors to be a kind of trigger mechanism for the disease:

psycho-emotional stress;

ionizing radiation;

selenium deficiency in the soil at the patient’s place of residence;

living in areas with poor environmental conditions, when the body is exposed to excessive exposure to fluorine and chlorine;

the presence of a chronic infection in the body: chronic sinusitis, untreated caries, chronic tonsillitis;

taking iodine in large quantities;

previously suffered influenza, less often other respiratory viral pathologies, as well as measles, mumps.

Stages of the disease and symptoms

Hashimoto's thyroiditis is divided into several stages, which smoothly transition from one to another.

Euthyroid stage

The disease begins when immune system cells gain access to the cells of the thyroid gland, namely thyrocytes. These structures are foreign to lymphocytes, so the immune system decides to attack these cells with the help of special chemicals dissolved in the blood, while “pulling” new forces to the place of “conflict”. As a result of the attack on thyrocytes, antibodies are produced, which can be synthesized in various quantities. When there are few antibodies, many gland cells die, but the euthyroid phase of the disease is maintained, hormone levels remain at the same level, and the symptoms correspond to the behavior of those with an enlarged gland:

the patient gets tired even when doing work that is less than usual;

there are difficulties with swallowing food, especially hard ones (lump in the throat);

the thyroid gland becomes visually detectable;

The gland can also be palpated.

Subclinical stage

The same symptoms of autoimmune thyroiditis are observed in the subclinical phase. At this time, the number of cells in the gland decreases, but the level of performance is maintained by attracting cells from the reserve. This occurs due to TSH (thyroid stimulating hormone).

Thyrotoxicosis

When too much thyroid-stimulated antibodies are produced, the thyrotoxic phase of the disease occurs. It is characterized by the following symptoms:

menstrual irregularities;

poor tolerance to hot climates;

decreased libido levels;

tendency to diarrhea;

tachycardia that is felt;

hot flashes;

weakness;

anger, tearfulness, irritability;

fast fatiguability.

If the disease appears in a child, at this stage the main symptom is noticeable thinness and lack of weight gain, even despite increased appetite.

Hypothyroidism

If antibodies eliminate large volumes of the working zone of the thyroid gland, the last stage of the disease occurs - hypothyroidism. It is distinguished by the following characteristics:

joint pain;

brittle nails;

rare and scanty menstruation;

hair begins to fall out more;

a person suffers from rapid freezing;

constipation appears;

puffiness of the face;

the skin acquires a pale tint, becomes swollen, dense, and gradually turns yellow;

weight gain due to poor appetite;

slower reaction and speech;

apathy, depression;

weakness.

In children, hypothyroidism is accompanied by poor weight gain, memory loss, and increased phlegmatism; if the pathology appears at an early age, the mental development of such a child is far behind what is necessary.

Postpartum thyroiditis

In this case, after giving birth at 14 weeks, symptoms of mild hyperthyroidism occur:

weakness;

weight loss;

fatigue.

These symptoms can intensify to the point of trembling of the limbs, rapid mood swings, insomnia, a feeling of strong heartbeat, and a feeling of heat. About five weeks after the first symptoms (usually by the end of 4 months from the date of birth), symptoms of hypothyroidism appear, which are often attributed to postpartum depression.

Silent thyroiditis

A characteristic feature of this type of pathology is the symptoms of mild hyperthyroidism: increased heart rate, sweating, irritability. All these symptoms are usually attributed to overwork.

Cytokine-induced thyroiditis

During therapy with injectable forms of Viferon and Alveron, signs of both decreased and increased thyroid function may appear. Usually the severity of symptoms is minor.

Fertility and autoimmune thyroiditis

At the subclinical, euthyroid and thyrotoxic stages, autoimmune thyroiditis is not an obstacle to successful conception. However, this cannot be said for the disease in the stage of hypothyroidism, since the thyroid hormone significantly affects the functions of the ovaries. If this stage is accompanied by adequate treatment with synthetic hormones, pregnancy occurs. But there is a possibility of miscarriage, since antibodies to the gland, the degree of production of which depends on the dose of L-thyroxine, have a negative effect on ovarian tissue. However, the situation can be corrected with progesterone replacement therapy, which helps maintain pregnancy.

A woman who suffers from thyroiditis should also be observed by an endocrinologist throughout the entire gestation period. If a hypothyroid state is detected, the dose of thyroxine should be increased (the total need for thyroid hormones for two organisms, so the dose is increased by 40%). Otherwise, when the mother’s body contains insufficient amounts of thyroid hormones, the fetus may develop severe pathologies, which in some cases are incompatible with life. If the child survives, he is born with severe hypothyroidism, which indicates severe mental retardation and metabolic disorders.

Diagnosis of pathology

If autoimmune thyroiditis is suspected, the following diagnosis should be performed. Blood sampling to detect hormones:

T4 – free and general;

T3 – free and general.

With an increase in TSH and normal T4 levels, we can talk about the presence of a subclinical stage of the pathology, but if, with an increase in TSH, the T4 level decreases, this means that the first symptoms of the disease are approaching.

The diagnosis is made based on the combination of the following data:

the concentration of T4 and T3 is reduced, and the level of TSH is increased;

Ultrasound of the thyroid gland determines the hypoechogenicity of the tissue;

the level of antibodies to the thyroid enzyme – thyroid peroxidase (AT-TPO) in the venous blood increases.

If there are deviations in only one of the indicators, it is difficult to make a diagnosis. Even in the case of an increase in AT-TPO, we can talk about the patient’s predisposition to autoimmune damage to the thyroid gland.

In the presence of nodular thyroiditis, a biopsy of the node is performed to visualize the pathology, as well as to exclude oncology.

Complications

Each degree of thyroiditis has characteristic complications. Thus, the hyperthyroid stage can be complicated by heart failure, arrhythmia, and even cause myocardial infarction.

Hypothyroidism can provoke:

depression;

atherosclerosis;

dementia;

congenital hypothyroidism in a newborn;

recurrent miscarriage;

infertility;

myxedema – intolerance to the slightest cold and chronic drowsiness. If, while in this state, you introduce sedatives into the body, get an infectious disease, or get stressed, a hypothyroid coma may develop.

The great news is the fact that this disease is highly treatable, so if you constantly take a dose of AT-TPO and hormone levels, you can not even feel the presence of pathology for a long time.

Diet for autoimmune thyroiditis

Nutrition for this disease should have the usual calorie content (energy value not lower than 1500 kcal), but Mary Chaumont calculated it best - body weight * 25 minus 200 kcal.

The amount of protein should be increased to 3 g per kilogram of weight, while easily digestible carbohydrates and saturated fats should be limited. Food should be taken every three hours.

What you can eat:

butter;

• dairy products;

  pasta;

  liver: beef, pork, cod;

  fish fat;

  baked red fish;

  vegetable dishes.

You need to exclude seasonings and alcohol, smoked and spicy foods, fried and salty foods from your diet. Water should not exceed 1.5 liters per day. Once a week or every 10 days it is worth doing fasting days on fruits and juices.

Treatment

Treatment of the pathology is completely medicinal and depends on the stage at which autoimmune thyroiditis is. Treatment is prescribed regardless of age and does not stop even in case of pregnancy, of course, if there are necessary indications. The goal of therapy is to maintain thyroid hormones at their physiological level (monitoring indicators every six months, the first control should be carried out after 1.5-2 months).

At the stage of euthyroidism, drug treatment is not carried out.

Regarding the treatment tactics of the thyrotoxic stage, the decision is left to the doctor. Typically, thyreostatics like Mercazolil are not prescribed. Therapy is symptomatic: for tachycardia, beta blockers are used (Anaprilin, Nebivolol, Atenolol); in case of severe psycho-emotional excitability, sedatives are prescribed. In the case of a thyrotoxic crisis, treatment in a hospital is carried out using injections of glucocorticoid hormones (Prednisolone, Dexamethasone). The same drugs are used when autoimmune thyroiditis is combined with subacute thyroiditis, but therapy is performed on an outpatient basis.

In the stage of hypothyroidism, “Euthyrox” or “L-thyroxine” (this is a synthetic form of T4) is prescribed; in case of a lack of triiodothyronine, its analogs created in the laboratory are administered. For adults, the dose of thyroxine is 1.4-1.7 mcg/kg of body weight, for children – up to 4 mcg/kg.

For children, "Thyroxine" is prescribed only if TSH is elevated and T4 levels are low or normal, when there is an increase in the gland of 30 percent or more of the normal level for age. Also, if the gland is enlarged and there is a heterogeneous structure of its tissues in the absence of AT-TPO, potassium iodide is prescribed with a daily dose of 200 mcg.

When a diagnosis of autoimmune thyroiditis is made to a patient who lives in a region with natural iodine deficiency, physiological doses of this element are used - at a dosage of 100-200 mcg per day.

"L-thyroxine" is prescribed to pregnant women if the TSH level exceeds 4 mU/l. If there is only AT-TPO and a low TSH level (less than 2 mU/l), Thyroxine is not used, but TSH levels are monitored every trimester. In the presence of AT-TPO and a TSH level of 2-4 mU/l, it is necessary to prescribe “L-thyroxine” in prophylactic doses.

When nodular thyroiditis is present and it is not possible to exclude oncology, or the thyroid gland compresses the organs of the neck, causing difficulty breathing, surgical intervention is performed.

Forecast

If treatment was started in a timely manner before more than 40% of the thyroid cells die, the process can be controlled, and the prognosis is therefore favorable.

If a woman develops thyroiditis after childbirth, the probability of its recurrence after the next birth is 70%.

1/3 of cases of postpartum thyroiditis gradually transforms into a chronic form and leads to the development of persistent hypothyroidism.

Disease prevention

It is impossible to prevent the transmission of a defective gene. However, it is worthwhile to regularly monitor the function of your own thyroid gland (especially if you have a tendency to gain excess weight or vice versa) once a year. It is also necessary to donate blood for TSH and T4. The optimal preventive solution is to perform an ultrasound of the thyroid gland 1-2 times a year.

Particularly relevant is a routine examination for TSH, AT-TPO, T4, and when pregnancy occurs. These tests are not mandatory for the study, so to take them you need to independently contact an endocrinologist for a referral.

Recently, diseases associated with the functioning of the human immune system have become quite common. One of these is autoimmune thyroiditis. This disease has the most detrimental effect on the thyroid gland. The main symptoms are associated with this.

Reasons for development

The occurrence of this autoimmune disease is directly related to the disruption of the immune system. Because of this, the body’s protective functions begin to attack healthy thyroid cells, perceiving them as foreign. This organ is responsible for the production of hormones, so the disease most often occurs in women. Their hormonal levels are more susceptible to various changes and surges.

The body's aggression directed at the thyroid gland leads to its tissues becoming saturated with leukocytes. And this, in turn, leads to inflammation of the organ - thyroiditis. This process causes cell death. Those that remain are not enough for the full production of the required amount of hormones. This condition is called hypothyroidism.

One of the causes of autoimmune thyroiditis is considered to be a hereditary predisposition. In addition, the launch of such a negative process requires the presence of several predisposing factors at once. These most often include:

• psycho-emotional stress, stress;
• decreased immunity due to frequent viral and colds, as well as uncontrolled use of antiviral drugs;
• frequent intake and use of iodine-containing drugs in excess of the norm;
• hormone replacement therapy;
• surgical intervention on the thyroid gland or its injury;
• hormonal imbalances (pregnancy, conditions before and after menopause), etc.

Effect on the body

The main danger during this disease is its asymptomatic nature in the early stages. The condition caused by thyroiditis can easily be confused with ordinary fatigue. A characteristic phenomenon is memory impairment, depression, weakness and drowsiness, hair loss, etc. Such lack of expression often affects the time of recognition of the disease, which goes through a number of stages.

• Hyperthyroidism

The primary stage after the onset of the disease is characterized by the destruction of thyroid cells. This process leads to the release of hormones that were previously synthesized in them. Thus, the level of T3 and T4 in the blood increases. This condition is called hyperthyroidism.

The main symptoms of this stage are pain in the thyroid gland, irritability and a periodic feeling of “lump in the throat”, increased sweating, sore throat, accelerated heartbeat, as well as menstrual irregularities in women.

This stage lasts from 1 to 6 months.

• Euthyroidism

After stabilization of hormonal levels and functions of the thyroid gland, the disease enters a quiescent stage (euthyroidism). Despite the absence of any symptoms, thyroiditis did not recede. The silent destruction of the thyroid gland by the immune system began. The process may be accompanied by the appearance of nodes and cysts, which will increase over time. At the same time, the thyroid gland itself may well remain the same size as it was. And it can change in any direction (increase, decrease). Only a doctor can notice this condition upon palpation.

• Hypothyroidism

The destructive effect of antibodies that our body secretes on the thyroid gland due to disorders of the immune system, over time, leads to a decrease in the tissue of this organ. Functionality decreases, and this is evidence of the onset of hormonal imbalance, since the production of thyroid hormones has dropped significantly. A decrease in thyroxine and triiodothyronine, which are very important hormones for metabolism in the body, leads to a condition called hypothyroidism. Almost all functions of the human body suffer from this.

The described process is accompanied by symptoms such as depression, weakness, fatigue, decreased overall performance and memory levels, excess weight gain due to metabolic disorders, hair loss, menstrual irregularities, shortness of breath, bradycardia, and increased cholesterol levels.

Diagnostics

Diagnosis of autoimmune thyroiditis is extremely difficult. The disease can be identified only by the most obvious factors (changes in the structure of thyroid tissue, increased levels of antibodies, increases and decreases in the level of certain hormones in the blood). Timely detection can make the patient’s life much easier.

So, if the diagnosis was made at the initial stages, then drug treatment can delay the process of destruction of thyroid tissue for quite a long time. This will allow you to maintain stable hormonal levels at the same level longer.

Consequences

It should immediately be noted that the prognosis for the future can be quite favorable even with autoimmune thyroiditis. The worst thing to expect from this disease is a number of possible complications. However, they will appear only in the complete absence of adequate treatment. If the disease was diagnosed on time, and subsequently you fully followed all the recommendations, then there will be no serious consequences. It is worth saying right away that the mortality rate for this disease is not high. Life expectancy is practically no different from healthy people.

A cure in this case is impossible, since the hormonal balance will no longer be able to recover on its own. Treatment is mainly aimed at minimizing symptoms and improving the patient’s quality of life.

The absence of therapy can cause a number of negative consequences for a person. So, this can lead to complications:

• from the nervous system: the occurrence of depression, a general decrease in intelligence and memory, dementia;
• from the cardiovascular system: coronary disease, hypertension, hydropericardium;
• from the gastrointestinal tract: pancreatitis, kidney stones, general digestive disorders (constipation, etc.);
• from the genital system and functions (in women): infertility, uterine bleeding, etc.

One of the worst consequences of thyroiditis is the appearance of thyroid cancer. This can happen if cancer cells appear in the nodes that arise in the thyroid gland against the background of an autoimmune disease.

Understanding the danger of the disease itself should lead patients to promptly tell their doctor about any problems, especially hormonal ones. Timely diagnosis of many diseases can prevent a number of negative consequences for humans. And thyroiditis detected in time can significantly reduce the severity of symptoms and the overall standard of living in the future. To the point of avoiding disability.

Autoimmune thyroiditis is an autoimmune disease of the thyroid gland, which is characterized by a chronic course. As it develops, gradual and long-term destruction of thyrocytes occurs. As a result, the hypothyroid state begins to progress. Medical statistics are such that the disease occurs in 3–11% of the total population.

Representatives of the fair sex suffer from it several times more often. Autoimmune thyroiditis of the thyroid gland can affect a person at any age, but most often it affects people in the age group of 50–70 years.

Causes

Most often, this pathology is caused by a hereditary predisposition. But even in this case, provoking factors are needed for its development, such as:

• the presence of foci of chronic infection in the body;
• transferred pathologies of a viral nature - acute respiratory infections;
• long-term and improper use of synthetic medications. More often, the disease develops as a result of taking hormonal drugs or iodine-containing drugs;
• exposure to radiation on the human body;
• prolonged exposure to sunlight;
• severe stress. This includes a strong shock - the death of a loved one, loss of a job, etc.;
• unfavorable ecological situation in the place where a person lives.

Classification

Several classifications are used in medicine:

• for reasons of occurrence;
• by development mechanism;
• according to the characteristics of the clinic.

Classification by causes:

• chronic autoimmune thyroiditis. The pathology progresses due to the penetration of T-lymphocytes into the thyroid parenchyma. Its destruction occurs - structures are affected and basic functions are disrupted, which leads to the progression of the primary. This condition is dangerous because the thyroid gland stops producing the normal amount of hormones, which can lead to the development of dangerous pathologies. Hypothyroidism should be identified and treated as soon as possible. Chronic autoimmune thyroiditis is a hereditary pathology;
• postpartum. The main reason for the development is increased activation of the immune system after its long-term suppression during pregnancy;
• silent;
• cytokine-induced thyroiditis.

Classification by development mechanism:

• euthyroid phase. At this stage, the functions of the gland are not impaired. In terms of duration, such a phase can last several years or a lifetime;
• subclinical phase. If the disease begins to progress, then the aggression of T-lymphocytes increases, which “attack” and completely destroy the gland cells and reduce the level of thyroid hormones. But at the same time, there is an increase in TSH production;
• thyrotoxic phase. The aggression of T-lymphocytes increases and damaged gland cells release thyroid hormones into the blood. Thyrotoxicosis develops. The destruction of the gland progresses and the phase of severe hypothyroidism begins;
• hypothyroid phase. Its duration is one year, after which the lost functions of the gland are restored. Sometimes persistent hypothyroidism occurs.

Classification depending on clinical manifestations:

• latent form. Symptoms of autoimmune thyroiditis do not appear;
• hypertrophic. Signs of hypothyroidism are more pronounced. The gland becomes enlarged and nodules may form. Gradually, the autoimmune process progresses, and the functions of the gland are disrupted, hypothyroidism develops;
• atrophic. As a rule, the size of the gland remains normal. Sometimes it decreases. This pathological condition is observed mainly in older people. In young people, it can begin to progress due to exposure to radioactive radiation on the body.

Symptoms

The main symptoms of chronic autoimmune thyroiditis, like any other form of it, appear during the active phase of development of the disease, when morphological changes, as well as inflammatory processes, are observed in the tissues of the gland.

Symptoms:

• weakness;
• the gland becomes denser and increases in size;
• when you press on the thyroid gland with your fingers, you can notice the presence of nodes;
• joint pain;
• breathing is difficult, and it is also difficult to fully swallow food;
• the patient constantly feels the presence of a lump in the throat;
• pain in the area where the thyroid gland is located;
• sweating;
• trembling of fingers;
• memory impairment;
• attention disorder;
• constant mood changes.

Symptoms of postpartum thyroiditis:

• weight loss;
• hormone production is disrupted;
• increased fatigue;

It is worth noting that often the disease occurs absolutely without symptoms, while the main symptoms are directly related to the presence of other pathologies in the body, primarily hypothyroidism:

• menstrual irregularities;
• muscle pain.

Autoimmune thyroiditis in children progresses slowly. For a long time, they can be observed to be in a state of euthyroidism (no symptoms). Typically, the diagnosis is made during a patient's examination for goiter. The gland is evenly enlarged and soft to the touch. It is worth noting the fact that the atrophic form is not typical for autoimmune thyroiditis in children.

Diagnostics

Diagnosis of AIT consists of an assessment of symptoms, results of laboratory and instrumental examinations. It will be possible to begin treating the disease only after an accurate diagnosis. It is worth noting that it can be very difficult to confirm the presence of AIT before clinical manifestations.

The main diagnostic program includes:

• immunogram analysis;
• T4 and T3 balance test;
• a test that determines the level of TSH in the blood;
• fine needle biopsy.

Treatment

Latent forms of AIT, as a rule, are not treated with medication or surgery. But doctors constantly monitor a patient who has such a disease. Thyroiditis in the active phase is almost impossible to cure completely. But it is immediately worth noting that it does not have any lethal consequences for the human body.

Treatment of autoimmune thyroiditis should begin only after an accurate diagnosis. The plan is outlined by the attending physician, based on the characteristics of the pathology in the patient, as well as on the basis of the general condition of his body.

Treatment of autoimmune thyroiditis is usually conservative. If hypothyroidism has developed, it is corrected with the help of hormonal drugs. If the autoimmune form is combined with subacute thyroiditis, then in this case they resort to the use of Prednisolone.

The isolated autoimmune form is treated with drugs based on white cinquefoil - Alba, Zobofit, etc. Surgical treatment is used if the thyroid gland has enlarged to such an extent that the patient cannot swallow or breathe normally.

Complications

The consequences of the pathology are not lethal. Typically, adults experience the following conditions:

• decreased intelligence.

Children may develop the following consequences of AIT:

• underdevelopment of the genital organs;
• cretinism;
• dwarf stature.

Diet

Treatment of autoimmune thyroiditis also includes prescribing a special diet. A very important point is that the calorie content of the diet should not be reduced in any way. If the diet restricts calorie intake, the patient's condition may only worsen.

The diet requires maintaining an optimal balance of carbohydrates, fats and proteins. You need to eat every three hours. The patient’s diet should include more foods that contain unsaturated fatty acids. The diet includes a sharp restriction of saturated fats. The patient's diet must contain sufficient amounts of carbohydrates. Therefore, the patient should eat pasta, cereals, and bread.

The diet excludes the consumption of:

• spicy dishes;
• alcohol;
• pickles and marinades;
• fried and smoked foods.

The optimal diet is prescribed only by a qualified specialist. Sometimes it will be necessary to adhere to it throughout your life so as not to aggravate the course of autoimmune thyroiditis.

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Answer only if you have proven medical knowledge

Diseases with similar symptoms:

Chronic fatigue syndrome (abbr. CFS) is a condition in which mental and physical weakness occurs, caused by unknown factors and lasting from six months or more. Chronic fatigue syndrome, the symptoms of which are believed to be to some extent associated with infectious diseases, is also closely associated with the accelerated pace of life of the population and with the increased flow of information literally falling on a person for subsequent perception.

Autoimmune thyroiditis (abbreviated as AIT) has another name - Hashimoto's thyroiditis (the disease was first described by the Japanese scientist Hashimoto). This is one of the most common thyroid pathologies, affecting one in ten women between the ages of thirty and fifty.

What is autoimmune thyroiditis? This is a chronic process that develops in the thyroid gland, leading subsequently to the destruction (destruction) of the follicles of which it consists.

AIT is an autoimmune disease of the thyroid gland, in which pathological aggression of the immune system manifests itself, that is, the thyroid tissue is recognized as a foreign and dangerous object that must be destroyed. Such a reaction pulls protective cells directly into the lesion, which leads to the production of autoantibodies.

The process takes the form of a specific autoimmune inflammation and this is fraught with the destruction of the follicles in which hormones are produced. Thus, AIT has a second name - chronic lymphocytic thyroiditis.

In the future, this leads to a decrease in thyroid function () or intoxication with its own hormones. This process is fraught with changes in the tissue of the endocrine organ, which in many cases leads to the formation of nodes and cysts.

Areas in which lymphocytes accumulate are prone to overgrowth (hyperplasia). Such disorders lead to a visual enlargement of the thyroid gland and such changes are clearly visible to the naked eye.

The main reasons that provoke an autoimmune process in the thyroid gland:

1. Hereditary factor. It has been noted that if one of the close relatives in the family (for example, mother or grandmother) has encountered thyroid disease, then there is a high risk for a certain individual to also develop hormonal pathology. Scientists have even proven this phenomenon by discovering a transmission gene that causes the development of thyroiditis.
2. Stressful situations, neuropsychic stress. This factor provokes the thyroid gland to release excessive amounts of thyroid hormone into the blood. Subsequently, this leads to increased growth of the endocrine organ and also causes disruption of its function.
3. Deterioration of the surrounding ecology, decreased quality of food, industrial pollution, exposure to toxic factors on the body (alcohol, smoking) leads to hormonal imbalance of the entire endocrine system, in particular the thyroid gland.
4. The source of infection, which is located “next door” to the gland. These include diseases such as chronic rhinitis, adenoiditis, tonsillitis, frequent pharyngitis and acute sore throats. An infectious agent, due to its close anatomical location, can cause an infectious process in the cells of the thyroid gland, which are directly responsible for the production of hormones.
5. Incorrectly selected immunostimulant therapy. This can disrupt humoral and cellular immune responses, which can lead to the development of a number of abnormalities, such as hyperstimulation and cloning of T lymphocytes.
6. General hormonal imbalance– an “excellent” impetus for the development of the disease. The “trigger” factor is pregnancy, menopause, adolescence, strict diets (fasting).

Women are at risk for the described hormonal pathology: according to statistics, this disease is diagnosed in them 7 times more often than in men. It also occurs in medical practice, and in children under six years of age the disease is almost never detected.

Initial stage of the disease: patient actions and disease development

During the initial development of the pathological process, the general condition is not disturbed, so patients are often unaware of changes in hormonal levels. The “origin” of the disease can only be determined by laboratory tests.

To differentiate AIT from a number of diseases, the examination begins with a general blood test. If lymphocytes, ESR and monocytes increase, the doctor may suspect autoimmune thyroiditis. In the future, the patient will be asked to undergo an ultrasound examination of the gland and.

Important! As a rule, only a few patients consult a specialist before clinical signs appear. In most cases, treatment occurs at the very “height” of the disease.

At the beginning of the development of the pathology, the patient feels causeless weakness, malaise, and drowsiness. At the end of the working day (especially if the work involves physical stress), you feel powerless and tired.

If medical assistance was not provided at this stage, then the following signs are determined:

• slight swelling around the neck and deepening of the transverse folds are visualized;
• the swallowing process is disrupted;
• hoarseness occurs;
• there is a feeling of squeezing (as if a scarf is tightly wrapped around the neck).

Table. Symptomatic manifestations depending on increased or decreased thyroid function:

In almost all situations, women experience various menstrual and cycle disorders: heavy or, on the contrary, scanty bleeding, severe premenstrual syndrome, changes in the duration of the follicular, ovulatory or luteal phase.

Analyzes and research: what does a specialist offer?

Ultrasound of the thyroid gland is one of the main diagnostic methods

If symptoms reminiscent of autoimmune thyroid diseases occur, you should consult an endocrinologist. At the appointment, the doctor takes an anamnesis (studies the patient’s medical history, analyzes the nature of the complaints), and also examines the thyroid gland by palpation.

To make an accurate conclusion, you must undergo the following examinations:

1. Study of hormones TSH, T3, T4. An increase in T3 and T4 with a decreased TSH is observed in the case of thyrotoxicosis. If T3 and T4 levels are reduced and TSH is higher than normal, then this is a clinical sign of hypothyroidism. If thyroid hormone levels are normal, euthyroidism is diagnosed.
2. Determination of the level of antithyroid autoantibodies to thyroid peroxidase (AT-TPO) and to (AT-TG). With autoimmune thyroiditis, the levels will be higher than normal.
3. Ultrasound examination of the thyroid gland. AIT is characterized by a diffuse decrease in tissue echogenicity, and an increase or decrease in the parameters and volume of the thyroid gland is also noted.

The diagnosis of autoimmune thyroiditis is made only if the following test results are positive:

• ultrasound signs indicate the presence of a pathological process;
• presence of symptoms of hypothyroidism;
• detection of autoantibodies in the blood.

If at least one parameter is negative, then the diagnosis of autoimmune thyroiditis is questioned, but not excluded.

Conducting a fine-needle biopsy (FNAB) is another method of confirming the disease

This technique allows you to identify the accumulation of lymphocytes and other cells characteristic of autoimmune thyroiditis. Fine needle aspiration biopsy of the thyroid gland is performed on an outpatient basis. No special preparation is required to perform the manipulation.

The procedure is carried out without general anesthesia, since the anesthetic drug may end up in the biological material and thereby affect the information content of the result. To reduce the sensitivity of medical actions, the doctor treats the skin at the puncture site with anesthetic ointment or administers a special subcutaneous injection.

The manipulation is carried out using a thin needle, in some cases it is necessary to make several punctures to take material from different areas. The location of the biopsy is determined using an ultrasound machine. The depth of needle insertion is controlled “blindly” (see photo of the procedure).

The puncture material is applied in a thin layer to a glass slide, which is then sent to the laboratory. The procedure lasts approximately ten to fifteen minutes. The manipulation is low traumatic and relatively painless. Patients often tolerate it well, so they are immediately sent home.

FNA is characterized by high information content, therefore, based on the results of the study, one can be almost 100% confident in the final diagnosis. The average cost of the procedure is 1,700-9,000 rubles.

Treatment of autoimmune thyroiditis – what does modern medicine offer?

Today, medicine has not yet developed drugs that would effectively and safely correct autoimmune pathology. The treatment used only inhibits the development of hypothyroidism, but does not exclude its progression in the future.

Autoimmune thyroiditis almost never causes hyperfunction of the thyroid gland, therefore drugs to reduce hormone levels (thyrostatics) such as Thiamazol, Cardimazol are not prescribed. If hypothyroidism is detected, replacement therapy with synthetic hormonal medications, which include L-thyroxine (“Levothyroxine”), is prescribed. Treatment is carried out under constant monitoring of the clinical picture and the level of thyrotropin in the blood serum.

Glucocorticoid therapy is prescribed when AIT is combined with subacute thyroiditis (relapses are often observed in the autumn-winter period). Reducing the titer of autoantibodies is carried out with the help of non-steroidal anti-inflammatory drugs, and immunocorrectors are also widely used for this purpose.

In addition, it is important not to forget about the treatment of concomitant diseases: in case of cardiac dysfunction, beta-blockers are prescribed, and in case of negative changes in the liver, hepatoprotectors are recommended.

What are the restrictions?

Patients who suffer from AIT must adhere to certain restrictions so as not to provoke the development of another relapse.

Autoimmune thyroiditis - contraindications:

1. Many people mistakenly believe that if the thyroid gland is dysfunctional, iodine-containing medications are necessary. In fact, these medications can both help and harm, so in this case it is important not to self-medicate, even if we are talking about “healthy” vitamins or mineral complexes. For example, iodine in autoimmune thyroiditis increases the number of antibodies that destroy thyroid cells. Only a doctor, based on the results of T3 and T4 tests, has the right to prescribe iodine-containing drugs for the main treatment.
2. In cases of selenium deficiency, the conversion of T3 and T4 is disrupted, which leads to the development of hypothyroidism. In other words, this trace element synthesizes a hormone that creates energy in cells. When a disorder occurs, the thyroid gland improves its function by increasing its surface area (it grows, nodes or cysts appear on it). But the microelement is still missing! Thus, selenium plays an important role in autoimmune thyroiditis. However, it is not prescribed in all cases: if the patient has thyrotoxicosis, then this microelement is contraindicated.
3. Many patients are interested in whether it is possible to get vaccinated (for example, against influenza) if the thyroid gland is not functioning properly? Endocrinologists note that autoimmune thyroiditis and vaccinations are not compatible concepts. The fact is that AIT is a serious immune disorder, so vaccination can only aggravate the hormonal imbalance.

To find out what dietary restrictions there are for autoimmune thyroid disease, we recommend watching the video in this article.

Complications of hormonal imbalance

The prognosis for autoimmune thyroiditis is satisfactory. Patients who start treatment in a timely manner experience an improvement in their well-being due to a decrease in thyroid function.

With the help of medications, in many cases it is possible to achieve long-term remission. Thus, in the first 10-15 years, normal performance and good health are noted, despite short periods of exacerbation.

The negative consequences of autoimmune thyroiditis occur in those patients who, for some reason, do not receive treatment. Over time, they develop such serious pathologies as coronary heart disease, myocardial infarction, cerebral atherosclerosis, and sexual dysfunction.

Attention! Autoimmune thyroiditis and infertility are phenomena that go hand in hand. Antibodies to the thyroid gland directly increase the risk of miscarriage. In addition, the likelihood of the embryo attaching to the uterine lining is reduced. Before planning a pregnancy, a woman suffering from AIT is recommended to stabilize her hormonal levels. This contributes to successful pregnancy and the birth of a healthy child.

Against the background of impaired immunity, infectious diseases often occur, and progression of autoimmune processes up to the formation of oncology can also be observed.

It is categorically not recommended to be treated with the same drugs that helped your neighbor, even if the symptoms are very similar, and the instructions for the drug “promise” to soon improve the general condition. It is important to promptly seek medical help at the first signs of pathology, listen to the doctor’s advice and fully follow the recommendations.

Among all thyroid diseases, autoimmune thyroiditis raises many questions among patients. This pathology is often called a time bomb due to its long and asymptomatic course: most patients consult a doctor already with severe hormonal imbalances that are difficult to correct.

In our review and video in this article, we will try to understand what is the worst thing about a diagnosis of autoimmune thyroiditis: what the patient can expect, and how to avoid complications of the disease.

Autoimmune thyroiditis is a chronic inflammatory disease of the thyroid gland. Its causes are not fully understood, but appear to be related to inherited genetic mutations.

This is interesting. For the first time, a strange disease accompanied by destruction of the thyroid gland and gross hormonal disturbances was described by the Japanese doctor Hashimoto (Hashimoto) Hakaru in 1912. Therefore, another name for the pathology is Hashimoto’s thyroiditis.

The pathology is based on a complex autoimmune process: for some reason, immune cells begin to attack healthy thyroid tissue, causing their damage and death. Thus, the organ can be completely destroyed.

Consequences of the disease: what patients need to know

How dangerous is autoimmune thyroiditis? There are several factors that make the disease dangerous for the patient and “problematic” for the doctor. But forewarned means forearmed. Let's consider the main features of the pathology.

Sudden onset and asymptomatic course

The prevalence of autoimmune thyroiditis is quite high - today it is diagnosed in 2.5-3% of the world's population. Moreover, the majority of patients are women, since this pathology occurs 7-8 times more often in them than in men.

It is known that the first signs of chronic thyroiditis can appear at any age. Until now, scientists cannot say what exactly is the provoking factor in the development of an autoimmune disease.

There are several reasons that “trigger” the process of antibody formation and cause destruction of thyroid cells:

• frequent ARVI;
• foci of chronic infection in the body (untreated caries, adenoiditis, sinusitis, etc.);
• unfavorable environmental conditions;
• increased content of iodine, chlorine and fluorine in the environment;
• excessive exposure to ultraviolet radiation (infatuation with tanning, including in a solarium);
• long-term use of iodine preparations and vitamins containing this trace element in large quantities;
• treatment with hormonal medications (glucocorticosteroids, estrogen-containing drugs);
• diseases of the immune system, tendency to allergic reactions;
• hormonal fluctuations in the body (puberty, pregnancy and childbirth, menopause);
• surgeries, injuries of the thyroid gland;
• stress.

According to the development mechanism, all cases of autoimmune thyroiditis can be divided into 4 large groups.

Table 1: Classification of autoimmune thyroiditis by pathogenesis:

	Chronic Hashimoto's thyroiditis	Postpartum thyroiditis	Silent thyroiditis	Cytokine-induced thyroiditis
Reason for development	Purely genetic abnormality	The appearance of the first symptoms of the disease is caused by pregnancy and childbirth.	Genetic predisposition + one or more factors listed above	In this case, the disease is provoked by long-term use of immunomodulators or interferon indicators that activate the body's defenses
Character of the current	The classic version of the disease, characterized by a slowly progressive course, symptoms of hypothyroidism and an increase in the size of the thyroid gland (the so-called Hashimoto’s goiter)	It proceeds aggressively, with pronounced destruction of thyroid tissue. Quickly leads to decompensation and severe hormonal imbalances	Long-term asymptomatic course	It provokes massive destruction of thyroid tissue and destructive thyrotoxicosis (a sharp increase in the concentration of thyroid hormones in the blood). This condition is then replaced by endocrine organ failure and severe hypothyroidism

Note! The appearance of the first signs of autoimmune thyroiditis during pregnancy requires strict medical supervision. Endocrine disruption is dangerous not only for the expectant mother, but also for the fetus, since its growth, physical development and proper formation of internal organs depend on the action of maternal hormones.

Thus, timely diagnosis can be complicated not only by the chronic course of autoimmune thyroiditis with a minimum of symptoms, but also by its sudden onset: often the disease develops against the background of complete health and remains unnoticed for a long time by both medical professionals and patients.

Serious hormonal imbalances in the body

Signs of hypothyroidism are a classic manifestation of autoimmune thyroiditis

Classic hypothyroid syndrome with autoimmune thyroiditis (sometimes it can appear only several years after the onset of the disease) is characterized by:

• weakness, apathy;
• decreased performance;
• constant drowsiness;
• increase in body weight;
• chilliness, poor tolerance to cold;
• swelling of the face, feet and palms;
• slowness, impaired memory and concentration processes;
• heart rhythm disturbances, decreased heart rate.

Note! Thyroid hormone deficiency is much more dangerous for children than for adults. Chronic hypothyroidism, caused by autoimmune inflammation, can lead to severe retardation in the physical and mental development of the baby (up to cretinism), dwarfism, and pathologies of the development of the genital organs.

Often patients do not pay attention to the changes occurring in the body, attributing them to chronic fatigue or seasonal blues. Lack of treatment can lead to a serious complication of thyroiditis - hypothyroid coma.

Hypothyroid coma is a serious threat to life

A sharp decrease in the concentration of thyroid hormones in the blood leads to a critical slowdown in metabolism and oxygen starvation of the brain and, ultimately, depression of consciousness and coma.

Typical symptoms that suggest a patient has extremely low levels of thyroid hormones:

• decrease in body temperature to 35-35.5 ° C;
• disorders of the heart and blood vessels – heart rate less than 60 beats/min, pulse difficult to palpate, thread-like, blood pressure sharply reduced;
• respiratory disorders - a decrease in the number of respiratory movements, periods of apnea - temporary cessation of breathing;
• dysfunction of the nervous system - impaired consciousness, the patient does not respond to speech addressed to him, attempts to bring him to his senses;
• dermatological disorders - pallor and dry skin, which acquires a waxy tint, severe dense swelling;
• problems with the digestive system - enlarged liver, intestinal paresis.

Early diagnosis and comprehensive treatment, including intravenous administration of thyroid hormones and glucocorticoids, as well as correction of respiratory disorders and symptomatic therapy, saves the patient’s life in 50-60% of cases.

Hypothyroid coma is a severe condition that is difficult to correct. Prevention of hypothyroid coma is one of the main tasks of modern healthcare.

Note! If a patient is admitted to the clinic with a hypothyroid coma, after restoration of vital functions and correction of metabolic disorders, medical instructions prescribe a complete examination of the hormonal status and functional state of the thyroid gland to determine the causes of the complication.

Signs of hyperthyroidism in AIT

With the development of destructive thyrotoxicosis, patients, on the contrary, complain of:

• irritability, increased excitability;
• anxiety;
• insomnia;
• increased appetite;
• weight loss;
• constantly elevated body temperature at 37.0-37.5 ° C;
• trembling throughout the body, trembling of the fingertips, tongue, chin;
• feeling of sand in the eyes.

Since the hyperthyroid stage of the disease, if present, is extremely short-lived, its treatment is often not carried out at all.

Lack of pathogenetic treatment of the disease

Unfortunately, there is currently no medicine that would interfere with complex immune processes and suppress the destruction of healthy thyroid tissue. Physicians can correct emerging hormonal imbalances by prescribing lifelong medications that are analogues of the thyroid hormone thyroxine (L-Thyroxine, Euthyrox).

Comprehensive treatment of the disease is necessarily supplemented by the prescription of non-steroidal anti-inflammatory drugs, adaptogens, vitamin complexes, and general restoratives. If the hypothyroid condition is accompanied by compensatory growth of the thyroid gland (Hashimoto's goiter), and the organ reaches a large size, the issue of its surgical removal is decided.

Note! You should not turn to healers with the problem of autoimmune thyroiditis. Traditional medicine and homemade potions will not only not bring the desired effect for this disease, but will also cause wasted time. The cost of such experiments on one's own health may be too high.

The lack of prospect of a “cure forever” also makes the disease dangerous for the patient. Often doctors are faced with forgetfulness or a simple reluctance of the patient to take hormones daily. Many patients explain this by saying that “they already feel pretty good.”

However, disruption of the supply of thyroid hormones from the outside leads to severe endocrine imbalance and the development of complications. Remember the importance of taking your pills.

Do not be alarmed if you have been diagnosed with autoimmune thyroiditis: the consequences of the disease, of course, can be dangerous, but in general this pathology can be easily corrected with medications. Regular visits to the endocrinologist and the tablets prescribed by the doctor will allow you to lead a normal lifestyle and avoid complications of Hashimoto’s disease.