Autoimmune thyroiditis: symptoms, treatment. Treatment of autoimmune thyroiditis

The thyroid gland is an organ of internal secretion, which is one of the most important regulators of the metabolic processes that occur in the human body. This body is very sensitive to internal and external influences. Violation of the thyroid gland affects the condition of the skin, cardiac activity, weight, 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 cells of the thyroid gland by the body's own immune system. More often, the disease develops in women and can be asymptomatic for a long time, therefore, it is most often detected during a planned ultrasound scan, determining the level of antibodies to gland peroxidase in the blood. Treatment of pathology is selected by the endocrinologist, taking into account the stage and nature of the course of the process. Autoimmune thyroiditis can be completely cured or controlled with the help of constant use of drugs, 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 behavior of immunity?

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 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 the blood vessels, constantly check each cell for danger to the body precisely by reading autoantigens and checking them against the “list” of allowed 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 the birth of a person, lymphocytes undergo special preparation, resulting in a list of antigens of their own cells, which should not be attacked by the production of antibodies. However, not all departments and organs of the human body normally have 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, the lens, the thyroid gland; also this kind of protection is formed around the child growing in the uterus.

When the barrier around the thyroid gland is destroyed (temporary or permanent), autoimmune thyroiditis develops. The culprits of this situation are genes that endow lymphocytes with increased aggressiveness. In most cases, as mentioned earlier, women get sick, because 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 detected 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 she who will be considered further. The disease occurs due to genetic causes. Its course is chronic, but benign. In order to maintain the quality of life at a normal level, you need to constantly take drugs as part of hormone replacement therapy.

Hashimoto's disease is also known as lymphomatous goiter, because the thyroid gland increases in size due to edema in response to a massive attack of tissues by lymphocytes. Quite often there is a combination of it with other diseases of an autoimmune origin, if not in a particular 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 mellitus.

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, during the entire pregnancy, the immune system is in a suppressed state 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 excessively.

Painless form of pathology - this disease has a development mechanism according to the principle of postpartum thyroiditis, but its causes have not yet been established.

Cytokine-induced form of autoimmune thyroiditis. It develops as a result of the bombardment of the thyroid gland with cytokine substances that are present in the body in significant quantities during the patient's treatment with interferon preparations - Viferon, injectable Laferon (usually some blood diseases and viral hepatitis C are treated in this way before it ends in cirrhosis).

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

Atrophic: the size of the thyroid gland is reduced, the amount of secreted hormones is reduced. In fact, this is hypothyroidism with 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 such predisposing factors as a kind of trigger for the disease:

psycho-emotional stress;

ionizing radiation;

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

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;

intake of iodine in large quantities;

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

Disease stages and symptoms

Hashimoto's thyroiditis is divided into several stages, which smoothly pass one into another.

Euthyroid stage

The disease begins with the fact that the cells of the immune system gain access to the cells of the thyroid gland, namely thyrocytes. These structures are alien 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 site of the “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 an enlarged gland:

the patient gets tired even when doing work that is smaller in volume than usual;

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

the thyroid gland becomes visually identifiable;

also gland is probed by palpation.

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 efficiency is maintained by attracting cells from the reserve. This is due to TSH (thyroid-stimulating hormone).

Thyrotoxicosis

When thyroid-stimulated antibodies are produced too much, the thyrotoxic phase of the disease begins. It is characterized by such signs:

violation of the menstrual cycle;

poor tolerance to hot climates;

decreased libido;

tendency to diarrhea;

tachycardia that is felt;

flushes of heat;

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 an increased appetite.

Hypothyroidism

In the case of elimination of large volumes of the working area of the thyroid gland by antibodies, the turn of the last stage of the disease comes - hypothyroidism. It is distinguished by such features:

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 shade, becomes edematous, dense, gradually turns yellow;

weight gain in the presence of poor appetite;

slow reaction and speech;

apathy, depression;

weakness.

In children, hypothyroidism is accompanied by weak weight gain, memory impairment, increased phlegm, if the pathology appeared at an early age, the mental development of such a child lags far behind what is necessary.

Postpartum thyroiditis

In this case, after childbirth at week 14, symptoms of a mild degree of hyperthyroidism occur:

weakness;

weight loss;

fatigue.

These symptoms can intensify up to the occurrence of trembling of the limbs, a rapid change in mood, insomnia, a feeling of a strong heartbeat, a feeling of heat. Approximately five weeks after the first symptoms (usually by the end of 4 months from the moment of delivery), symptoms of hypothyroidism appear, which are often attributed to postpartum depression.

Painless 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

Against the background of therapy with injectable forms of "Viferon" and "Alveron", signs of both reduced and increased thyroid function may appear. The symptoms are usually mild.

Fertility and autoimmune thyroiditis

At the subclinical, euthyroid and thyrotoxic stage, autoimmune thyroiditis is not a hindrance to successful conception. However, this cannot be said with a disease in the stage of hypothyroidism, since thyroid hormone significantly affects ovarian function. If this stage is associated with adequate treatment with synthetic hormones, pregnancy occurs. But at the same time, there is a possibility of miscarriage, since antibodies to the gland, the degree of production of which depends on the dose of L-thyroxine, adversely affect the tissues of the ovaries. However, the situation can be corrected with the help of progesterone replacement therapy, which helps to maintain the 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 thyroxin 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 an insufficient amount of thyroid hormones, the fetus may develop severe pathologies, which in some cases are incompatible with life. If the child survives, then it is born with a severe degree of hypothyroidism, which indicates severe mental retardation and metabolic disorders.

Diagnosis of pathology

In case of suspicion of the presence of autoimmune thyroiditis, the following diagnostics should be carried out. Blood sampling for the detection of hormones:

T4 - free and general;

T3 - free and general.

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

The diagnosis is established by the combination of the following data:

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

on ultrasound of the thyroid gland, hypoechoic tissue is determined;

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, one can speak of a 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, arrhythmias, and even cause myocardial infarction.

Hypothyroidism can be caused by:

depression

atherosclerosis;

dementia;

congenital hypothyroidism in a newborn;

habitual miscarriage;

infertility;

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

The great news is that this disease responds well to treatment, so if you constantly take the therapy adjusted to the AB-TPO dose and hormone level, you can not even feel the presence of pathology for a long time.

Diet in the presence of autoimmune thyroiditis

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

The amount of proteins 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 can be eaten:

butter;

dairy products;

pasta;

liver: beef, pork, cod;

fish fat;

baked red fish;

vegetable dishes.

Seasonings and alcohol, smoked and spicy dishes, fried and salty foods should be excluded from the 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 pathology is completely medical and depends on the stage at which autoimmune thyroiditis is located. 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 (control of 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 tactics of treating the thyrotoxic stage, the decision is left to the doctor. Usually, thyreostatics of the Mercazolil type are not prescribed. The 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 with the help of 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.

At the stage of hypothyroidism, "Eutiroks" or "L-thyroxine" (this is a synthetic form of T4) is prescribed, in case of a shortage of triiodothyronine, its analogues created in the laboratory are administered. For adults, the dose of thyroxin is 1.4-1.7 mcg / kg of body weight, for children - up to 4 mcg / kg.

For children, "Thyroxin" is prescribed only if TSH is increased and at a reduced or normal level of T4, when there is an increase in the gland by 30 or more percent of the normal level for age. Also, with an increase in the gland and the presence of a heterogeneous structure of its tissues against the background of the absence of AT-TPO, potassium iodide is prescribed with a daily dose of 200 μg.

When the diagnosis of autoimmune thyroiditis is made to a patient who lives in a region with a 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 level of TSH exceeds 4mU / l. In the presence of only AT-TPO and a low level of TSH (less than 2mU / l), "Thyroxin" is not used, however, the level of TSH is monitored in each trimester. In the presence of AT-TPO and the level of TSH 2-4mU / l, it is necessary to prescribe "L-thyroxine" in prophylactic doses.

When nodular thyroiditis is present and there is no way to exclude oncology, or the thyroid gland compresses the organs of the neck, causing difficulty in breathing, surgery is performed.

Forecast

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

If thyroiditis develops in a woman 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 gene with a defect. However, it is worthwhile to control the function of your own thyroid gland as planned (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 the planned examination for TSH, AT-TPO, T4, and when pregnancy occurs. These tests are not mandatory for the study, therefore, in order to pass them, you must 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. These are the main symptoms.

Reasons for development

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

Aggression of the body, directed at the thyroid gland, leads to the fact that its tissues are impregnated 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 hereditary predisposition. In addition, the launch of such a negative process requires the presence of several predisposing factors at once. They most often include:

psycho-emotional stress, stress;
decreased immunity against the background of frequent viral and colds, as well as uncontrolled use of antiviral drugs;
frequent intake and use of iodine-containing drugs above the norm;
hormone replacement therapy;
surgical intervention in the work of the thyroid gland or its injury;
hormonal disruptions (pregnancy, before and after menopause), etc.

Effect on the body

The main danger during this disease is its asymptomaticity in the early stages. The condition caused by thyroiditis may well be confused with ordinary fatigue. A characteristic phenomenon is memory impairment, depression, weakness and drowsiness, hair loss, and so on. This lack of expression often affects the time of recognition of the disease, which goes through a series 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 soreness in the thyroid gland, irritability and a recurring feeling of "lump in the throat", increased sweating, sore throat, rapid heartbeat, and menstrual irregularities in women.

This stage lasts from 1 to 6 months.

Euthyroidism

After stabilization of the hormonal level and thyroid function, the disease passes into the stage of calm (euthyroidism). Despite the absence of any symptoms, thyroiditis did not recede. 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 in size may well remain the same as it was. And it can change in any direction (increase, decrease). Only a doctor can notice this condition during 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 tissues of this organ. Functionality is reduced, and this is evidence of the onset of a hormonal failure, since the production of thyroid hormones has dropped significantly. A decrease in thyroxine and triiodothyronine, which are very important hormones for the body's metabolism, 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, increased overweight due to metabolic disorders, hair loss, menstrual irregularities, shortness of breath, bradycardia, increased cholesterol levels.

Diagnostics

Diagnosis of autoimmune thyroiditis is extremely difficult. It is possible to identify the disease only by the most obvious factors (changes in the structure of thyroid tissues, an increased level of antibodies, an increase and decrease in the level of certain hormones in the blood). Timely detection can greatly facilitate the life of the patient.

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 a stable hormonal background at the same level for a longer time.

Consequences

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

A cure in this case is impossible, since the hormonal background 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 lack 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 a depressive state, a general decrease in intelligence and memory, dementia;
from the side of the cardiovascular system: ischemic disease, hypertension, hydropericardium;
from the gastrointestinal tract: pancreatitis, kidney stones, general digestive disorders (constipation, etc.);
from the system of genital organs 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 occur in the thyroid gland against the background of an autoimmune disease.

Understanding the danger of the disease itself should lead to patients telling their doctor about any problems, especially on the hormonal background, in time. Timely diagnosis of many diseases can prevent a number of negative consequences for a person. 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, a gradual and prolonged 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.

The fair sex suffers from them several times more often. Autoimmune thyroiditis of the thyroid gland can affect a person at any age, but most often people from the age group of 50-70 years suffer from it.

Causes

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

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

Classification

In medicine, several classifications are used:

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

Classification by cause:

chronic autoimmune thyroiditis. Pathology progresses due to the penetration of T-lymphocytes into the parenchyma of the thyroid gland. Its destruction comes - the structures are affected and the main functions are violated, which leads to the progression of the primary. This condition is dangerous, since the thyroid gland ceases to produce a normal amount of hormones, which is fraught with 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 the increased activation of the immune system after its long-term suppression during childbearing;
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 proceed both for several years and for a lifetime;
subclinical phase. If the disease begins to progress, then the aggression of T-lymphocytes increases, which “attack” and completely destroy the cells of the gland and reduce the level of thyroid hormones. But at the same time, an increase in the production of TSH is observed;
thyrotoxic phase. 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 pronounced hypothyroidism begins;
hypothyroid phase. Its duration is one year, after which the lost functions of the gland are restored. Sometimes there is persistent hypothyroidism.

Classification depending on clinical manifestations:

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

Symptoms

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

Symptoms:

weakness;
the gland thickens and increases in size;
when pressing with fingers on the thyroid gland, the presence of nodes can be noted;
pain in the joints;
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 of the thyroid gland;
sweating;
trembling of the fingers;
memory impairment;
attention disorder;
constant mood swings.

Symptoms of postpartum thyroiditis:

weight loss;
hormone production is impaired;
increased fatigue;

It is worth noting that often the disease proceeds absolutely without symptoms, the main symptomatology is 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 observe a state of euthyroidism (no symptoms). Usually the diagnosis is established during the examination of the patient about the goiter. The gland is evenly enlarged, 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, the results of laboratory and instrumental examinations. It will be possible to start treating the disease only after an accurate diagnosis. It should be noted that it is very difficult to confirm the presence of AIT before clinical manifestations.

The main diagnostic program includes:

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

Treatment

Latent forms of AIT, as a rule, are not treated medically or surgically. 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 carry any lethal consequences for the human body.

Treatment of autoimmune thyroiditis should begin only after an accurate diagnosis. The plan is written by the attending physician, based on the characteristics of the course 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, then 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.

An isolated autoimmune form is treated with preparations based on white cinquefoil - Alba, Zobofit and others. Surgical treatment is resorted to if the thyroid gland has enlarged to such an extent that the patient cannot swallow or breathe normally.

Complications

The consequences of pathology are not lethal. As a rule, in adults the following conditions are observed:

decline in intelligence.

Children may develop the following consequences of AIT:

underdevelopment of the genital organs;
cretinism;
dwarf growth.

Diet

Treatment of autoimmune thyroiditis also includes the appointment of a special diet. It is very important that the caloric content of the diet should not be reduced in any way. If the diet restricts calorie intake, then the patient's condition can only worsen.

The diet prescribes 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 calls for a drastic reduction in saturated fats. The patient's diet should contain carbohydrates in sufficient quantities. Therefore, the patient should eat pasta, cereals, 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 need to be adhered to throughout life so as not to aggravate the course of autoimmune thyroiditis.

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Diseases with similar symptoms:

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

Autoimmune thyroiditis (abbreviated as AIT) has another name - Hashimoto's thyroiditis (the disease was first described by the Japanese scientist Hashimoto). It is one of the most common thyroid disorders, 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, which subsequently leads 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 is manifested, that is, the thyroid tissue is recognized as a foreign and dangerous object to be destroyed. Such a reaction pulls protective cells directly into the focus, which leads to the production of autoantibodies.

The process is in 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 a change in the tissue of the endocrine organ, which in many cases entails the formation of nodes and cysts.

Areas where lymphocytes accumulate are prone to overgrowth (hyperplasia). Such violations lead to a visual increase in 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:

hereditary factor. It has been noticed that if one of the close relatives in the family (for example, mother or grandmother) has experienced thyroid disease, then there is a high risk for a certain individual to also know hormonal pathology. Scientists have even proven this phenomenon by finding a transmission gene that causes the development of thyroiditis.
Stressful situations, neuropsychic overstrain. This factor provokes the thyroid gland to secrete an excessive amount of thyroid hormone into the blood. Subsequently, this leads to increased growth of the endocrine organ, and also causes a violation of its function.
Environmental degradation, reduced food quality, 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.
The focus of infection, which is located "next door" to the gland. These include diseases such as chronic rhinitis, adenoiditis, tonsillitis, frequent pharyngitis and acute tonsillitis. 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.
Incorrectly selected immunostimulant therapy. This can impair humoral and cellular immune responses, leading to a number of abnormalities such as overstimulation and T-lymphocyte cloning.
Violation of the general hormonal background- "excellent" impetus to the development of the disease. The “starting” factor is pregnancy, menopause, teenage transition, strict diets (starvation).

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

The initial stage of the disease: the actions of the patient and the development of the disease

During the initial development of the pathological process, the general condition is not disturbed, so patients are often unaware of the change in hormonal levels. To determine the "origin" of the disease is possible only by passing laboratory tests.

To differentiate AIT with a number of diseases, the examination begins with the delivery of a general blood test. With an increase in lymphocytes, ESR and monocytes, 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 turn to a specialist before the appearance of clinical signs. In most cases, treatment occurs at the very "height" of the disease.

At the beginning of the development of pathology, the patient feels causeless weakness, malaise, drowsiness. At the end of the working day (especially if the work is associated with physical stress), one feels powerless and tired.

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

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

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

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

Analyzes and research: what does the specialist offer?

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

If you experience symptoms that resemble autoimmune thyroid diseases, you should contact an endocrinologist. At the appointment, the doctor collects an anamnesis (studies the patient's medical history, analyzes the nature of complaints), and also examines the thyroid gland by palpation.

To make an accurate conclusion, it is necessary to undergo the following examinations:

Study of TSH, T3, T4 hormones. An increase in T3 and T4 with reduced TSH is observed in the case of thyrotoxicosis. If T3 and T4 levels are reduced, and TSH is above normal, then this is a clinical sign of hypothyroidism. With normal levels of "thyroid" hormones, euthyroidism is diagnosed.
Determination of the level of antithyroid autoantibodies to thyroperoxidase (AT-TPO) and to (AT-TG). With autoimmune thyroiditis, the indicators will be higher than normal.
Ultrasound examination of the thyroid gland. AIT is characterized by a diffuse decrease in tissue echogenicity, 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 results of the study listed below are positive:

ultrasound signs show the presence of a pathological process;
the 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 called into question, but not excluded.

Fine needle biopsy (FNAB) is another way to confirm 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. To perform the manipulation does not require special training.

The procedure is performed without general anesthesia, as the anesthetic may be 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 an anesthetic ointment or injects a special subcutaneous injection.

Manipulation is carried out using a thin needle, in some cases it is necessary to make several punctures in order 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 on a glass slide, which is then sent to the laboratory. The procedure lasts approximately ten to fifteen minutes. Manipulation has low invasiveness and is relatively painless. Patients often tolerate it well, so they are immediately sent home.

TAPB is characterized by high information content, therefore, according to the results of the study, one can be almost 100% sure of the final diagnosis. The price of the procedure is on average 1700-9000 rubles.

Treatment of autoimmune thyroiditis - what does modern medicine offer?

To date, medicine has not yet developed drugs that would effectively and safely correct autoimmune pathology. The applied treatment only slows down the development of hypothyroidism, but does not exclude its progression in the future.

Autoimmune thyroiditis almost never causes hyperfunction of the thyroid gland, so drugs to reduce hormone levels (thyrostatics) such as Thiamazole, Cardimazole are not prescribed. If hypothyroidism is detected, replacement therapy with synthetic hormonal drugs, 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). A decrease in the titer of autoantibodies is carried out with the help of non-steroidal anti-inflammatory drugs; 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 violation of the function of the heart, beta-blockers are prescribed, and in the event 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:

Many people mistakenly believe that iodine-containing drugs are necessary for thyroid dysfunction. In fact, these medicines can both help and harm, so in this case it is important not to self-medicate, even if we are talking about “useful” vitamins or mineral complexes. For example, iodine in autoimmune thyroiditis increases the amount of antibodies that destroy thyroid cells. Only a doctor, based on the result of T3 and T4 tests, has the right to prescribe iodine-containing drugs for the main treatment.
In cases of selenium deficiency, the conversion of T3 and T4 is disrupted, which leads to the development of hypothyroidism. In other words, this microelement synthesizes a hormone that creates energy in cells. When a violation occurs, the thyroid gland improves its work by increasing its surface area (it grows, nodes or cysts appear on it). But the trace element is still not enough! 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.
Many patients are interested in whether it is possible to carry out vaccination (for example, against influenza) in case of impaired thyroid function? Endocrinologists note that autoimmune thyroiditis and vaccinations are not compatible concepts. The fact is that AIT is a severe immune disorder, so vaccination can only aggravate hormonal imbalance.

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

Complications of hormonal imbalance

The prognosis for autoimmune thyroiditis is satisfactory. In patients who started treatment in a timely manner, there is an improvement in well-being due to a decrease in thyroid function.

With the help of medications, in many cases it is possible to achieve a long-term remission. Thus, in the first 10-15 years there is a normal working capacity, good health, despite short periods of exacerbation.

The negative consequences of autoimmune thyroiditis occur in those patients who, for whatever 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. Thyroid antibodies directly increase the risk of miscarriage. In addition, the likelihood of attachment of the embryo to the uterine membrane is reduced. Before planning a pregnancy, a woman suffering from AIT is advised to stabilize her hormonal levels. This contributes to the successful bearing of the fetus 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 means that helped the neighbor, even if the symptoms are highly similar, and the instructions for the drug “promises” to improve the general condition soon. It is important at the first signs of pathology to seek medical help in a timely manner, listen to the doctor's advice and fully follow the recommendations.

Among all diseases of the thyroid gland, autoimmune thyroiditis raises many questions in patients. Often this pathology is called a time bomb for a long and asymptomatic course: most patients go to the doctor already with severe hormonal disorders that are difficult to correct.

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

Autoimmune thyroiditis is a chronic inflammatory disease of the thyroid gland. The reasons for it are not fully understood, but, apparently, are associated with hereditary genetic mutations.

This is interesting. For the first time, a strange disease, accompanied by destruction of the thyroid gland and gross hormonal disorders, 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 damage and death. Thus, the organ can be completely destroyed.

Consequences of the disease: what patients need to know

Why is autoimmune thyroiditis dangerous? There are several factors that make the disease dangerous for the patient and "problematic" for the doctor. But forewarned is forearmed. Consider the main features of 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. At the same time, 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 a provoking factor in the development of an autoimmune disease.

There are several reasons that "start" the process of antibody formation and cause destruction of thyroid cells:

frequent SARS;
foci of chronic infection in the body (untreated caries, adenoiditis, sinusitis, etc.);
unfavorable ecological situation;
increased content of iodine, chlorine and fluorine in the environment;
excessive action of ultraviolet radiation (passion for tanning, including in a solarium);
long-term use of iodine and vitamins containing this trace element in large quantities;
treatment with hormonal drugs (glucocorticosteroids, estrogen-containing drugs);
diseases of the immune system, a tendency to allergic reactions;
hormonal fluctuations in the body (puberty, pregnancy and childbirth, menopause);
operations, trauma of the thyroid gland;
stress.

According to the mechanism of development, 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	Painless thyroiditis	Cytokine-induced thyroiditis
Reason for development	Exceptionally genetic anomaly	The appearance of the first symptoms of the disease is caused by pregnancy and childbirth.	Genetic predisposition + one or more of the 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.
The nature of the flow	The classic variant of the course 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 severe destruction of thyroid tissue. Quickly leads to decompensation and severe hormonal disorders	Prolonged asymptomatic course	It provokes massive destruction of thyroid tissue and destructive thyrotoxicosis (a sharp increase in the concentration of thyroid hormones in the blood). Then this condition is replaced by insufficiency of the endocrine organ and severe hypothyroidism.

Note! The appearance of the first signs of autoimmune thyroiditis during pregnancy requires strict medical supervision. Endocrine failure is dangerous not only for the expectant mother, but also for the fetus, since its growth, physical development and proper laying 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 a sudden onset: the disease often develops against the background of complete health and goes unnoticed by both medical workers and patients for a long time.

Serious hormonal disorders in the body

Signs of hypothyroidism - a classic manifestation of autoimmune thyroiditis

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

weakness, apathy;
decrease in working capacity;
constant drowsiness;
an increase in body weight;
chilliness, poor cold tolerance;
swelling of the face, feet and hands;
slowness, violation of the processes of memorization and concentration of attention;
cardiac arrhythmias, 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 a pronounced lag in the physical and mental development of the baby (up to cretinism), dwarfism, and pathologies in the development of the genital organs.

Often patients do not pay attention to the changes taking place 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 make it possible to suspect an extremely low level of thyroid hormones in a patient:

decrease in body temperature to 35-35.5 ° C;
disorders of the heart and blood vessels - heart rate less than 60 beats / min., the pulse is poorly palpable, filiform, blood pressure is sharply reduced;
violation of the respiratory system - a decrease in the number of respiratory movements, periods of apnea - a temporary stoppage of breathing;
dysfunction of the nervous system - a violation of consciousness, the patient does not respond to the speech addressed to him, attempts to bring to life;
dermatological disorders - pallor and dryness of the skin, which acquires a waxy hue, pronounced dense edema;
problems from the digestive organs - an increase in the size of the liver, intestinal paresis.

Early diagnosis and complex 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 serious condition that is difficult to correct. Prevention of hypothyroid coma is one of the main tasks of modern healthcare.

Note! If the patient was admitted to the clinic with a hypothyroid coma, after the restoration of vital functions and the correction of metabolic disorders, the medical instruction prescribes 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 the level of 37.0-37.5 ° C;
trembling all over body, trembling of fingertips, tongue, chin;
feeling of sand in the eyes.

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

Lack of pathogenetic treatment of the disease

Unfortunately, there is currently no drug that interferes with complex immune processes and suppresses the destruction of healthy thyroid tissue. Doctors can correct emerging hormonal disorders by prescribing life-long intake of drugs that are analogues of the thyroid hormone thyroxin (L-Thyroxin, Euthyrox).

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

Note! You should not contact healers with the problem of autoimmune thyroiditis. Do-it-yourself traditional medicines and potions, with this disease, will not only not bring the desired effect, but will also be the cause of wasted time. The price of such experiments on one's own health may be too high.

The absence of the prospect of a “permanent cure” also makes the disease dangerous for the patient. Often, doctors are faced with forgetfulness or the patient's banal unwillingness to take hormones daily. Many patients explain this by the fact that "and so feel good."

However, a violation of the supply of thyroid hormones from the outside leads to a pronounced endocrine imbalance and the development of complications. Remember the importance of taking pills.

Do not be afraid if you have been diagnosed with autoimmune thyroiditis: the consequences of the disease, of course, can be dangerous, but in general, this pathology lends itself well to correction with medications. Regular visits to the endocrinologist and taking the pills prescribed by the doctor will allow you to lead a normal life and avoid the complications of Hashimoto's disease.