Thyroiditis (the full name autoimmune thyroiditis, AIT), sometimes called lymphomatous thyroiditis, is nothing more than inflammation of the thyroid gland, which results in the formation of lymphocytes and antibodies in the body, which begin to fight with the cells of the thyroid gland, as a result of which the gland cells begin to die.
The statistics of the domestic Ministry of Health found that autoimmune thyroiditis accounts for almost 30% of the total number of thyroid diseases. This disease is usually manifested in people aged 40–50 years, although in recent years the disease has become “younger” and is increasingly diagnosed in young people, and sometimes in children.
Autoimmune thyroiditis can be divided into several diseases, although they all have the same nature:
1. Chronic thyroiditis (aka – lymphomatoid thyroiditis previously worn title autoimmune thyroiditis Hashimoto or goiter Hashimoto ) develops due to a sharp increase in specific antibodies and form lymphocytes (T cells), which start to destroy the thyroid cells. As a result, the thyroid gland dramatically reduces the amount of hormones produced. This phenomenon has received the name of hypothyroidism from physicians . The disease has a pronounced genetic form, and the relatives of the patient very often suffer from diabetes and various forms of thyroid disease.
2. Postpartum thyroiditis is best studied due to the fact that this disease occurs more often than others. There is a disease due to overloading of the female body during pregnancy, as well as in the case of existing predisposition. It is this relationship that leads to the fact that postpartum thyroiditis turns into destructive autoimmune thyroiditis.
3. Painless (silent) thyroiditis is similar to postpartum, but the cause of its occurrence in patients has not yet been identified.
4. Cytokine-induced thyroiditis can occur in patients with hepatitis C or with blood disease in the case of treatment of these diseases with interferon.
According to clinical manifestations and depending on changes in the size of the thyroid gland, autoimmune thyroiditis is divided into the following forms:
- Latent – when clinical symptoms are absent, but immunological signs appear. In this form of the disease, the thyroid gland is either of normal size or slightly enlarged. Its functions are not impaired and there are no seals in the gland body;
- Hypertrophic – when the functions of the thyroid gland are disturbed, and its size increases, forming a goiter. If the increase in the size of the gland is uniform throughout the volume, then it is a diffuse form of the disease. If the formation of nodes in the body of the gland occurs, then the disease is called the nodular form. However, there are cases of simultaneous combination of both these forms;
- Atrophic – when the size of the thyroid gland is normal or even reduced, but the amount of hormones produced is sharply reduced. Such a picture of the disease is common for elderly people, and among young people only if they are exposed to radiation.
Even with a genetic predisposition for the occurrence and development of thyroiditis, additional factors are necessary that trigger the occurrence of the disease:
- acute respiratory viral diseases;
- foci of chronic diseases (in the sinuses, palatine tonsils, carious teeth);
- the negative impact of ecology, excessive consumption of iodine, fluorine and chlorine in water and food;
- lack of medical control over the administration of drugs, in particular iodine-containing and hormonal preparations;
- long exposure to the sun or radiation exposure;
- stressful situations.
In most cases, thyroiditis occurs very unnoticed, without any symptoms. Very rarely, the patient has slight fatigue, weakness, pain in the joints and discomfort in the area of the thyroid gland – a feeling of pressure, coma in the throat.
Postpartum thyroiditis is usually manifested by a violation of the production of thyroid hormones at about 14 weeks after delivery. Symptoms of such thyroiditis manifested through fatigue, severe weakness and weight loss. Sometimes a thyroid disorder ( thyroxycosis ) manifests itself as tachycardia, hot flashes , excessive sweating, trembling of the limbs, instability of mood, and even insomnia . A sharp malfunction of the gland usually occurs on the 19th week and may be accompanied by postpartum depression.
Silent (silent) thyroiditis is expressed by a slight dysfunction of the thyroid gland.
Cytokine-induced thyroiditis also almost does not affect the patient’s condition and is detected only with the help of tests.
Before the appearance of thyroid gland abnormalities detected by tests, it is almost impossible to diagnose the disease. Only conducted laboratory tests can establish the presence (or absence) of the disease. If other family members have any autoimmune disorders, then laboratory testing should be carried out, which in this case should include:
- complete blood count to detect an increased number of lymphocytes;
- an immunogram to determine the presence of antibodies to thyroglobulin (AT-TG), thyroperoxidase and thyroid thyroid hormones;
- determination of T3 and T4 (common and free), that is, determination of the level of TSH (thyroid-stimulating hormone) in blood serum;
- Thyroid ultrasound, which will help to identify an increase or decrease in the size of the thyroid gland and changes in its structure;
- fine needle biopsy, which will help identify an increase in lymphocytes and other cells characteristic of autoimmune thyroiditis.
If at least one of the indicators of the disease is absent in the results of the studies performed, then it is not possible to diagnose autoimmune thyroiditis due to the fact that the presence of AT-TPO ( hypoechoicity , that is, a suspected gland change during ultrasound examination) cannot serve as evidence of the manifestation of the disease, if other types of analyzes do not give grounds for such a conclusion.
So far, effective methods for the treatment of autoimmune thyroiditis have not been developed. In case of thyrotoxic phase of the disease (appearance of blood thyroid hormones) Appointment tirostatikov , that is, drugs that suppress the activity of the thyroid gland ( methimazole , carbimazole , propitsil ) is not recommended.
If a patient with an autoimmune thyroiditis has identified abnormalities in the work of the cardiovascular system, then beta-blockers are assigned.
When a thyroid dysfunction is detected, a thyroid drug is prescribed – levothyroxine (L-thyroxin) and the treatment is necessarily combined with regular monitoring of the clinical picture of the disease and determination of the content of thyroid-stimulating hormone in the blood serum.
Often in the autumn-winter period in a patient with autoimmune thyroiditis, subacute thyroiditis occurs, that is, thyroid inflammation. In such cases, glucocorticoids (prednisone) are prescribed. To combat the increasing amount of antibodies in the patient’s body, such non-steroidal anti-inflammatory drugs as voltaren, indomethacin, metindol are used.
In case of a sharp increase in the size of the thyroid gland, surgical treatment is recommended.
Normal health and performance in patients can sometimes persist for 15 years or more, despite short-term exacerbations of the disease.
Autoimmune thyroiditis and elevated levels of antibodies can be considered as a factor of increased risk of hypothyroidism in the future, that is, reducing the amount of hormones produced by the gland.
In the case of postpartum thyroiditis, the risk of its recurrence after a second pregnancy is 70%. However, about 25–30% of women subsequently have chronic autoimmune thyroiditis with a transition to persistent hypothyroidism.
In identifying autoimmune thyroiditis without pronounced impairment of thyroid function, the patient needs constant medical monitoring in order to timely diagnose and immediately begin treatment for manifestations of hypothyroidism.