Thyroid

Thyroid Autoimmune Thyroiditis

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Autoimmune thyroiditis is one of the most common diseases in Russia, especially in areas remote from the sea. But not every person realizes that his thyroid gland does not work in full force: it can be detected only by passing a special laboratory analysis. And therapists give the direction to this analysis is not so often, not seeing the need for it. The fact is that the symptomatic picture of the disease is so vague that even an experienced doctor will first of all assume the presence of other non-endocrine pathologies.

AIT - what is it?

When our immune system begins to attack the cells of our own body, this process is called autoimmune. A virus enters the body and penetrates into the cell and remains there, but our immunity antibodies do not have to “get” the virus out of the cell to destroy it, in the arsenal of their capabilities only the destruction of the cell along with the “enemy”.

Viruses in the thyroid gland get very often. The organ, located on the front surface of the neck, serves as a specific filter for the air we breathe, so all pathogens fall into the thyroid tissue. Of course, not every person will immediately become ill with thyroiditis, for this hereditary predisposition is needed, but considering how many people already suffer from this pathology, you can be sure that almost everyone has a relative with this autoimmune disease.

When immunity cells attack an organ as a target, they damage it, after which it cicatrizes - gradually becomes covered by replacement tissue, as does the disease called autoimmune thyroiditis. The worst thing that can be expected is that the organ will heal completely and stop producing hormones. Fortunately, all these hormones are already in the synthetic version in the form of tablets, which will need to be taken as part of replacement therapy.

When a person hears the name of the diagnosis, which sounds impressive, it seems to him that the disease is very dangerous. And he begins to look for information on the topic "Autoimmune thyroiditis." The worst thing to expect - the symptoms of the disease, as some people think, because they, at first glance, really make you tense up. But it is important to remember that for most people, making a diagnosis is a complete surprise, that is, they did not even suspect that they were sick. Therefore, the symptoms of AIT, of course, are, and their list is wide, but to live a full life with them is quite realistic.

And therein lies the main problem of such pathology as autoimmune thyroiditis. The worst thing to expect signs of illness can be infinite, and they will not appear until the function of the thyroid gland completely disappears.

It does not make sense to list all the symptoms, because the thyroid gland produces gomons, which are absolutely involved in all body systems. When an organ is damaged, the amount of hormone in the blood becomes smaller and all organs suffer. But clearly only those systems that were initially problematic signal this.

If a person has a weak nervous system, AIT will reward him with asthenia, irritability and drowsiness, a person with a weak digestive system will suffer from constipation and diarrhea, and so on.

Therefore, when it comes to the diagnosis of autoimmune thyroiditis, the most terrible thing to expect is that the clinical manifestations will not give an opportunity to quickly make a diagnosis by referring to the right doctor. In most cases, the person will rationalize all the symptoms, explaining them by their temperament or external factors.

Diagnostics

When a person gets an appointment with an endocrinologist, the question of diagnosis is only in two laboratory blood tests:

  1. First, it is the blood for the content of thyroid hormone in the blood (T4) and the pituitary hormone (TSH), which interacts with the thyroid gland, and the production of these hormones is always interrelated: if the TSH decreases, T4 rises and vice versa.
  2. Secondly, it is the analysis for the presence of antibodies to the cells of the thyroid tissue.

If tests detect both the presence of antibodies and an increase in the level of TSH, a diagnosis of autoimmune thyroiditis is made. The most terrible thing to expect is that the diagnosis has led to a definitive diagnosis, and now it is necessary to be treated for life if, of course, science does not invent other methods to replace replacement therapy.

When the thyroid gland does not produce enough hormone, the only cure is to give it as a pill. For this, there are drugs on the pharmaceutical market:

The drugs are available in different dosages: 25, 50, 75, 100, 150 mcg. The doctor prescribes treatment with the smallest dosage, gradually increasing and determining the dose that a person will drink constantly throughout his life. Therefore, in the diagnosis of autoimmune thyroiditis, the worst thing to expect is the need to take the drug on an empty stomach every morning, regardless of the circumstances. But in fact, patients quickly get used to it.

Dosage adjustment

Of course, a certain dosage once will not last forever, as the organ (thyroid gland) continues to collapse under the influence of antibodies and will produce less and less natural hormone. In addition, factors such as weight and even climate change can affect fluctuations in hormone levels.

Therefore, at least once every six months, it is necessary to take an analysis determining the amount of TSH and T4 in order to understand whether it is necessary to increase the dosage of the drug or reduce it. In any case, the dose change should not exceed 25 mcg for 14 days. With the right treatment, a person will not experience any unpleasant symptoms of a disease such as autoimmune thyroiditis. The worst thing to expect: treatment will require regular blood donation, which means visits to the clinic and patience in the queues at the treatment room.

Prevention

If someone from close relatives suffers from AIT disease, it is likely that they will get sick too, especially pathology is transmitted from mother to daughter. It is impossible to completely eliminate the risk of the disease, but to delay as much as possible the time of the onset of the development of pathology is real. To do this, you need to take iodine preparations, for example, "Iodomarin", according to the instructions. Endocrinologists claim that taking iodine and regular rest on the seashore can increase the level of thyroid defense against antibodies and adjust immune function.

In addition, it is important to avoid factors that can become provocateurs for the development of the disease:

  • work or living in an environmentally unfriendly region is contraindicated, for example, a person who has a high risk of getting sick with AIT, you should not get a job at a gas station,
  • It is important to avoid stress, not only emotional, but also physical, such as climate change,
  • It is important to protect yourself from colds that make the immune system aggressive, and especially to monitor the absence of foci of chronic infection in the nasopharynx.

Such simple ways you can save yourself from the risk of getting such a pathology, such as autoimmune thyroiditis. The worst thing to expect: prevention can seem frivolous to a person, because it includes a list of simple recommendations for a healthy lifestyle. And in this case, the person, not following the recommendations, is likely to face the disease.

Weight gain

According to the majority of patients who were diagnosed with autoimmune thyroiditis, the worst thing to expect is manifestation in the form of weight gain, which will be uncontrollable and rapid, because the doctor suggests drinking hormones!

In fact, the metabolism of thyroid hormone insufficiency really slows down, and a person can gain weight. But drugs replacement therapy normalize the level of the hormone, so when properly selected dosage metabolism in a person with AIT is the same as in any other person. In order to protect yourself from weight gain, simply “spur” the metabolism, eating often in small portions.

There is a share of the probability of gaining excess weight not due to fat mass, but due to the accumulation of lymph. Therefore, endocrinologists advise their patients to monitor the amount of fluid consumed. You need to drink 1.2-2 liters of fluid a day, and the habit of drinking tea is not from thirst, but boredom will have to be abandoned. And this is with the diagnosis of autoimmune thyroiditis, the most terrible thing to expect from the scope of prohibitions, because otherwise the life of a person with AIT is no different from the life of a healthy person.

AIT and pregnancy

Today, more and more often, AIT is diagnosed with very young girls, although earlier, according to statistics, the disease was detected at the age of 40-45 years. But absolutely all diseases, not only endocrine pathologies, become “younger”.

Often, young girls think that with the diagnosis of autoimmune thyroiditis, the worst thing to expect is infertility. But this idea is fundamentally wrong, because with compensated AIT-euthyroidism, a woman is quite fertile and can have children. However, before that, she will have to visit the family planning office, report her illness so that the doctor can advise her on how to change the dosage of the replacement therapy drug from the first weeks of pregnancy.

AIT and life expectancy

Most people think that when they get absolutely any diagnosis, including “autoimmune thyroiditis,” the worst thing to expect is a reduction in life. In fact, thyroid hormone in many countries is recommended to take after a certain age, even without a diagnosed AIT for prolonging life and preserving youth.

Causes

Regardless of the traditionally assumed main reason - hereditary predisposition, thyroiditis requires the emergence of special conditions and additional reasons for development.

  1. Uncontrolled medication, especially hormonal or containing iodine in the active composition,
  2. The presence of foci of chronic diseases of various types in the acute form (carious teeth, inflammation in the tonsils or sinuses),
  3. Harmful environment, the negative impact of ecology, an overabundance in water and food chlorine, iodine, second air, they are supersaturated
  4. Hormonal instability - a violation of the hormonal background of the body due to other diseases, due to injuries, pregnancy, after taking the drugs and in other cases,
  5. The presence of radiation exposure during radiation therapy, or when working with radioactive substances, is also active solar irradiation,
  6. Injuries, stressful situations, chemical and thermal burns, in general and directly in the area of ​​the thyroid gland, may equally adversely affect surgery.

The development of the disease occurs gradually, some factors in combination may become the basis for its acceleration or recurrence of the active forms.

Classification

What are autoimmune thyroiditis in terms of type classification? The following types of illness are distinguished:

  1. Postpartum thyroiditis, which becomes a consequence of excessively increased activity of the immune system after depression during pregnancy.
  2. Chronic thyroiditis of autoimmune origin, in which primary hypothyroidism develops (deficiency of thyroid hormones).
  3. Cytokine-induced variant of the disease that develops with long-term treatment with interferons.
  4. Silent (silent) thyroiditis of the thyroid gland, similar to postpartum, but not caused by pregnancy.

According to the nature of the flow, 3 main forms of autoimmune thyroiditis are distinguished. It:

The development of all types of autoimmune thyroiditis passes through 4 phases:

  • euthyroidism - with preservation of the function of the gland,
  • subclinical phase - with partial disruption of the synthesis of hormones,
  • thyrotoxicosis - a characteristic feature of which is a high level of the hormone T4,
  • hypothyroid phase - when, with further damage to the gland, the number of its cells decreases below the critical threshold.

Symptoms of autoimmune thyroiditis

Manifestations of various forms of the disease have some characteristic features.

Since the pathological significance of chronic autoimmune thyroiditis for an organism is practically limited to hypothyroidism developing at the final stage, neither the euthyroid phase nor the phase of subclinical hypothyroidism have clinical manifestations.

The clinical picture of chronic thyroiditis is formed, in fact, by the following polysystem manifestations of hypothyroidism (suppression of the functions of the thyroid gland):

  • intolerance of usual physical activities,
  • slowing reactions to external stimuli,
  • depressive states
  • apathy, drowsiness,
  • feeling unmotivated fatigue
  • loss of memory and concentration
  • “Myxedematous” appearance (puffiness of the face, puffiness of the area around the eyes, paleness of the skin with jaundice tint, weakening of the facial expression),
  • pulse rate reduction
  • decreased appetite
  • addiction to constipation
  • dullness and fragility of hair, their enhanced loss,
  • decreased libido
  • dry skin,
  • the tendency to increase body weight
  • chilliness of the limbs
  • menstrual dysfunction in women (from intermenstrual uterine bleeding to complete amenorrhea).

A unifying feature for postpartum, mute, and cytokine-induced thyroiditis is a sequential change in the stages of the inflammatory process.

Symptoms characteristic of the thyrotoxic phase:

  • weight loss,
  • intolerance of stuffy rooms,
  • tremor of the limbs, trembling of the fingers,
  • concentration disorder, memory impairment,
  • emotional lability (tearfulness, mood swings),
  • tachycardia, increased blood pressure (blood pressure),
  • feeling hot, flushing, sweating,
  • decreased libido
  • fatigue, general weakness, alternating with episodes of increased activity,
  • menstrual dysfunction in women (from intermenstrual uterine bleeding to complete amenorrhea).

Manifestations of the hypothyroid phase are similar to the manifestations of chronic autoimmune thyroiditis.

A characteristic sign of postpartum thyroiditis is the debut of thyrotoxicosis symptoms by the 14th week, the appearance of signs of hypothyroidism by the 19th or 20th week after delivery.

Painless and cytokine-induced thyroiditis do not show, as a rule, a vigorous clinical picture, manifesting symptoms of moderate severity, or are asymptomatic and are detected during a routine study of the level of thyroid hormones.

How to treat autoimmune thyroiditis?

So far, in autoimmune thyroiditis, effective treatment methods have not been developed. In the case of the thyrotoxic phase of the disease (the appearance of thyroid hormones in the blood), the administration of thyrostatics, that is, drugs that suppress the activity of the thyroid gland (tiamazole, carbimazole, propitsil), is not recommended.

  • If a patient has an abnormality in the work of the cardiovascular system, then beta-blockers are assigned. When a thyroid dysfunction is detected, a thyroid preparation, levothyroxine (L-thyroxin), is prescribed 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, the patient with AIT has the occurrence of subacute thyroiditis, that is, inflammation of the thyroid gland. In such cases, glucocorticoids (prednisone) are prescribed. To combat the increasing amount of antibodies in the patient's body, nonsteroidal anti-inflammatory drugs such as voltaren, indomethacin, metindol are used.

In case of a sharp increase in the size of the thyroid gland, surgical treatment is recommended.

Autoimmune thyroiditis in most cases has a favorable prognosis. When diagnosing persistent hypothyroidism, lifelong therapy with levothyroxine is necessary. Autoimmune thyrotoxicosis tends to slow, in some cases, patients may be in satisfactory condition for about 18 years, despite minor remissions.

Observation of the dynamics of the disease should be carried out at least once in 6-12 months.

When identifying nodes during an ultrasound examination of the thyroid gland, an immediate consultation with an endocrinologist is necessary. If nodes with a diameter of more than 1 cm were detected and under dynamic observation, comparing previous ultrasound results, their growth is noted, it is necessary to perform a puncture biopsy of the thyroid gland to rule out a malignant process. Thyroid monitoring using ultrasound should be carried out once in 6 months. When the diameter of the nodes is less than 1 cm, control ultrasound should be performed once every 6-12 months.

При попытках воздействия на аутоиммунные процессы (в частности на гуморальный иммунитет) в щитовидной железе на протяжении длительного периода времени при данной патологии назначались глюкокортикостероиды в достаточно высоких дозах. На данный момент четко доказана неэффективность такого рода терапии при аутоиммунном тиреоидите. Appointment of glucocorticosteroids (prednisone) is advisable only in the case of a combination of subacute thyroiditis and autoimmune thyroiditis, usually occurring in the autumn-winter period.

In clinical practice, there were cases when patients with autoimmune thyroiditis with signs of hypothyroidism during pregnancy had spontaneous remission. There were also cases when patients with autoimmune thyroiditis, in whom the euthyroid state was manifested before and at the time of pregnancy, were aggravated by hypothyroidism after giving birth.

Symptoms of the disease

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

  • weakness,
  • iron compacted and increased in size,
  • when pressing fingers on the thyroid gland, it is possible to note the presence of nodes,
  • joint pain,
  • breathing is difficult, and also difficult to fully swallow food,
  • the patient constantly feels the presence of a lump in his throat,
  • pain in the area of ​​the thyroid gland,
  • sweating
  • trembling fingers,
  • memory impairment
  • attention disorder,
  • constant mood swings.

Symptoms of postpartum thyroiditis:

  • weight loss,
  • hormone production is impaired,
  • increased fatigue
  • heat,
  • tachycardia.

It is worth noting that the illness often occurs with absolutely no symptoms, the main symptoms are directly related to the presence of other pathologies in the body, primarily hypothyroidism:

  • constipation
  • obesity,
  • menstrual disorders,
  • muscle pain.

Autoimmune thyroiditis in children progresses slowly. For a long time, they can observe the state of euthyroidism (no symptoms). Usually, the diagnosis is established during the examination of the patient for goiter. The gland is enlarged evenly, soft when palpating. It is worth noting the fact that atrophic form is not characteristic of autoimmune thyroiditis in children.

Disease treatment

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

Treatment of autoimmune thyroiditis should be initiated only after an accurate diagnosis. His plan is described by the attending physician, based on the characteristics of the pathology of the patient, as well as on the basis of the general condition of his body.

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

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

Complications

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

  • radiculitis,
  • bradycardia,
  • heart failure,
  • reduced intelligence.

Bradycardia

Children may develop the following effects of AIT:

Treatment of autoimmune thyroiditis also includes the appointment of a special diet. It is very important that the calorie intake should in no way be reduced. If the diet will limit calorie intake, the patient’s condition can only worsen.

Diet prescribes the optimal balance of carbohydrates, fats and proteins. Eating is necessary every three hours. In the diet, the patient should include more foods that contain in their composition unsaturated fatty acids. The diet provides a sharp limit on saturated fat. Sufficient carbohydrates should be present in the patient’s diet. Therefore, the patient should eat pasta, cereal, bread.

Diet excludes consumption:

  • spicy dishes,
  • alcohol,
  • pickles and marinades,
  • fried and smoked products.

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

If you think you have Autoimmune thyroiditis and symptoms characteristic of this disease, the endocrinologist can help you.

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What it is?

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

Causes of AIT

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

  • regular stressful situations
  • emotional stress
  • excess iodine in the body
  • unfavorable heredity
  • the presence of endocrine diseases,
  • uncontrolled antivirals,
  • negative influence of the external environment (it can be a bad environment and many other similar factors),
  • malnutrition, etc.

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

Stages of development

If the disease was not detected in a timely manner, or for any reason it was not treated, this may be the reason for its progression. Stage AIT depends on how long it has evolved. Hashimoto disease is divided into 4 stages.

  1. Eutheroid phase. For each patient, it has its own duration. Sometimes it may take several months to move the disease to the second stage of development, but in other cases it may take several years between phases. During this period, the patient does not notice any special changes in his state of health, and does not consult a doctor. Secretory function is not impaired.
  2. In the second, subclinical, stage, T-lymphocytes begin to actively attack the follicular cells, leading to their destruction. As a result, the body begins to produce a significantly smaller amount of the hormone St. T4. Eutheriosis persists due to a sharp increase in the level of TSH.
  3. The third phase is thyrotoxic. It is characterized by a strong jump in the hormones T3 and T4, which is explained by their release from the destroyed follicular cells. Their entry into the blood becomes a powerful stress for the body, as a result of which the immune system begins to rapidly produce antibodies. When the level of functioning cells falls, hypothyroidism develops.
  4. The fourth stage is hypothyroid. Thyroid functions can recover themselves, but not in all cases. It depends on the form of the disease. For example, chronic hypothyroidism can last for quite a long time, going into the active stage, replacing the remission phase.

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

What will happen if not treated?

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

Hypothyroidism can lead to the following complications:

  • dementia,
  • atherosclerosis,
  • infertility
  • premature abort pregnancy
  • inability to bear fruit,
  • congenital hypothyroidism in children
  • deep and prolonged depression,
  • myxedema

With myxedema, the person becomes hypersensitive to any changes in temperature downward. Even a banal flu, or another infectious disease, which was transferred in this pathological condition, can cause hypothyroid coma.

However, you should not worry too much - such a deviation is a reversible process, and is easily treatable. If you choose the right dosage of the drug (it is appointed depending on the level of hormones and AT-TPO), then the disease over a long period of time may not remind you of yourself.

Treatment of autoimmune thyroiditis

AIT treatment is carried out only at the last stage of its development - with hypothyroidism. However, in this case, certain nuances are taken into account.

Thus, therapy is carried out exclusively for manifest hypothyroidism, when the level of TSH is less than 10 IU / l, and St. T4 reduced. If the patient suffers from a subclinical form of pathology with TSH in 4-10 IU / 1 l and with normal indicators of St. T4, in this case, treatment is carried out only if there are symptoms of hypothyroidism, as well as during pregnancy.

Today, levothyroxine-based drugs are the most effective in treating hypothyroidism. A feature of such drugs is that their active substance is as close as possible to the human hormone T4. Such funds are absolutely harmless, so they are allowed to take even during pregnancy and HB. Drugs practically do not cause side effects, and, despite the fact that they are based on the hormonal element, they do not lead to an increase in body weight.

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

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

Today, there are many analogues of these drugs, but it is better to give preference to the originals. The fact is that they have the most positive effect on the patient's body, while analogs can only bring a temporary improvement in the patient's state of health.

If from time to time you switch from originals to generics, then you should remember that in this case, you will need to adjust the dosage of the active ingredient - levothyroxine. For this reason, every 2-3 months it is necessary to take a blood test to determine the level of TSH.

Nutrition with AIT

Treatment of the disease (or a significant slowdown in its progression) will give better results if the patient avoids food that is harmful to the thyroid gland. In this case, it is necessary to minimize the frequency of use of products containing gluten. Under the ban fall:

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

At the same time you should try to eat foods enriched with iodine. They are especially useful in controlling the hypothyroid form of autoimmune thyroiditis.

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

  • dairy products,
  • Coconut oil,
  • fresh fruits and vegetables
  • lean meat and meat broths,
  • different types of fish
  • sea ​​kale and other algae,
  • germinated cereals.

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

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

When AIT is important to give preference to the following substances:

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

Treatment prognosis

What is the worst thing to expect? The prognosis of AIT treatment is, on the whole, quite favorable. If persistent hypothyroidism occurs, the patient will have to take levothyroxine-based drugs for the rest of his life.

It is very important to monitor the level of hormones in the patient's body, therefore, once in six months, you must undergo a clinical blood test and ultrasound. If during ultrasound a knotty seal in the area of ​​the thyroid is noticed, this should be a good reason for consulting an endocrinologist.

If during the ultrasound scan, an increase in the nodules was observed, or their intensive growth is observed, the patient is prescribed a puncture biopsy. The obtained tissue sample is examined in the laboratory in order to confirm or deny the presence of a carcinogenic process. In this case, an ultrasound scan is recommended every six months. If the node has no tendency to increase, then ultrasonic diagnostics can be performed once a year.

Statistics

The frequency of occurrence of the disease, according to various data, varies from 1 to 4%, in the structure of the thyroid gland pathology, its autoimmune damage occurs every 5-6th case. Women are exposed to autoimmune thyroiditis much more often (4–15 times).

The average age of occurrence of a developed clinical picture, indicated in the sources, varies considerably: according to one data, it is 40–50 years old, according to others - 60 and older, some authors indicate the age of 25–35 years. It is reliably known that the disease is extremely rare in children, in 0.1–1% of cases.

Symptoms of hypothyroidism are:

Weakness, loss of memory, apathy, depression, depressed mood, pale dry and cold skin, rough skin on palms and elbows, slowed speech, facial swelling, eyelids, overweight or obesity, chilliness, cold intolerance, decreased sweating, increased, swelling of the tongue, increased hair loss, brittle nails, swelling in the legs, hoarseness, nervousness, menstrual disorders, constipation, pain in the joints.

Symptoms are often non-specific, occur in a large number of people, and may not be associated with impaired thyroid function. However, if you have most of the following symptoms, it is necessary to investigate thyroid hormones.

Symptoms of thyrotoxicosis are:

Increased irritability, weight loss, mood swings, tearfulness, rapid heartbeat, a feeling of heart failure, increased blood pressure, diarrhea (loose stools), weakness, a tendency to fractures (reduced bone strength), a feeling of heat, intolerance to a hot climate, sweating, increased hair loss, menstrual disorders, decreased libido (sexual desire).

The worst thing to expect: possible complications of thyroiditis

Different stages of thyroiditis - various complications. Thus, the hyperthyroid stage can be complicated by arrhythmia, heart failure, and even provoke a myocardial infarction.

Hypothyroidism can cause:

  • infertility,
  • habitual miscarriage,
  • congenital hypothyroidism in an unborn child,
  • dementia,
  • atherosclerosis,
  • depressed
  • Myxudema, which looks like intolerance of the slightest cold, constant drowsiness. If in such a state to introduce sedatives, to get severe stress, or to become ill with an infectious disease, it is possible to provoke a hypothyroid coma.

Fortunately, this condition responds well to treatment and, if you take the drugs in a dose selected by hormone levels and AT-TPO, you may not feel the presence of the disease for a long time.

What is dangerous thyroiditis during pregnancy?

The thyroid gland weighs only fifteen grams, but its influence on the processes occurring in the body is enormous. The hormones produced by the thyroid gland are involved in metabolism, in the development of certain vitamins, as well as in many vital processes.

Autoimmune thyroiditis provokes thyroid dysfunction in two thirds of cases. And pregnancy very often gives impetus to exacerbate the disease. With thyroiditis, the thyroid gland produces less hormones than it should. This disease is related to autoimmune diseases. Тиреоидит отличается от иных заболеваний щитовидной железы тем, что даже употребление лекарственных препаратов чаще всего не помогает усилить выработку гормонов. А эти гормоны обязательно нужны как организму мамы, так и развивающемуся организму малыша.Thyroiditis can cause disturbances in the formation of the nervous system in the unborn child.

During pregnancy, do not be negligent of such a disease as thyroiditis. The fact is that it is especially dangerous in the first trimester, when thyroiditis can provoke a miscarriage. According to studies, forty-eight percent of women suffering from thyroiditis, pregnancy was threatened with miscarriage, and twelve and a half percent suffered from strong forms of toxicosis in the early stages.

How to treat thyroiditis?

The treatment of the pathology is completely medical and depends on the stage at which the autoimmune thyroiditis is located. Treatment is prescribed regardless of age and does not stop even in the case of pregnancy, of course, if there are necessary indications. The goal of therapy is to maintain thyroid hormones at their physiological level (monitoring 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 treatment of the thyrotoxic stage, the decision is provided to the doctor. Usually thyreostatics like "Merkazolil" are not assigned. Therapy is symptomatic: with tachycardias, beta-blockers are used (“Anaprilin”, “Nebivolol”, “Atenolol”), in case of pronounced psycho-emotional excitability, sedatives are prescribed. In the case of a thyrotoxic crisis, inpatient treatment is carried out with the help of injections of glucocorticoid homones ("Prednisolone", "Dexamethasone"). The same drugs are used when autoimmune thyroiditis is combined with subacute thyroiditis, but therapy will be performed on an outpatient basis.

At the hypothyroid stage, synthetic T4 (thyroxin) is assigned under the name "L-thyroxin" or "Eutirox" and, if there is a shortage of triiodothyronine, its laboratories created in the laboratory. Dosage of thyroxine for adults - 1.4-1.7 mg / kg of body weight, in children - up to 4 mg / kg.

Thyroxin is prescribed to children if there is an increase in TSH and a normal or decreased T4 level, if the gland is increased by 30 percent or more of the age limit. If it is enlarged, its structure is heterogeneous, while there is no AT-TPO, iodine is administered in the form of potassium iodide at a dosage of 200 µg / day.

When the diagnosis of autoimmune thyroiditis is made to a person living in an area with iodine deficiency, physiological doses of iodine are applied: 100-200 mcg / day.

Pregnant L-thyroxin is prescribed if TSH is more than 4 mU / L. If they have only AT-TPO, and the TSH is less than 2 mU / L, thyroxin is not applied, but the TSH level is monitored every trimester. In the presence of AT-TPO and TSH 2-4 mU / l L-thyroxin is needed in prophylactic doses.

If thyroiditis is nodular, in which cancer cannot be ruled out, or if the thyroid squeezes the neck organs, making breathing much more difficult, surgical treatment is carried out.

The diet should be normal in calories (energy value of at least 1500 kcal), and it is better if you calculate it according to Mary Chaumont: (weight * 25) minus 200 kcal.

The amount of proteins should be increased to 3 g per kg of body weight, and limit the saturated fats and digestible carbohydrates. There is a need every 3 hours.

  • vegetable dishes
  • baked red fish
  • fish fat,
  • liver: cod, pork, beef,
  • pasta,
  • milk products,
  • cheese,
  • legumes,
  • eggs,
  • butter,
  • porridge,
  • bread.

Salty, fried, spicy and smoked dishes, alcohol and seasonings are excluded. Water - not more than 1.5 l / day.

We need fasting - once a week or 10 days - days on juices and fruits.

Folk remedies

Treatment of autoimmune thyroiditis with folk remedies is contraindicated. With this disease in general, you should refrain from any self-treatment. Adequate in this case, the treatment is able to appoint only an experienced physician, and it should be carried out under mandatory systematic control tests.

Immunomodulators and immunostimulants in autoimmune thyroiditis are not recommended. It is very important to observe some principles of proper healthy nutrition, namely: to eat more fruits and vegetables. During illness, as well as during periods of stress, emotional and physical exertion, it is recommended to take micronutrients and vitamins necessary for the body (such vitamin preparations as Supradin, Centrum, Vitrum, etc.)

Prognosis for life

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.

3 comments

Hello! I am 29 years old. I turned to the endocrinologist just to check. Very quickly and strongly recovered, the weight is not reset. I notice that I can forget the name of some of the items or things. Has passed analyzes TTG and AT-TPO, and ultrasonography. TSH 1.71 mU / l (0.4-4.0), AT-TPO 787.2 U / ml (

More recently, with horror, I learned that thyroiditis is not treated. It turns out that people who suffer from this disease, all life should sit on hormones. Constantly need to maintain the amount of the hormone in the body, which the thyroid gland itself can no longer produce. Strains, of course, all my life to drink medicine. Although it is better to drink and live than before the time go to the next world. The main thing is that the drugs also help.

How, then, do a woman during pregnancy if she has thyroiditis? If no medicine helps, then what will help? I know that when a sick thyroid gives thyroid hormones and everything falls into place. The body balances hormones, everything works as it should. And what to do if hormones do not help. And in general, why don't they help? I do not understand the mechanism of the occurrence of this disease, or what the disease is.

Nature of the disease

In autoimmune thyroiditis, the thyroid gland does not cope with its work. The immune system begins to produce antibodies that destroy the thyroid from the inside. Thyroid cells become foreign to immunity. As a result, thyroid hormone production is reduced.

Until recently, it was believed that autoimmune thyroiditis leads to hypothyroidism. But in recent years, experts believe that everything is just the opposite. First, the activity of the thyroid gland decreases, which ceases to “catch” the incoming iodine and produce iodine-containing hormones. Hypofunction of the thyroid gland creates an excess of iodine and causes intoxication, inflammatory reactions that trigger autoimmunization. Against this background, autoimmune thyroiditis develops.

Therefore, to determine the true causes of chronic thyroiditis, it is necessary to establish the factors that contribute to a decrease in the activity of the thyroid gland.

Provoking factors

Why do some people develop thyroid symptoms while others do not? It is all about a combination of certain predisposing factors:

  • past infectious diseases
  • the presence of foci of chronic infection in the tonsils, sinuses and teeth, affected by caries,
  • contamination of water and food that a person consumes, deficiency of vitamins and trace elements,
  • prolonged unreasonable use of hormones and drugs that contain iodine,
  • radiation effects on the body
  • chronic intoxication,
  • lack of vitamin D and silen involved in the synthesis of thyroid hormones and its work,
  • a large number of traumatic situations
  • thyroid injury.

All autoimmune diseases are somehow related to the state of the psyche. When experts talk about the great influence of the nervous system on health, they are not at all exaggerated.

Among the causes of autoimmune thyroiditis are two main highlights: severe stress and infectious diseases.

Women are 4-8 times sick with autoimmune thyroiditis more often than men. Hormonal changes can provoke the development of the disease. Also often found autoimmune thyroiditis during pregnancy. The main reason is the hyperreaction of the immune system to the body's natural suppression of its activity in order to save the child.

It is also found in women with postpartum thyroiditis. It manifests itself in the 14th week after the birth of the child. In most cases, the disease passes on its own. But the woman still needs competent help from an endocrinologist.

First signs and symptoms

Symptoms of thyroiditis autoimmune nature for a long time absent. The thyroid gland does not change in size, painless when probing. Chronic autoimmune thyroiditis is formed over the years. A sick person complains of difficulty in swallowing food, respiratory failure, discomfort in the throat area. Sometimes when probing the thyroid gland is sealed, may have small nodules.

Autoimmune thyroiditis occurs in several phases:

  • Euthyroid. Not accompanied by dysfunction of the thyroid gland, the symptoms of autoimmune thyroiditis are absent.
  • Subclinical. Thyroid gland cells are destroyed, the amount of thyroid hormones decreases. The synthesis of thyroid-stimulating hormone (TSH) increases.
  • Thyrotoxic. When thyroiditis of the thyroid gland is destroyed much more actively, thyroid hormones and follicular cells get into the blood, which increase the production of antibodies. The amount of hormone T4 is sharply reduced.
  • Phase of restoration of thyroid function or development of persistent hypothyroidism.

Autoimmune thyroiditis may not develop in several phases, but only as a single phase. In many patients, the disease occurs in a latent form, when antibodies to the thyroid gland are detected in the blood, but there are no clinical manifestations of the disease. The size of the affected organ may vary depending on the form of the pathology (atrophic, hypertrophic).

Atrophy of the thyroid gland with thyroiditis is more often observed in old age, and in young people - with radiation exposure.

The absence of obvious symptoms of autoimmune thyroiditis is the reason for the delayed start of treatment. Pay attention to the following suspicious changes in health:

  • cardiopalmus,
  • feeling hot
  • increased sweating,
  • trembling limbs
  • hair loss, brittle hair,
  • irritability and sleep disturbance
  • weight loss.

When these symptoms appear, be sure to contact an endocrinologist who can examine the thyroid gland and confirm or deny the presence of thyroiditis.

Features of treatment

Many consider autoimmune thyroiditis to be almost the most terrible disease and do not know what to expect from it. In fact, the disease is not as dangerous as is commonly believed. The lack of thyroid function has long been learned to compensate with the help of drugs.

Treatment of autoimmune thyroiditis is carried out under the supervision of a physician. The patient should be tested regularly to determine the level of thyroid hormones. Postpartum thyroiditis, which is not accompanied by apparent hypothyroidism, does not require treatment. But women should understand that in subsequent pregnancies, thyroid dysfunction with a probability of 60-70% will occur again and may lead to a decrease in the production of the main thyroid hormones.

If autoimmune thyroiditis is not accompanied by hypothyroidism, specific therapy is not required. With a decrease in the activity of the thyroid gland, replacement therapy with levothyroxine or other hormonal drugs is used. They are prescribed only under the control of the content of TSH in the blood.

If autoimmune thyroiditis is combined with subacute thyroiditis, glucocorticosteroid agents are prescribed. To reduce autoantibodies in the blood, nonsteroidal anti-inflammatory drugs are used that suppress the activity of the inflammatory process and reduce the manifestations of the underlying disease. At detection of growth of a thyroid gland, formation of nodes, histological research is necessarily carried out. According to its results, an operation is prescribed.

Changes in nutrition and lifestyle

The speed of development of autoimmune processes can be influenced by the state of the organs of the digestive tract and the nature of nutrition. Check the work of the intestines, hand over feces for dysbiosis. Sometimes problems with other organs, including the thyroid gland, begin with microflora disorders.

It is necessary to exclude from the diet foods that increase inflammation of the gastrointestinal mucosa:

  • any alcoholic beverages,
  • sugars, simple carbohydrates that contribute to the formation of free radicals, increase the risk of diabetes and obesity,
  • excessive fatty foods, trans fats,
  • vegetables that are high in starch, especially potatoes,
  • legumes, coarse grains, including barley and millet,
  • sauces, mayonnaise,
  • bread, muffins and other products with gluten,
  • spiciness, spices,
  • tuna (accumulates mercury, like other large fish,
  • canned food.

Food should be varied. Eat fruits, vegetables, lean meat and seafood more often. It is recommended to abandon milk, as it may increase the inflammatory processes in the intestine. But lactic acid products, especially cooked at home, are useful for thyroiditis. Own curd, kefir on kefir fungus, ryazhenka - they can be consumed regularly without harm to health.

There is no need to follow a strict diet with autoimmune thyroiditis. Each person must deal with the factors that have provoked a dysfunction of the thyroid gland.

Pay special attention to the state of the nervous system. If you are used to worrying about trifles, it is necessary to urgently change the attitude to stress and unforeseen circumstances. Excitement will not help solve the accumulated domestic and financial problems. You must remain calm and always think about your health.

I recommend to watch this video about products that damage the thyroid gland.

What recommends traditional medicine

Treatment of folk remedies autoimmune thyroiditis is carried out with extreme caution. Some herbs can negatively affect the state of the thyroid gland and provoke hypothyroidism and other endocrine pathologies. If the survey did not reveal characteristic hormonal disorders in the presence of antibodies, no treatment should be performed. Try to change the diet, restore the intestinal microflora, get rid of chronic foci of infections and constant stress, and the autoimmune process can self-destruct.

Tincture of green walnut

If there is a clear violation of the thyroid gland, you can try one well-known recipe. For its preparation you need green walnuts. Take 30 unripe fruits, chop them and mix with 2 cups of fresh flower honey (better than linden) and 1 liter of vodka.

Put the composition for two weeks in a dark place. After the infusion, strain and take several times a day 20 minutes before meals - a tablespoon. The course of treatment is 1-2 months.

Juice therapy

Freshly squeezed vegetable juices are rich in vitamins and minerals. Try to restore the thyroid gland with a mixture of carrot and beet juice. It is recommended to add a few tablespoons of flaxseed oil, which is rich in antioxidants and unsaturated fatty acids. Mix 150 g of carrot juice and 50 g of beet juice. Add a spoonful of flaxseed oil. Drink this portion the day before meals, preferably in the morning and in the evening.

Useful in reducing the activity of thyroid sea buckthorn juice. In our family, it is customary to make sea buckthorn compote. It has a peculiar taste and smell, but I like it. You can just freeze the berries, and in the winter to make compote from them. To get a rich taste, after boiling water, mash the fruit with tolkushkoy, add sugar or honey to taste, wait a few minutes and remove the pan from the heat.

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Evgenia Nabrodova

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Definition of the disease. Causes of disease

Chronic autoimmune (lymphomatous) thyroiditis (HAIT) - chronic thyroid disease of autoimmune origin, was described by H. Hashimoto in 1912. The disease is more common in women and is most often diagnosed among the known thyroid abnormalities. Autoimmune thyroiditis is detected in one of 10-30 adult women. [one]

The disease under consideration is of an autoimmune nature, and the presence of antibodies is mandatory for it. For the first time published data on the detection of antibodies to thyroid tissue in serum in patients with autoimmune thyroiditis in 1956. It later emerged that autoimmune thyroiditis implies the presence of antibodies to thyroglobulin, the second colloidal antigen, and thyroperoxidase (a microsomal antigen).

Today, it is considered that apoptosis, that is, programmed death of the follicular cells of the thyroid gland - is one of the main mechanisms that provokes the pathology of the thyroid gland, including HAIT. [2]

Pathogenesis of autoimmune thyroiditis

Эндогенный (внутренний) критерий наследования аутоиммунных заболеваний взаимосвязан с клонами Т-лимфоцитов. In order for a chronic disease to develop, taking into account the existing genetic predisposition, exogenous factors (viral and any other infections, pharmaceuticals) that activate T-lymphocytes are activated, they subsequently activate B-lymphocytes, triggering a chain reaction. Further, T-cells, cooperating with antithyroid antibodies, act on the epithelial cells of the follicles, facilitating their destruction, as a result of which the number of properly functioning structural units of the thyroid gland is reduced. [14]

The amount of antithyroid antibodies in this disease directly reflects the severity of the autoimmune process and sometimes tends to decrease as the duration of the disease increases. Only the presence of antithyroid antibodies is not enough to injure the structural elements of the thyroid gland. To realize the toxic properties of existing antibodies, it is necessary to interact with T-lymphocytes, which are sensitive to thyroid antigens with HAIT, which is not the case with the usual goiter or if thyroid pathology is not detected. Normally, all cells have immunological insensitivity to other cells of their own organism, which is acquired during fetal development (even before birth), during the interaction of mature lymphocytes with their antigens. Any disruption in this interaction and the synthesis of specific clones of T-lymphocytes, which interact with their own antigens, can become the reason that leads to a violation of immunological insensitivity and subsequently lead to the formation of any autoimmune pathologies, including HAIT.

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