What is ait in endocrinology. Autoimmune thyroiditis (AIT, Hashimoto's thyroiditis)

How is this pathology classified?

Classification of a disease is associated with the need to distinguish between one or another of its varieties.

1. Chronic autoimmune thyroiditis (Hashimoto's goiter) is a disease thyroid gland, developing as a result of prolonged infiltration of T-lymphocytes into the organ tissue. It is possible for a person to develop autoimmune thyroiditis.
2. Postpartum thyroiditis is diagnosed very often and is therefore well studied. The cause of this type of thyroiditis is the increased reactivity of the woman’s immune system due to the fact that she was in a depressed state during pregnancy.
3. Painless thyroiditis is an analogue of postpartum thyroiditis, but the causes of this type of pathology have not been studied.
4. Patients suffering from hepatitis type C may develop cytokinin-induced AIT of the thyroid gland. It occurs when patients take interferon.

All types of thyroiditis have such phases of development.

1. Euthyroid. The functions of the organ are not impaired in case of euthyroidism of the thyroid gland. It can last for years, sometimes even throughout life.
2. Subclinical. It appears in humans as a result of the progression of CAIT. At the same time, a significant number of t-lymphocytes enter the blood. As a result, the cells are progressively destroyed.
3. Thyrotoxic. A person develops signs of thyrotoxicosis, destroyed parts of internal cell fragments. They provoke active processes of antibody production. The number of cells capable of producing hormones decreases below permissible level, causing the patient to develop hypothyroidism.
4. Hypothyroid. May last for about a year, after which normal function the organ is restored. Sometimes a patient may develop persistent hypothyroidism, which can only be relieved by taking thyroid hormone medications.

In addition, there are:

• acute thyroiditis;
• subacute thyroiditis;
• primary disease;
• fibrous thyroiditis;
• de Quervain's thyroiditis (giant cell form of pathology)

Causes of pathologies

The exact causes of autoimmune thyroiditis still remain poorly understood. For signs of the pathology in question to appear, the following factors must be exposed:

• acute viral respiratory infectious diseases;
• persistent areas of infection on the tonsils, sinuses, carious teeth;
• unfavorable natural environment, excess of iodine, fluorine and chlorine salts;
• long-term use without proper monitoring of iodine-containing drugs and hormonal medications;
• prolonged exposure to direct sunlight;
• influence of radiation;
• psychological trauma.

General signs

Most cases of this disease, if it occurs in the euthyroid or subclinical phase, do not manifest themselves. The patient has normal sizes thyroid gland upon palpation. He doesn't feel any pain. It is extremely rare for a person to have an enlarged thyroid gland and a feeling of tightness and pressure in the throat.

Depending on the type of pathology, the patient may develop symptoms of autoimmune thyroiditis:

Features of hypothyroidism

Hypothyroidism in autoimmune thyroiditis can be latent, manifest, or complicated. General manifestations of this state are:

Hyperthyroidism

Manifestations of hyperthyroidism in autoimmune thyroiditis may be temporary.

Note the presence of the following symptoms:

Compression of other organs

When the thyroid gland changes in size, a person feels pain in the chest or neck. Often his temperature rises (to subfebrile levels). Due to pressure on vocal cords the timbre of a person’s voice decreases significantly (this is especially noticeable in women).

Compression of the esophagus can be manifested by a constant feeling of a lump in the throat, a violation respiratory function and other symptoms. When the mediastinal organs are compressed, there may be a constant noise in the ears, disorders visual function and other signs.

Manifestations of inflammatory processes

When the thyroid gland is inflamed, patients experience the following symptoms.

1. Phenomena of intoxication (that is, weakness and aches in the joints and head).
2. Rising temperature.
3. Enlarged lymph nodes.

Diagnostic features

Diagnosis of the disease can only be carried out on the basis of a comprehensive examination of the person. He is prescribed the following laboratory tests:

• on TSH;
• on T3 and T4;
• for the presence of microsomal antibodies to thyroid peroxidase;
• for the presence of antibodies to thyroglobulin in the blood.

Blood for analysis is taken only from venous blood. An indispensable condition for the correctness and accuracy of the results of clinical examinations is taking the material on an empty stomach. If, under these conditions, AT TG is greatly increased, this indicates possible development diseases.

In addition, to make a correct diagnosis of Hashimoto’s disease, it is necessary to diagnose the thyroid gland using instrumental methods. Ultrasound is most often used for this. Using ultrasound, you can determine the following signs of AIT on an ultrasound of the thyroid gland:

• size and location of the thyroid gland (signs of normovolumia);
• its structure and the presence in it diffuse changes, pseudoknots;
• echo signs of damage to the parathyroid glands;
• condition of nearby lymph nodes;
• features of blood flow in the area under study.

A puncture biopsy is performed only under ultrasound guidance. During this examination, a small piece of tissue is removed from the gland, which is then sent to cytological examination. Often, based on the data of such an examination, a diagnosis of AIT is made.

The most complete and reliable picture of the processes occurring in the thyroid gland is provided by magnetic resonance or CT scan. Moreover, MRI has more advantages due to the absence of radiation.

Treatment options

Therapeutic measures should be prescribed only on the basis of data diagnostic examination. They are aimed at eliminating one or another factor contributing to the development of a characteristic clinical picture of the pathology.

1. Thyroid drugs. These are L-thyroxine, Triiodothyronine, Thyroidin, Thyroid.
2. Glucocorticosteroids (which are analogues of adrenal hormones). The drug of choice is Prednisolone.
3. Antibiotics are used for severe inflammation caused by bacteria. Patients are prescribed Cephelim, Augmentin, Amoxiclav, drugs from fluoroquinolones, tetracyclines, aminoglycosides and other groups.
4. For pain and inflammatory processes of non-infectious origin, Indomethacin and its analogues are used. The use of Diclofenac ointment is also indicated.
5. Beta blockers - Propranolol and others.
6. Levamisole and other immunomodulatory drugs are used to support the immune system.
7. If you are prone to allergies, use Tavegil, Diazoli, Loratadine.
8. Endorm and the treatment of autoimmune thyroiditis are closely related, since the use of this drug makes it possible to control the activity of the thyroid gland.
9. Iodine-containing preparations (Ioddicerin, Iodomarin).

Treatment folk remedies should be considered only as an auxiliary method of therapy. A diet is indicated (eating foods enriched with iodine, selenium, and vitamins).

Prognosis and prevention

The prognosis for this disease is favorable. Early treatment can significantly slow down the destruction of thyroid tissue and degradation of the organ. A correctly selected set of drugs makes it possible to achieve remission. If thyroiditis occurs after childbirth, a woman’s risk of developing autoimmune lesions of the organ increases significantly. Dangerous consequences thyroid lesions can be observed when the process is advanced.

Specific measures to prevent the disease have not been developed. Women who are carriers of antibodies to thyroid peroxidase are recommended to undergo clinical observation.

Autoimmune forms of thyroiditis respond well to treatment and compensation with the help of modern medications. Early detection of such a pathology will help cure the disease and help maintain high performance and quality of life.

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Autoimmune thyroiditis (AIT) or, as it is also called, Hashimoto's thyroiditis, is one of the most common autoimmune diseases of the thyroid gland. It is the most common cause of hypothyroidism - decreased thyroid function.

Most often, AIT is detected in women aged 30–50 years or after pregnancy, and in men aged 40–65 years. The disease has no pronounced clinical symptoms. For many years, and sometimes decades, it may not manifest itself at all.

There is no pain with this disease. And often the only sign of the presence of sluggish pathological changes in the thyroid gland may be an increased titer of AT-TPO.

What it is?

Autoimmune thyroiditis (AIT) is inflammatory disease thyroid gland, which occurs as a result of the body producing antibodies to its own thyroid gland (thyroid gland). It affects 10 people out of a thousand.

Causes

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

1. Uncontrolled use of medications, especially hormonal ones or those containing iodine in the active composition;
2. Presence of foci of chronic diseases various types V acute form(carious teeth, inflammation in the tonsils or sinuses);
3. Harmful environment Negative influence ecology, excess of chlorine, iodine, chlorine in water and food, air oversaturated with them;
4. Hormonal instability is a disruption of the body’s hormonal levels due to other diseases, injuries, pregnancy, after taking medications and in other cases;
5. Presence of radiation exposure during radiation therapy, or when working with radioactive substances, also active exposure to the sun;
6. Injuries, stressful situations, chemical and thermal burns, in general and directly in the thyroid gland, can also be negatively affected by surgical intervention.

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

Classification

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

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

Based on the nature of the course, there are 3 main forms of autoimmune thyroiditis. This:

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

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

Symptoms of autoimmune thyroiditis

Manifestations various forms diseases have some characteristic features.

Since the pathological significance of chronic autoimmune thyroiditis for the body 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 multisystem manifestations of hypothyroidism (suppression of thyroid function):

• intolerance to habitual physical activity;
• slower reactions to external stimuli;
• depressive states;
• apathy, drowsiness;
• feeling of unmotivated fatigue;
• decreased memory and concentration;
• “myxedematous” appearance (facial puffiness, swelling of the area around the eyes, pallor skin with a jaundiced tint, weakened facial expressions);
• decreased heart rate;
• decreased appetite;
• tendency to constipation;
• dullness and fragility of hair, increased hair loss;
• decreased libido;
• dry skin;
• tendency to increase body weight;
• chilliness of the limbs;

A common feature for postpartum, silent and cytokine-induced thyroiditis is a consistent change in the stages of the inflammatory process.

Symptoms characteristic of the thyrotoxic phase:

• weight loss;
• intolerance to stuffy rooms;
• tremor of the limbs, trembling of the fingers;
• impaired concentration, memory impairment;
• emotional lability (tearfulness, abrupt change mood);
• tachycardia, increased blood pressure (blood pressure);
• feeling of heat, hot flashes, sweating;
• decreased libido;
• fatigue, general weakness, followed by episodes of increased activity;
• violation menstrual function in women (from intermenstrual uterine bleeding until complete amenorrhea).

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

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

Painless and cytokine-induced thyroiditis, as a rule, does not demonstrate a violent clinical picture, manifesting itself with moderate symptoms, or is asymptomatic and is detected during routine testing of thyroid hormone levels.

Diagnostics

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

1. T4 – free and general;
2. T3 – free and general.

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

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

• the concentration of T4 and T3 is reduced, and the level of TSH is increased;
• Ultrasound of the thyroid gland determines the hypoechogenicity of the tissue;
• the level of antibodies to the thyroid enzyme – thyroid peroxidase (AT-TPO) in the venous blood increases.

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

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

How to treat autoimmune thyroiditis?

To date, no methods have been developed for autoimmune thyroiditis. effective treatment. If the thyrotoxic phase of the disease occurs (the appearance of thyroid hormones in the blood), the prescription of thyrostatics, that is, drugs that suppress the activity of the thyroid gland (thiamazole, carbimazole, propicil), is not recommended.

• If a patient has problems with the cardiovascular system, beta-blockers are prescribed. If dysfunction of the thyroid gland is detected, a thyroid drug is prescribed - levothyroxine (L-thyroxine) and treatment is necessarily combined with regular monitoring of the clinical picture of the disease and determination of the content of thyroid-stimulating hormone in blood serum.
• Often in the autumn-winter period, a patient with AIT experiences the occurrence of subacute thyroiditis, that is, inflammation of the thyroid gland. In such cases, glucocorticoids (prednisolone) are prescribed. To combat the increasing number of antibodies in the patient’s body, non-steroidal anti-inflammatory drugs such as voltaren, indomethacin, and methindole are used.

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

Forecast

Autoimmune thyroiditis in the vast majority of cases has favorable prognosis. When persistent hypothyroidism is diagnosed, lifelong therapy with levothyroxine is necessary. Autoimmune thyrotoxicosis tends to be slow; in some cases, patients can remain in a satisfactory condition for about 18 years, despite minor remissions.

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

If nodules are detected during an ultrasound examination of the thyroid gland, immediate consultation with an endocrinologist is necessary. If nodes with a diameter of more than 1 cm have been identified and during dynamic observation, comparison of previous ultrasound results, their growth is noted, it is necessary to perform a puncture biopsy of the thyroid gland to exclude a malignant process. Monitoring of the thyroid gland using ultrasound should be carried out once every 6 months. If the diameter of the nodes is less than 1 cm, control ultrasound should be performed once every 6-12 months.

When trying to influence autoimmune processes (in particular, humoral immunity) in the thyroid gland throughout long period For this pathology, glucocorticosteroids were prescribed in fairly high doses. On this moment The ineffectiveness of this type of therapy for autoimmune thyroiditis has been clearly proven. The prescription of glucocorticosteroids (prednisolone) is advisable only in the case of a combination of subacute thyroiditis and autoimmune thyroiditis, which usually occurs in the autumn-winter period.

In clinical practice, there have been cases where spontaneous remission occurred in patients with autoimmune thyroiditis with signs of hypothyroidism during pregnancy. There have also been cases when patients with autoimmune thyroiditis, who had a euthyroid state before and during pregnancy, were aggravated by hypothyroidism after childbirth.

Autoimmune thyroiditis is a chronic inflammatory process in the thyroid gland caused by malfunction immune system. Accompanied by dysfunction of the organ, which negatively affects the condition of the entire organism.

AIT of the thyroid gland - what is it?

When answering the question, what is thyroid thyroiditis, you need to understand that the disease is a consequence of the destructive action of antibodies produced by the immune system. Under the influence of certain factors, immune cells begin to destroy healthy thyrocytes, which causes a persistent inflammatory process to develop.

Due to progressive infiltration, the thyroid tissue disintegrates, resulting in hypothyroidism. Answering the question of what autoimmune thyroiditis is, we can say that it is a disease characterized by a gradual decrease in the activity of the thyroid gland.

Causes and mechanism of development of thyroiditis

The mechanism of development of AIT includes:

• a malfunction of the immune system, in which it begins to produce antibodies that damage healthy cells;
• destruction of thyroid follicles;
• proliferation of fibrous tissues replacing parenchymal ones;
• decreased production of thyroid hormones.

The following factors lead to the development of the disease:

1. Genetic pathologies of the immune system. The result of such diseases is the development of morphological changes varying degrees expression in organs endocrine system. The process is slow. As pathological changes in the tissues of the thyroid gland progress, the activity of the organ decreases.
2. Increased levels of antibodies to thyroid peroxidase and thyroglobulin during pregnancy and breastfeeding. After the end of the postpartum period, signs of the disease often disappear.
3. The presence of bad habits, psycho-emotional and physical overload, hypothermia, poor nutrition, exposure to ionizing radiation can also cause a malfunction of the immune system.
4. Uncontrolled use of interferon drugs. Medicines used to stimulate the immune system during viral infections and diseases of the hematopoietic system. They can provoke increased production of antibodies that attack healthy cells.
5. The presence of chronic foci of infection in the body. These include carious teeth, tonsillitis, and sinusitis. Improper treatment of infections, in which viruses and bacteria persist in the body, contributes to disruption of the immune system.
6. Living in an unfavorable ecological situation. Toxic substances accumulate in the body, disrupting the functioning of all organs and systems.
7. Metabolic disorders (diabetes mellitus).
8. The presence of systemic autoimmune pathologies. Hashimoto's thyroiditis is often associated with pernicious anemia, lupus erythematosus, rheumatoid lesions joints, chronic non-infectious hepatitis or Sjogren's syndrome.

Forms of pathology and their symptoms

The following forms of chronic autoimmune thyroiditis exist:

• hypertrophic (accompanied by proliferation of thyroid tissue);
• atrophic (characterized by a decrease in the size of the organ).

According to the activity of the gland:

• euthyroid (the amount of hormones produced remains within normal limits);
• thyrotoxic (gland activity increases);
• hypothyroid (characterized by the production of insufficient amounts of hormones).

With autoimmune thyroiditis, the symptoms are as follows:

1. Change in appearance. The skin takes on a yellowish tint and the face becomes puffy. An unhealthy blush appears on the cheeks.
2. Patchy baldness. Hair becomes brittle and begins to fall out in small patches. The pathological process covers not only the scalp, but also the eyebrows, armpits and groin area. In some cases, Hertog's symptom is detected - thinning of hair in the outer third of the eyebrows.
3. Lack of facial expressions. The patient's face practically does not change expression.
4. Speech impairment. A person with thyroiditis speaks slowly, has difficulty remembering the names of objects and phenomena, and takes a long time to construct sentences.
5. Swelling of the tongue. The organ increases in size, which is why teeth marks remain on the side surfaces.
6. Impaired nasal breathing. The mucous membranes of the nasal passages swell, which is why the patient often walks with his mouth slightly open. Shortness of breath is quite common.
7. Dry skin. The skin folds into large folds and becomes rough. Psoriasis-like rashes and cracks may appear.
8. General weakness, decreased performance, drowsiness. The patient's memory deteriorates and intellectual abilities decrease.
9. Impaired intestinal motility. It is accompanied by constipation, which forces the patient to constantly take laxatives.
10. Functional impairment reproductive system. There are constant delays in menstruation in women. Menstrual flow is scanty. Intermenstrual bleeding occurs. Such pathological conditions cause infertility.
11. Mastopathy. Pathological condition characterized by soreness of the mammary glands, the appearance of discharge from the nipples.
12. Decreased sexual desire and erectile disfunction in men.
13. Retardation in psychophysical development in children. A child with thyroiditis is short in height and weight and is difficult to learn.

Diagnosis and treatment of autoimmune hypothyroidism

Autoimmune disease is detected using the following procedures:

1. Clinical blood test. With thyroiditis, there is an increase in the number of lymphocytes.
2. Immunograms. The result of the study reflects the presence of antibodies to thyroid peroxidase, thyroglobulin and colloid antigen.
3. Blood test for hormones. Using this procedure, the degree of activity of the gland is determined.
4. Ultrasound of the cervical region. Reflects changes in the size and structure of the gland. The procedure is used as additional method diagnostics
5. Fine needle biopsy. The resulting material reveals an increased number of lymphocytes and other inflammatory cells. If malignant degeneration is suspected, the sample undergoes histological examination.

To treat autoimmune thyroiditis use:

1. Thyreostatics (Thiamazole, Carbimazole). The drugs are prescribed for early stages pathologies characterized by increased levels of thyroid hormones.
2. Beta blockers (Atenolol). Used to eliminate signs of damage to the cardiovascular system.
3. Hormone replacement therapy drugs (L-thyroxine). Treatment is combined with constant monitoring of the level of thyroid and thyroid-stimulating hormones in the blood.
4. Glucocorticoids (Prednisolone). Indicated for combination of autoimmune inflammation with subacute thyroiditis.
5. Non-steroidal anti-inflammatory drugs (Indomethacin). Reduce the rate of development of the inflammatory process.
6. Surgical interventions. They are used for pathological growth of the gland, which contributes to compression of surrounding tissues.

Life forecast and prevention

Forecast at proper treatment quite favorable. The patient goes into remission, the functions of the gland are normalized. Despite short-term exacerbations, satisfactory condition the body persists for 10-15 years. Prevention of autoimmune thyroiditis of the thyroid gland involves the exclusion of provoking factors, regular examination by an endocrinologist, timely treatment chronic diseases.

Today, thyroid diseases are main reason contacting endocrinological specialists.

The current epidemiological situation is based on the increased sensitivity of this internal organ to such unfavorable factors as pollution environment, growing background radiation and chronic stress.

As a result of their negative impact violated normal operation thyroid gland, occur structural changes thyroid tissue and hormonal dysfunctions develop. One of the most commonly diagnosed disorders of the endocrine system is autoimmune thyroiditis (AIT).

And, of course, every sane person, upon discovering this pathology, has a reasonable question: “AIT of the thyroid gland - what is it, is there a danger to health and what effective methods of treating the disease are available? modern medicine?»

What is AIT of the thyroid gland?

With this disease, healthy thyroid tissue, perceived as foreign, is destroyed (not always!) by the immune system’s own cells.

Naturally, destruction of the thyroid gland subsequently leads to the development of primary hypothyroidism.

Despite the fact that autoimmune thyroiditis is always accompanied by the presence of circulating antibodies to thyroid tissue, it is absolutely wrong to equate these two concepts. Thus, among the female population, the prevalence of carriage of antibodies to thyroid cells reaches 27%, but the development of the disease is observed only in 3–6% of cases. Only in older women (after 60 years) the incidence of hypothyroidism is 15–20%.

Unfortunately, in medical practice there are still situations in which the presence of antibodies to thyroid tissue, in a minimally increased titer with an absolutely normal level of thyroid-stimulating hormone (TSH), becomes a formal reason for diagnosing AIT and prescribing a “preventative” course of Levothyroxine. The consequence of this erroneous approach is thyrotoxicosis.

Symptoms of autoimmune thyroiditis

Most often, the clinical picture in the early stages of AIT of the thyroid gland is latent.

Thus, upon palpation of the thyroid gland, it is not possible to detect signs of its enlargement, there are no symptoms of endocrine abnormalities, and the content of hormones in the blood plasma is within the physiological norm.

In some cases, the onset of the disease occurs against the background of transient thyrotoxicosis, which is never associated with a hyperfunctional state of the thyroid gland. The pathogenesis is based on either the destruction of follicles and the release of hormones into the blood, or the temporary production of thyroid-stimulating antibodies.

The thyrotoxic phase lasts 3–6 months. It has a mild course and is usually detected completely by chance when a low TSH concentration is detected. Among its symptoms are:

• low-grade fever;
• slight trembling;
• emotional lability;
• increased sweating;
• insomnia;
• weight loss;
• tachycardia;
• arterial hypertension.

Often, patients with an enlarged thyroid gland present the following complaints:

• increased weakness;
• fast fatiguability;
• arthralgia;
• a feeling of pressure and a lump in the throat.

In the final stage of autoimmune thyroiditis, primary hypothyroidism develops, which determines the main clinical manifestations of the disease:

• decreased performance;
• swelling of the face;
• slower speech and thinking;
• memory impairment;
• obesity;
• chills;
• dysmenorrhea;
• female infertility;
• reduction heart rate;
• yellowness of the skin;
• dyspnea;
• hypothermia;
• coarsening of facial features;
• decreased hearing acuity;
• hoarseness of voice;
• heart failure, etc.

If the node is large, problems with breathing and swallowing may occur due to compression of the esophagus and trachea.

Diagnostics

The “major” diagnostic criteria, the combination of which makes it possible to confirm AIT, include:

• an increase in the volume of the gland in women and men by more than 18 and more than 25 ml, respectively;
• detection of antibodies to thyroid tissue in a diagnostically significant concentration and/or characteristic signs of an autoimmune process according to the results of ultrasound examination (ultrasound);
• clinical picture of subclinical or manifest hypothyroidism.

It is worth noting that the absence of at least one of the “big” ones presented above diagnostic signs significantly reduces the likelihood of having AIT.

Among laboratory diagnostic methods, the most informative are:

• determination of the titer of antibodies to thyroglobulin, thyroid peroxidase and thyroid hormones;
• blood test for the content of thyroid-stimulating hormone, triiodothyronine (T3) and tetraiodothyronine (T4).

Importance in endocrinological practice is given to ultrasound of the thyroid gland, which allows one to determine the position, shape and size of the organ, its echogenicity and echostructure, as well as the presence of tumors.

If malignant degeneration of a nodular formation is suspected, a puncture biopsy is performed, followed by morphological analysis of the obtained material. By the way, an absolute indication for such a study is the detection of a single node larger than 10 mm in size (usually accessible to palpation).

The question of a person’s life expectancy after an oncological diagnosis is made is very acute. In the case of thyroid cancer, the prognosis is most often favorable. In this topic, we will consider the prognosis of the disease and data on five-year survival after treatment.

AIT of the thyroid gland - treatment

Therapeutic tactics in the management of patients with various pathologies thyroid gland is based on a differentiated approach. And autoimmune thyroiditis is no exception here.

Most leading experts in the field of thyroidology consider it rational to begin therapy for AIT only if signs of a hypofunctional state of the thyroid gland appear.

Until this point, endocrinologists advise adhering to a wait-and-see approach with dynamic monitoring of patients and annual ultrasound.

This recommendation is due to the fact that today there are no medications that could stop or, at least, slow down the destruction of thyroid tissue with the subsequent development of hypothyroidism.

As mentioned earlier, sometimes the onset of the disease is hidden under the guise of thyrotoxicosis, which can lead to the erroneous prescription of thyreostatics: Thiamazole, Mercazolil or Propylthiouracil, because the increase in the concentration of T3 and T4 in AIT is not associated with hyperfunction of the thyroid gland. To avoid serious endocrine disorders due to improper treatment, it is important to conduct a thorough medical examination every patient.

The outcome of long-term autoimmune thyroiditis is hypothyroidism, the effective correction of which is possible only with the help of hormone replacement therapy.

If, in case of manifest hypothyroidism (T4 is low), Levothyroxine is immediately prescribed, then in case of its subclinical form (T4 is normal), a repeat study of the hormonal status is recommended after 3-6 months.

Indications for treatment with thyroid hormone preparations for subclinical hypothyroidism are:

• a single increase in the level of TSH in the blood plasma above 10 mU/l;
• no less than double detection of TSH concentration in the range of values ​​from 5 to 10 mU/l;
• treatment of older patients (after 55–60 years);
• the presence of cardiovascular pathologies.

In the last two cases, replacement hormone therapy used only if there is no history of evidence of deterioration in health status with accompanying chronic diseases against the background of its use, as well as with good tolerability of drugs.

If antithyroid antibodies and/or echographic signs (reduced echogenicity of the thyroid gland according to ultrasound) of autoimmune thyroiditis are detected in women planning pregnancy, a hormonal blood test (tests for TSH and free T4) is necessary not only before conception, but throughout the entire period bearing a child. If hypothyroidism is diagnosed directly during pregnancy, then Levothyroxine in a full replacement dose should be prescribed immediately.

Surgical treatment for AIT is used in exceptional cases. For example, the question of surgical intervention is raised when there is a significant volume of the thyroid gland, when life-threatening conditions arise due to mechanical compression of the trachea and esophagus.

An indicator of correctly selected conservative therapy is long-term maintenance of TSH levels within the physiological norm.

Although specific treatment autoimmune thyroiditis does not yet exist; modern medicine successfully copes with this disease, helping patients maintain good health and performance for decades.

If you discover this endocrine pathology you should trust your health into your hands qualified specialist, which will carry out regular medical supervision, and in case of manifestation of hypothyroidism, he will prescribe effective medications.

Neoplasms in the thyroid gland are most often diagnosed accidentally, since for a long time They don’t show themselves at all. , read on.

What can be seen on an ultrasound examination of the thyroid gland and what diseases are diagnosed using this survey, look on the page.

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Among the most common pathologies of the thyroid gland is a disease such as autoimmune thyroiditis (AIT). Among endocrinologists, it may be called differently: Hashimoto's thyroiditis, Hashimoto's disease, or even Hoshimoto's goiter. But this does not change the essence. This thyroid pathology is a chronic inflammatory processes in tissues endocrine organ having an autoimmune nature. Their target is the follicles of the thyroid gland and their constituent cells, which causes the destruction of the latter. For the most part, the course of the disease passes without obvious signs of thyroid dysfunction, however, in rare situations, the symptoms of autoimmune thyroiditis include the proliferation of endocrine organ tissue.

The diagnosis of autoimmune thyroiditis accounts for about a quarter of all diagnosed thyroid diseases. Moreover, the “weaker sex” is more susceptible to the development of such a pathology - according to statistics, almost 20 times more often. This is due to the effect on the lymphatic system female hormones, in particular estrogen, and conditions that cause negative changes in the X chromosome. The risk group mainly includes people aged 40 to 50 years, but statistics show that young people and even children have begun to appear among patients.

The concept of autoimmune thyroiditis consolidates a whole “layer” of diseases that have one root.

These include:

1. Chronic AIT (CAIT), also called lymphocytic thyroiditis or lymphomatous (an outdated name for Hashimoto's goiter). The cause of this disease is the saturation of the tissues of the endocrine organ with T-lymphocytes, whose task, as is known, is to recognize and destroy foreign antigens, and these are the thyroid cells. Such processes naturally lead to the destruction of endocrine organ cells, which in turn can cause the appearance of the primary form of hypothyroidism. This type of pathology is hereditary in nature, which makes it possible for any family member to develop it. Often develops together with other autoimmune diseases.
2. Postpartum thyroiditis. The most common disease of this series and therefore the most studied. It develops as a result of too “zealous” activity of the immune system after pregnancy, during which the work of the immune system is naturally suppressed. If there is a genetic predisposition to thyroid dysfunction, postpartum thyroiditis can cause the development of a destructive form of AIT.
3. Silent thyroiditis, also called silent thyroiditis. Similar to the previous pathology, except for the cause, which is naturally not related to bearing a child. By the way, the cause of this form of the disease in question is not known.
4. Cytokine-induced. This type of thyroiditis may occur as a result of interferon therapy in patients with certain blood disorders and hepatitis C.

The last three types of AIT, namely postpartum, silent and cytokine-induced, have similarities in the stages of the pathology. The first of these is thyrotoxicosis, which develops not due to hyperfunction of the thyroid gland, but due to the destruction of the cells of which the tissues of the endocrine organ are composed. The next phase is transient hypothyroidism, which is caused by an increased level of thyroid-stimulating hormone (TSH) and a slight decrease in the concentration of thyroid hormones. Such hypothyroidism most often resolves itself when the factors that caused it disappear, and the functions of the endocrine organ return to normal. This is the third and final phase in most cases of the development of AIT of the above types. Photo.

If we talk about general phases the course of all types of AIT, the following positions can be distinguished:

1. Euthyroidism. Borderline state between normal thyroid gland and pathological change her fabrics. This phase is characterized by the absence of thyroid dysfunction. This phase can last from several years to several decades, and in some cases throughout life.
2. Hidden or subclinical. The development of the disease, which is characterized by the activation of autoimmune processes, leads to the destruction of the cells that make up the thyroid gland, which in turn leads to a decrease in the level of thyroxine and triiodothyronine. To compensate for this loss, the pituitary gland begins increased production of thyroid-stimulating hormone, whose task is precisely to stimulate the hormone-synthesizing function of the thyroid gland.
3. Thyrotoxicosis. An increased autoimmune response in the body leads to a more aggressive attack by T lymphocytes on thyroid cells. When destroyed, they release accumulated thyroid hormones, saturating the blood with them - this condition is called thyrotoxicosis. In addition to this, in circulatory system Parts of destroyed thyroid tissue also enter, which in turn leads to further synthesis of antibodies that destroy thyroid tissue.
4. Hypothyroidism. This phase begins when critical point destructive activity of the immune system against thyroid tissue. The remaining thyroid cells are no longer enough to cover the lack of thyroxine (T4), the level of which drops sharply. The duration of this stage of the disease is approximately a year and after its completion, thyroid function returns to normal. Although in some cases the hypothyroid state can last much longer.

Sometimes the course of the pathology can be single-phase, that is, consist only of thyrotoxicosis or hypothyroidism.

Taking into account clinical changes and the degree of enlargement of the thyroid gland, the following forms of AIT can be distinguished:

1. Latent. This form is characterized by the presence of only immunological symptoms, without clinical manifestations. Most often, the endocrine organ is of normal size, although in some cases it may be slightly enlarged (grade 1 or 2 according to Nikolaev). Upon palpation, the compaction of the gland tissue is not palpable and the functionality of the thyroid gland is within normal limits. Mild manifestations of thyrotoxic or hypothyroid conditions are possible.
2. Hypertrophic. With this form thyroid increased in size (goiter). Conditions of hypothyroidism and thyrotoxicosis of moderate severity are often observed. Changes in the size of the thyroid gland can be either diffuse (uniform tissue enlargement) or nodular (autoimmune thyroiditis with nodulation). It is often found mixed look tissue changes - diffuse nodular. First stage This form of pathology may be caused by a thyrotoxic state, but for the most part the hormone-synthesizing function of the thyroid gland is within normal limits or even reduced. In any case, when autoimmune processes are activated, it ultimately leads to dysfunction of the thyroid gland against the background of destruction of its cells and, as a consequence, to the occurrence of pronounced hypothyroidism.
3. Atrophic. The dimensions of the thyroid gland in this form of Hashimoto's thyroiditis are within the normal range or below it. Symptoms are expressed by a monophasic state - hypothyroidism. Older people are most susceptible to the atrophic form of AIT. IN at a young age its occurrence may be due to exposure to radiation. This form of AIT is considered the most severe, since it is characterized by serious destruction of thyroid tissue, which is naturally characterized by its acute dysfunction.

A thyroid pathology such as AIT cannot appear “out of thin air.” Even a genetic predisposition to thyroid dysfunction is not a 100% condition for the occurrence of autoimmune thyroiditis.

Below are a number of factors that can trigger the appearance of this pathology:

• consequences of ARVI;
• development of chronic forms infectious diseases nasopharynx;
• unfavorable environmental conditions of the area of ​​residence (excess of iodine, fluorine and chlorine);
• self-medication (uncontrolled intake of iodine and hormone-containing medicines);
• exposure to radiation, as well as prolonged exposure to bright sun;
• severe psychological stress and trauma (for example, loss of loved ones or serious life disappointments).

Autoimmune thyroiditis, which occurs in childhood, is necessarily hereditary among the causes.

Signs of autoimmune thyroiditis depend on the phase of the disease. Euthyroidism and latent hypothyroidism, which can last a very long time, most often pass completely asymptomatically. The dimensions of the endocrine organ are within normal limits, there is no pain on palpation, and functionality is not impaired. Occasionally, the size of the thyroid gland is slightly enlarged, and discomfort is also felt in the neck area (the so-called “lump in the throat”), slightly increased fatigue and pain in the joints.

The phase of thyrotoxicosis leaves its mark on the picture of the disease. Symptoms characteristic of a thyrotoxic state are characteristic of the first few years of development of autoimmune thyroiditis.

Each type of autoimmune thyroiditis has its own characteristics in terms of symptoms. For example, symptoms of postpartum AIT include a mild thyrotoxic state approximately 3 months after birth, signs of which include increased fatigue and weakness, as well as slight weight loss.

In some cases, thyrotoxicosis can be more intensely expressed and then its signs become:

• heart rhythm disturbance;
• elevated temperature;
• increased sweating;
• emotional instability;
• insomnia;
• involuntary contraction of the muscles of the arms and legs (tremor).

The hypothyroidism phase of postpartum thyroiditis appears approximately 4-5 months after the birth of the child. Postpartum depression often goes hand in hand with it.

The symptoms of the painless type of AIT are most often represented by a mild thyrotoxicosis state. In cases with cytokine-induced autoimmune thyroiditis, thyrotoxicosis and hypothyroidism also do not differ in severity.

With autoimmune thyroiditis that has not yet entered the hypothyroid phase, its diagnosis is quite difficult. To make a diagnosis of AIT or CAIT, endocrinologists need to analyze both the clinical manifestations of the pathology and the results laboratory tests. If, as a result of taking an anamnesis, it is determined that close relatives have autoimmune diseases, the likelihood of developing AIT increases significantly.

Below is a list of tests that must be taken in case of suspected autoimmune thyroiditis of the thyroid gland, as well as their interpretation:

1. General analysis blood. This analysis determines increased level lymphocytes.
2. Immunogram. With AIT, the appearance of antibodies to thyroxine (T4), triiodothyronine (T3), thyroglobudin (TG) and others will be observed.
3. Blood test for hormone levels. During this laboratory research The content of free thyroxine (T4) and triiodothyronine (T3), as well as the level of thyroid-stimulating hormone (TSH), is determined. If the content of thyrotropin is higher than normal, and the level of thyroxine is within its limits, we can talk about a subclinical (latent) form of hypothyroidism. And an elevated TSH with thyroxine below normal signals a manifest (obvious) form of a hypothyroid condition of the thyroid gland.
4. Ultrasound examination (ultrasound) of the endocrine organ. Thanks to it, you can determine changes in the size of the thyroid gland in one direction or another, as well as possible pathologies structural in nature. The results of ultrasound in this case act as additional information necessary to determine the condition of the thyroid gland.
5. Puncture of thyroid tissue. Using this study, it is possible to determine the number of T-lymphocytes in the tissues of the endocrine organ, as well as other cellular changes characteristic of AIT. But the main reason for using this analysis is the suspicion of malignant processes in the thyroid gland.

To confirm the diagnosis of autoimmune thyroiditis, the diagnosis must reveal following states:

• the level of antibodies to thyroid peroxidase (AT to TPO) in the blood is increased;
• ultrasonography determined reduced echogenicity of thyroid tissue;
• There are symptoms of the primary form of hypothyroid condition of the thyroid gland.

A definitive diagnosis is made only if all of the above are present, otherwise we can only talk about the likelihood of AIT.

Separately, they can act as symptoms of other diseases. Considering that treatment of autoimmune thyroiditis is carried out only during the hypothyroidism phase, diagnosis during the euthyroidism phase is not mandatory.

How to treat AIT or chronic thyroiditis? There is still no treatment directed specifically against its nature. Endocrinologists are still searching for ways to combat the autoimmune component of this pathology. Of course, medicine does not stand still and currently there are drugs that provide a certain effect in the fight against AIT, but their effectiveness and, importantly, safety leave much to be desired. Therefore, each phase of the disease requires its own approach, depending on the specific course of this form of thyroiditis.

In case of autoimmune thyroiditis, during the phase of thyrotoxicosis, it is not recommended to take drugs with thyreostatic action (reducing the hormone-synthesizing function of the thyroid gland), since there is no hyperfunction of the endocrine organ, and the increased content of hormones in the blood is explained by the destruction of its cells. If the thyrotoxic phase is complicated by problems with cardiovascular system, it is advisable to use beta-adrenergic receptor blockers.

When the hypothyroid phase occurs, hormone replacement therapy is prescribed. At the moment, the most common drug for this purpose is L-thyroxine. Its dosage is calculated individually for each patient, depending on his weight and the degree of damage to the thyroid gland. Performance monitoring replacement therapy carried out every 3-6 months, through tests for thyroid hormones and TSH, as well as taking into account the overall clinical picture. This should only be done by the attending physician.

If AIT is complicated by thyroiditis resulting from previous viral infection(subacute thyroiditis), glucocorticoids are prescribed. Nonsteroidal anti-inflammatory drugs are used as a means to reduce the level of antibodies to thyroid cells.

Immunocorrective drugs and vitamin complexes.

If the proliferation of thyroid tissue begins to affect neighboring organs, that is, to compress them, surgical intervention is indicated - resection. This method is radical, but in this case it is necessary.

Not all people perceive well hormonal treatment. For the most part, this comes from excessive “reading” - on some resources, reviews describe frightening stories about negative consequences hormone replacement therapy, which are mostly unfounded. Against this background, treatment of autoimmune thyroiditis with homeopathy or other non-traditional or folk remedies is becoming increasingly widespread. Of course, such methods of therapy will not make things worse, and in some cases there is an improvement in the patient’s condition. One thing should be remembered: any treatment (whether it is a homeopathic method or another) must be carried out under the supervision of a specialist endocrinologist. Self-medication for autoimmune thyroiditis can cause irreparable harm!

If we talk about the prognosis for the development of AIT, it can be given a satisfactory assessment, although it is impossible to completely cure autoimmune thyroiditis. Timely diagnosis and therapy makes it possible to quite seriously slow down the processes of destruction of thyroid tissue and, accordingly, its dysfunction. In such cases, there is a long remission of the pathology, which can last up to 20 years, not counting rare and short periods of exacerbation of autoimmune thyroiditis. The main danger of AIT and high level AT to TPO is the possibility of developing a hypothyroid state of the thyroid gland in the future.

If a woman develops postpartum thyroiditis after pregnancy, in 2 out of 3 cases it will appear after the next child. And in about a quarter of cases, postpartum thyroiditis turns into chronic autoimmune thyroiditis and the consequences of this form of AIT are a persistent hypothyroid state of the thyroid gland.

Autoimmune thyroiditis and its chronic form are among the most common diseases of the thyroid gland. The danger of this pathology lies primarily in the difficulty of diagnosing it, so initial stages the euthyroid phase and subclinical phase of AIT can be completely asymptomatic. Symptoms mainly appear in the active stage of the disease.

Considering that the risk group is mostly people aged 40-50, they should regularly undergo examination of the condition of their thyroid gland. The same applies to parents, among whom there are patients with pathologies of the thyroid gland - a predisposition to dysfunction of the endocrine organ can be transmitted genetically, which means that the causes of autoimmune thyroiditis or its chronic form include heredity. And the last thing to remember: self-medication is not the answer - the harm can far exceed the planned benefit.