Autoimmune thyroiditis etiology. Symptoms and methods for diagnosing chronic hashimoto's thyroiditis

Hashimoto's thyroiditis is a chronic dysfunction thyroid gland as a result of the development of autoimmune processes, in which immune cells attack the follicles and parenchyma of the organ, which leads to its degeneration. In modern medical nomenclature, the disease is called autoimmune thyroiditis (AIT). This pathology is common, because it accounts for up to 30% of all thyroid diseases.

In women, pathology is diagnosed much more often than in men, which is explained by the increased probability of mutation of certain genes on the X chromosomes. Transformed cistrons affect the lymphoid system of female sex hormones.

The vast majority of diagnoses are registered in the age range from 40 to 55 years, but in the past few decades, people at a younger age and even children have become increasingly ill.

Hashimoto's thyroiditis is characterized by the development of several conditions distinguished by origin.

The classification of the disease is presented below:

1. . The pathology consists in the pathological infiltration of T-lymphocytes into the thyroid tissue, which leads to an excess of antibodies in the parenchyma of the organ. An excess of immune cells is the main cause of dysfunction, which is a decrease in the amount of thyroid hormones. Ultimately, stable hypothyroidism develops. The disease is often not independent and develops along with other autoimmune pathologies in the body. Chronic AIT is familial and is stably transmitted through generations.
2. Hashimoto is recorded more often than other species this disease, so it is well studied. The bottom line is this. In a woman during pregnancy, immunity is sharply reduced, which is a normal reaction of the body to the development of the fetus. However, subsequently immunity is restored, but its intensity becomes much stronger. If a woman is predisposed to the disease, then the likelihood of its development is significant.
3. Cytokine-induced thyroiditis. The disease is a consequence of the prolonged use of drugs containing interferon. Usually, such drugs are prescribed for blood diseases or hepatitis C.
4. Painless AIT. This condition is characterized by the absence of pain. The development of the disease is similar to that which develops in the postpartum period in women, but has no connection with pregnancy. At the moment, scientists have not yet been able to accurately establish the cause of the development of this form of AIT.

Note. All the types listed above, with the exception of chronic thyroiditis, have a certain similarity in the stages of development. In the beginning, the destruction of the tissues of the thyroid gland occurs, against this background, thyrotoxicosis develops. Subsequently, the organ cannot perform its functions in full, which leads to transient hypothyroidism.

Stages of the disease

Hashimoto's thyroiditis is characterized by sequential development and is divided into several phases that replace each other:

1. Euthyroid phase. This is a rather long stage of the disease. It can last for years or even a lifetime, without causing much concern to a person. In such a case, no pathological processes are observed in the organ, leading to the destruction of its cellular structure.
2. subclinical phase. This stage is characterized by a latent course, symptomatic signs are completely absent. At this time, T-lymphocytes destroy the tissues of the organ, however, in total, the hormonal function of the thyroid gland remains at the same level because at this time TSH (pituitary hormone) is secreted in an enhanced mode, which causes the thyroid gland to compensate for the lack of synthesis of iodine-containing hormones . The main load falls on the surviving healthy follicles that synthesize the T4 hormone. In the subclinical phase, a blood test shows the normal content of iodine-containing hormones.
3. thyrotoxic phase. At this stage, the attack of immune cells increases on the thyroid gland and follicles, therefore, an active release of hormones occurs not due to increased synthesis, but because they are released from collapsing follicles with an increasing attack of lymphocytes on the parenchyma. Since elements of dead cells are observed in the organ, the immune response becomes more intense. Thus, the tissue breakdown of the thyroid gland increases several times, which ultimately leads to a drop in synthetic activity due to a lack of normally functioning follicles. In the blood, the level of T4 sharply decreases and the disease flows into the last phase.
4. hypothyroid phase. The duration of this stage is about a year. At this time, the thyroid gland gradually restores its original structure, but this process is not possible in all patients. In chronic forms of autoimmune thyroiditis, stable hypothyroidism is observed, which will last a lifetime, and the patient will have to take hormone replacement therapy.

Note. Autoimmune thyroiditis can have only one phase. As a rule, in this case, either thyrotoxic or hypothyroid phases are observed.

Clinical forms

Depending on the manifestations and clinical picture, Hashimoto's goiter has three forms. The table shows a brief description of each of them, and on the video in this article you can find a more detailed description of them.

Table. Clinical forms of Hashimoto's thyroiditis:

Important. With the trophic form of Hashimoto's goiter, significant destruction of thyroid tissue is possible. In this case, it is not able to synthesize a sufficient amount of hormones due to the lack of follicles. This is the reason for the extremely low synthetic activity of the organ.

Reasons for the development of the disease

Autoimmune thyroiditis in most cases is hereditary in nature, however, for the onset of clinical signs, the presence of a genetic predisposition alone will not be enough.

In order for the disease to begin to develop, the influence of the following causes is necessary:

• the presence of serious infectious diseases in the past;
• chronic infectious diseases that are sources of constant infection, for example, chronic tonsillitis, caries, diseases of the nasopharynx or throat, and other infectious pathologies;
• poor ecology: constant exposure to toxic substances (especially chlorine and fluorine derivatives that enhance the activity of T-lymphocytes), increased background radiation, lack of iodine in the body, and others;
• long-term use hormonal drugs or containing iodine, as well as their independent use;
• prolonged exposure to sunlight (especially at lunchtime);
• chronic and prolonged stressful situations.

Signs of the disease

It has already been mentioned above that two initial stages AIT proceed latently - these are euthyroid and subclinical phases. In some cases, the initial forms of goiter may be recorded.

Then the patient feels mild symptoms in the form of increased fatigue, unusual sensations in the form of a coma in the throat, discomfort when swallowing, and possibly pain in the joints. The first signs of the disease in most cases begin to appear when it has been present for more than one year.

Symptoms correspond to the above phases. Under the hour of development of destructive processes in the thyroid gland, the disease stops for a certain period in the euthyroid phase, after which a drop in activity occurs and a stable form of hypothyroidism is observed.

In the case of postpartum hypothyroidism, symptoms begin to appear in the fourth month after birth. As a rule, a young mother begins to get very tired and lose weight for no reason.

In more rare cases Clinical signs pronounced clearly: increased sweating, changes in cardiac rhythm, fever, muscle tremors, as well as other signs that are manifested in diseases of the thyroid gland. At the end of the fifth month after the birth of the child, the hypothyroid phase develops, which in certain cases may coincide with postpartum depression.

The note. The painless form of autoimmune thyroiditis has a slightly noticeable clinical picture with mild signs of thyrotoxicosis.

Diagnostics

The definition of Hashimoto's autoimmune thyroiditis has its own characteristics, which lie in the fact that the disease is almost impossible to determine until the concentration of iodine-containing thyroid hormones begins to decrease. The doctor conducting the diagnosis (or primary examination) should get a complete picture of the symptoms that appear, so it is important for the patient to state in as much detail as possible all the features of the course of the disease. If close relatives have AIT, then this circumstance is a confirming factor for the diagnosis.

The presence of pathology is indicated by the following deviations in the analyzes:

• increased concentration of leukocytes in the blood test;
• an immunological blood test establishes an increased amount of antibodies to thyroid hormones of the thyroid gland;
• in a biochemical study of blood, a deviation from the norm of thyroid and pituitary hormones is determined;
• ultrasound diagnostics can show different echogenicity of the parenchyma, a change in the size of the organ, the presence of neoplasia or nodes;
• fine needle biopsy confirms an abnormally large number of lymphocytes infiltrating the thyroid tissue.

The presence of all three of the following parameters should be the basis for a correct diagnosis:

• increased amount of antibodies;
• Ultrasound registers hypoechoic parenchyma;
• characteristic symptoms for low hormone levels.

Only the simultaneous registration of these signs can allow the doctor to make a diagnosis. In the event that any parameter drops out, or its manifestation is weak, it is most often not necessary to talk about the presence of autoimmune thyroiditis, but the patient should be observed.

In most cases, treatment comes when the hypothyroid phase, that is, low hormone levels, is recorded. This circumstance explains the lack of urgency of making a diagnosis before the start of a decrease in the synthetic activity of the organ.

Treatment

Since it is not possible to identify an accurate diagnosis before the onset of negative symptoms, it is very problematic to stop the development of the disease at the initial stages. Treatment is started if the disease is already in the hypothyroid phase.

When the thyrotoxic phase of AIT is observed, blood tests detect an increase in the concentration of hormones in the blood. However, doctors do not prescribe drugs to reduce the synthetic activity of the organ, since this is not necessary. Hyperthyroidism in this case is caused by the release of hormones from the collapsing follicles under the action of aggressive lymphocytes. In such a case, patients often complain of tachycardia, so they are prescribed drugs to calm the heart rhythm.

With hypothyroidism of any form and duration, a person must constantly drink hormonal drugs in order to compensate for the lack of thyroid-stimulating substances in the body (hormone replacement therapy). If, simultaneously with autoimmune, subacute thyroiditis is also detected, then the use of glucosteroid drugs may be prescribed, which quite often happens during cold periods, for example, in winter.

The doctor can simultaneously prescribe non-hormonal anti-inflammatory drugs such as diclofenac and the like along with steroids. Mandatory is the appointment of immunomodulators to correct the work of the body's defenses. In severe situations, for example, with atrophy of the thyroid gland, surgical treatment can be performed.

Forecast

With timely therapy and patient compliance with the instructions issued by the doctor about the rules of behavior and nutrition, the prognosis is generally quite favorable. When there are no anatomical changes in the thyroid gland and adequate therapy is prescribed, the disease enters a long-term remission, since all negative processes slow down.

Such a state of proper treatment can last 10-15 and even 20 years. However, a prolonged remission will periodically be replaced by exacerbations. If this disease is detected and a stable symptomatic picture is present, the development of hypothyroidism is predicted in the future.

If autoimmune thyroiditis develops after childbirth, then the probability of recurrence of the disease during the next pregnancy is estimated at 70%. Stable forms of hypothyroidism are observed in every third patient with postpartum form of AIT.

Complications

Missed symptoms and treatment not started on time leads to a number of health problems:

• The appearance of goiter. With constant irritation of the thyroid gland, the amount of hormones entering the bloodstream increases and leads to its growth. By itself, the goiter does not have a significant effect on the well-being of a person, with the exception of discomfort due to an increase in the size of the neck. A large goiter changes the appearance of a person, making swallowing and breathing difficult.
• Deterioration of the heart. The disease increases the risk of developing cardiovascular pathologies. The prerequisite is a high level of low-density lipoprotein, which is found in blood tests in the form of "bad" cholesterol. If treatment is not started on time, the patient will experience a load on the heart, which threatens heart failure.
• Deterioration in mental health. Initially, a person experiences bouts of depression in the early stages of Hashimoto's disease, but they gradually become severe.
• Decreased libido. Sexual desire decreases in both men and women.
• Myxedema. With a long course of the disease, the occurrence of a life-threatening condition is not excluded, when the patient experiences lethargy and drowsiness, weakness up to loss of consciousness. Coma develops under the influence of cold, sedatives, infection or stress. It is very important not to miss this condition and get immediate medical attention.
• birth defects. There are cases of the birth of children with already developed abnormalities in women who had untreated hypothyroidism due to Hashimoto's disease. Such babies have problems with intellectual development, physical disabilities, kidney disease from childhood.

We insist before conceiving a child and be sure to early stages pregnancy, check the condition of the thyroid gland.

Preventive measures

At the moment, scientists have not yet been able to develop a set of preventive measures that would avoid the development of the disease. Based on this, early diagnosis is extremely important, which will allow starting a therapeutic effect and significantly slowing down the progression of the disease.

As a rule, in most cases, the treatment consists in compensating the weak activity of the thyroid gland with synthetic hormonal preparations, however, at this time the disease is already entering a stable state. chronic form. It is equally important to determine the presence of a predisposition to the disease, especially if there have been cases of autoimmune thyroiditis in the family.

To do this, donate antibodies to thyroid peroxidase. This diagnosis is especially important for women who are going to give birth. If a genetic predisposition is established, then the likelihood of developing postpartum autoimmune thyroiditis is quite high, therefore, during pregnancy and in the first year after the birth of a child, a woman should be under close medical supervision.

Hashimoto's thyroiditis is an endocrine pathology, an inflammatory process covering the tissues of the thyroid gland, due to autoimmune genesis. The immune system begins to “erroneously” destroy follicular cells.

Goiter Hashimoto, secondarily referred to as autoimmune thyroiditis, is named after the Japanese doctor who first described the pathogenesis of this disease.

Such a formulation is not entirely correct, since autoimmune thyroiditis (hereinafter referred to as AIT) is a generalized term that includes a number of diseases united by an identical nature of origin. Speaking of thyroiditis, Hashimoto's is one type of AIT.

Among thyroid diseases, the problem of AIT is a significant percentage, the figure ranges from 20-30%.

The weaker sex is at risk in the leading positions, since in women, acquaintance with this disease occurs ten times more often than in men. The age of patients with similar endocrine abnormalities exceeds the fifty-year mark. However, there are exceptions when AIT is diagnosed in young patients, even children.

Classification and stages

There are four types of endocrine pathologies that are united by autoimmune genesis.

Chronic lymphocytic thyroiditis- due to a number of causal circumstances (genetic predisposition,) performance is impaired immune system, which leads to the production of antibodies to thyroid cells by lymphocytes.

The result of such a “failure” is that antithyroid autoantibodies destroy healthy cells, provoking a malfunction of the gland. Among possible consequences AIT:

• decrease in the functional activity of the gland, the synthesis and concentration of hormones in the blood are reduced
• nodular growth

Postpartum thyroiditis- leads in "popularity", occurs due to excessive restoration of the activity of the mother's immune system after the birth of a child. The risks increase if the woman is type 1 diabetic.

Silent, or otherwise called painless form- identical to the postpartum type of AIT, however, the appearance of pregnancy is not due, the causes are not known.

The last type is called cytokine-induced, can manifest itself when using medicines based on interferon, in the treatment of patients with blood diseases, or diagnosed with hepatitis C.

Pathogenesis of AIT

In endocrine pathologies belonging to this group of diseases, four phases of development are possible:

• The first stage is called euthyroid, when there are no dysfunctions of the gland. The probable duration ranges from several years to a couple of decades.
• The second is called the subclinical phase, ascertained during the progression of the disease. Aggressive "behavior" entails the destruction of tissue and cellular structures, a decrease in the number of thyroid hormones produced.
• The third stage is called thyrotoxic, since the blood is filled with thyroid hormones. Destroyed cells that enter the bloodstream “increase” the production of antibodies. Thyroid tissues are destroyed. The number of cells producing hormones falls, which leads to a noticeable decrease in thyroxine in the blood. The functional activity of the gland decreases - hypothyroidism occurs.
• The fourth possible phase is called hypothyroid, lasts 1.5-2 years, and later the functionality of the gland is restored. An exception is when the nature of hypothyroidism is stable, persistent.

In addition to the above, there is another classification criterion:

• size of the gland

On this basis, three forms of AIT will be distinguished:

• Latent - the dimensions are normal, there are no seals, the functional activity is normal.
• Hypertrophic- a goiter appears, a uniform increase in the entire volume is possible,. It happens that a combination of both forms (diffuse + nodular) is diagnosed.
• atrophic form- the size is reduced, it is more often stated in people of advanced age. In young people, it is possible with radioactive exposure. The consequences for the thyroid gland are severe, since the follicular cells “die” en masse. A sharp decrease in functional activity is noted.

What are the causes of AIT

The main reason is a genetic predisposition, if any of your close people were sick, then the risks of “getting acquainted” with a similar disease increase for you.

The list of secondary negative factors that can become catalysts for the onset of the disease:

• prolonged uncontrolled intake of hormonal drugs, drugs containing iodine
• unsatisfactory environmental conditions
• stressful situations
• chronic infections, bacterial, viral nature - sinusitis, flu, dental caries

Signs of the disease

The difficulty lies in the long interval of asymptomatic course of the disease. Visible changes in the size of the gland does not occur, with palpation examination pain absent, the function is able to remain normal. Independently, it will not work to detect endocrine abnormalities, only with a planned examination.

AIT is indicated by:

• heterogeneity thyroid glands
• violation of the functional activity of the gland
• elevated levels of antibodies

An appeal to an endocrinologist usually occurs when a goiter occurs, complicating the patient's quality of life. There are situations when the amount of hormones produced by the gland exceeds the permissible norm, then we are talking about thyrotoxicosis. With AIT, a similar endocrine abnormality occurs in the first years of the disease. In the future, when the size of healthy thyroid tissue decreases, the disease “transforms” into hypothyroidism.

List of likely accompanying symptoms.

Feature reduced:

• lump in throat
• a feeling of squeezing is created, like a tightly buttoned collar
• fatigue, constant weakness of the body
• low sweating
• chills
• obesity
• trembling limbs
• apathy
• depression
• edematous manifestations on the face, eyelids, tongue
• hoarseness
• the patient is emotionally unstable
• sleep problems
• pain in the joints
• leg swelling
• brittle nails
• constipation

At function enhancement, another symptomatic pattern:

• high heart rate
• increased nervousness
• frequent mood swings
• pressure rise
• tendency to break
• diarrhea
• tearfulness
• hair fall out

Complications

• arrhythmias
• heart failure
• heart attack
• atherosclerosis

Diagnosis

List of laboratory tests:

• do an ultrasound
• check blood levels of TSH
• conduct an immunogram
• determine T3, T4
• fine needle aspiration biopsy

Treatment of Hashimoto's thyroiditis

Specific therapeutic methods against AIT have not been developed. It is not yet possible to safely and effectively correct emerging autoimmune failures in order to exclude the progression of pathology to stable hypothyroidism.

The task of the treatment process of AIT is to maintain a normal level of thyroid hormones in the blood. Creation of conditions for persistent euthyroidism.

The treatment process is based on two directions:

• use of L-thyroxine
• the use of immunomodulatory drugs

The foregoing is relevant for manifestations. The dosage is adjusted by the endocrinologist on an individual basis.

Thyrotoxicosis stage - selection of treatment strictly by a doctor, no amateur performance. Thyrostatic drugs that reduce synthesis hormones are not prescribed. Therapy is selected individually.

Use drugs that eliminate the painful symptoms of the underlying disease.

With pronounced cardiovascular disorders, beta-blockers are used.

Immunosuppressants(prednisolone, and its analogues) - medicines, whose task is to reduce the activity of immune inflammation, are practically not used in Hashimoto's thyroiditis. An exception is the joint course of autoimmune and subacute forms of thyroiditis.

To reduce the content of antibodies, therapy is supplemented with non-steroidal anti-inflammatory drugs: indomethacin, voltaren.

An impressive increase in the size of the gland, painfully perceptible pressure are indications for surgical intervention.

Herbal treatment

Decoctions and infusions, useful herbs, can be used in the treatment of endocrine pathologies related to autoimmune.

The folk remedies listed below can become an obstacle to the process of an autoimmune response from the outside. The actions of such “green doctors” are not aimed at suppressing the immune system, but only normalize the immune system.

Self-treatment of AIT is categorically unacceptable. An endocrinologist can prescribe adequate treatment. Regular hormone testing is required. Usage folk recipes, be sure to coordinate with an endocrinologist, an experienced phytotherapeutist.

Preparations based on bear bile "inhibit" autoimmune activity, restoring the physiological structure, normalizing the functionality of the gland.

You will need parsley, celandine, taken 50 gr., 500 ml. vodka. After mixing the components, we insist for a week. After seven days, add pre-crushed bear bile 20 gr. We withstand a week, not forgetting to shake the contents regularly.

A single dose of 20 drops, three times throughout the day. After a month, take a week break, and then repeat the course.

Now I'll tell you about oil extract- a procedure that reduces swelling, relieves inflammation of the thyroid gland, and prevents the formation of nodes.

Similar extracts from medicinal herbs impregnate the skin, freely penetrating into, quickly acting on the diseased thyroid gland. The list of plants that can be taken as the basis of oily extracts:

• cocklebur
• succession

Chop the grass, pour vegetable oil, without smell. The required proportion is 1.5/1. The storage place is dark, we stand for a month, drain the oil, squeeze the grass. Rub your neck before bed. Storage at t +10 up to one and a half years.

Tincture of pine buds - the resinous substances present in the composition increase the blood supply to the gland.

This tool contains iodine, which is easily absorbed in the right amount.

Pre-crushed pine buds fill 1/2 l. capacity, add 40% alcohol. Insist three weeks, in a place protected from light. Then the liquid is drained, filtered, and the raw material is squeezed through cheesecloth. The resulting tincture is treated with inflamed areas, twice a day.

The basis of the next collection is immunomodulators, which are so important for Hashimoto's goiter. List of required herbs:

• Cetraria Icelandic
• meadowsweet
• small duckweed
• sweet clover
• gorse dyeing
• horsetail
• common toadflax

From the first three herbs, from the list above, we take flowers - 2 parts. The rest are needed in 1 part, the grass will be required directly. After mixing the components thoroughly, pour water (200 ml.), 1 tbsp. l. resulting collection. We warm for a quarter of an hour in a water bath, insist for half an hour, and then filter. We restore the lost volume with boiled water. Without letting the broth cool down, add 50 drops of Rhodiola quadruple tincture. Course intake for a month and a half, a single dose of 70 ml, half an hour before meals. Break two weeks, and then repeat the course.

Good words need to be said about licorice, an extremely interesting medicinal plant. Folk therapy uses the root of the plant, rich in nutrients. Composition:

• pectin
• saponin
• glucose
• starch
• flavonoids
• asparagine
• sucrose
• vitamins
• minerals
• organic acids
• glycyrrhizin is especially valuable because it stabilizes the performance of the adrenal glands, strengthens immunity restores hormonal balance

• antitoxic
• antishock
• anti-allergic
• anti-exudative
• antimicrobial
• wound healing
• enveloping
• antipyretic
• antispasmodic

On the roots of licorice endowed with a mass of positive qualities:

• improve intestinal peristalsis
• normalize the secretion of gastric juice
• strengthen immunity
• lower cholesterol levels
• fight chronic constipation, which is characteristic of hypothyroidism
• normalize the nervous system
• disappears, sleep disturbances disappear
• increases the body's resistance to oxygen deficiency

Conclusion - the plant naked licorice is a universal natural medicine.

St. John's wort and celandine herbs deserve positive feedback, we will briefly mention each.

St. John's wort - flavonoids, which are in the composition, fight inflammation, viruses, purify the blood. The affected cellular structures of the thyroid gland are restored, while maintaining functionality.

Hashimoto's thyroiditis, provokes fibrous processes, the formation of nodes. Carotene, rutin, vitamins C, E are strong antioxidants that prevent the development of such a negative scenario of the disease.

Celandine is poisonous, but it has pronounced antitumor properties.

Now the recipe, where the herbs mentioned above are included in the composition, normalizes the function of the gland, promotes the “resorption” of nodules.

The list of herbs that you want to take in equal shares:

• liquorice root
• St. John's wort
• celandine
• dog-rose fruit
• angelica

In a way convenient for you, grind the ingredients thoroughly, mix, add boiling water. Ratio 200 ml. water / 1 tbsp. l. collection. Bringing to a boil, simmer over low heat for a quarter of an hour. Bay in a thermos, soak for four hours, filter. Take 100 ml. after meal. Last dose, at least five hours before bedtime.

Medicinal plants are an effective therapeutic tool that prevents the formation of tumors, controls the level of hormones, and stabilizes the functional activity of the thyroid gland.

To protect the body from unwanted consequences, treat Hashimoto's thyroiditis folk remedies permissible with mandatory approval, further control of the endocrinologist.

Take an interest in health, goodbye.

By etiology:

Infectious (bacteria, fungi)

Autoimmune

Caused by physical factors

unknown etiology

With the flow:

1. Podostye

De Quervain's granulomatous

lymphocytic

Chronic:

Hashimoto

Acute thyroiditis

Etiology:

Most often staphylococci, streptococci, Gr.”-“flora

Spread of the pathogen: hematogenous, lymphogenous, intracanalicular.

Clinic:

temperature, fever, chills, weakness. Pain in the neck and enlargement of the thyroid gland. When abscessing - softening.

Macroscopic picture:

The gland is enlarged, edematous.

Microscopic picture:

Hyperemia, PMN infiltration, dystrophic and necrobiotic changes in the parenchyma.

Exodus: sclerosis and hyalinosis with a decrease in the functioning parenchyma.

Subacute de Quervain's granulomatous thyroiditis

(viral, giant cell)

An infectious disease apparently of a viral nature. Until the end, its etiology is unknown.

Women get sick 5-6 times more often.

Duration ranges from 2 weeks to 2 years.

It is preceded by a viral infection: acute respiratory infections, mumps.

Pathogenesis:

The destruction of the follicles occurs, damage to their basement membrane and the release of the colloid into the stroma. In response, productive inflammation develops with the formation of infiltrates from lymphocytes and plasma cells. Giant cells of the Pirogov-Langans cell type appear, phagocytizing the colloid. At the same time, proliferation of connective tissue cells occurs in the stroma. As a result, the development of coarse fibrous connective tissue and its hyalinosis.

Clinically, the disease proceeds with fever, painful enlargement of the thyroid gland.

Macroscopic picture:

More often, part of one lobe is affected. Usually the increase is asymmetric, more often focal, but sometimes the entire gland increases unevenly. On the section, the affected area is pale, slightly transparent, crossed by many whitish strands. Its borders are indistinct, blurry.

Microscopic picture

Damage to individual follicles, desquamation of the thyroid epithelium, necrosis of the basement membrane. The accumulation of macrophages, among which there are giant cells, as well as PMNs, lymphoid elements.

In the future, fibrous bands are found, immuring granulomas containing giant cells. These granulomas are sometimes mistaken for tuberculosis.

Autoimmune Hashimoto's thyroiditis

Women 40-50 years old are more often affected. The onset of the disease is imperceptible, the course is long.

It is the most common cause of hypothyroidism.

Pathogenesis

Autoimmune reactions play a leading role. AIT can be combined with other autoimmune diseases: type 1 diabetes, Sjögren's disease, autoimmune gastritis, etc.

The disease is associated with the appearance of antithyroid autoantibodies;

to thyroglobulin

and microsomes of the follicular epithelium.

The autoimmune process leads to diffuse infiltration of the thyroid gland by lymphocytes and plasma cells, the formation of lymphoid follicles. Thyrocytes die as a result of the action of immune cells and are replaced connective tissue

Macroscopic picture:

The gland is enlarged, sometimes asymmetrically (weight increases up to 100 g), bumpy, dense, difficult to cut, pale yellow in section.

Microscopic picture:

A dense lymphocytic infiltration is determined with the formation of follicles with light centers and numerous mitoses in them. Follicles in small groups or singly are located among the infiltrates. They are atrophied. The earliest sign is the oxyphilic transformation of thyrocytes, i.e. the appearance of a large number of Ashkinazi cells. The stroma of the gland is fibrosed, especially in the interlobular septa. The gland acquires a large-lobular structure.

Thus, the main signs of Hashimoto's thyroiditis are:

oxyphilic transformation

lymphoid infiltration

parenchymal atrophy

stromal fibrosis

Exodus: The thyroid gland decreases, sclerosis, which is accompanied by hypothyroidism and myxedema.

Thyroid diseases are quite common today. Damage to the cells of an organ is fraught with a violation of hormonal synthesis and malfunctions of many body systems. One of the most severe pathologies that is very difficult to treat is Hashimoto's thyroiditis (autoimmune thyroiditis, AIT), the symptoms of which were first described by the Japanese doctor Hakaru Hashimoto.

Hashimoto's disease is an autoimmune disorder in which inflammation and death of thyroid cells (thyrocytes) develop due to the action of one's own immunity. In fact, the immune system, for some reason, begins to attack the cells of its own body, producing specific antibodies and affecting the thyroid gland. The main danger of Hashimoto's thyroiditis is the prospect of a gradual inhibition of the function of the organ and a total deficiency in the synthesis of thyroid hormones, which threatens to malfunction the whole organism.

Causes

Until now, experts have not figured out what becomes the immediate impetus for development, for what reasons the immune system ceases to recognize thyroid cells and begins to produce antibodies against them.

It is assumed that malfunctions in the immune system may occur under the influence of predisposing factors:

• heredity;
• viral and bacterial infections;
• severe nervous shocks;
• long-term use of hormonal drugs;
• presence of other autoimmune diseases ( rheumatoid arthritis, lupus);
• bad ecological situation.

Development phases and symptoms

The disease is quite insidious. At the first stages of its development, it proceeds almost asymptomatically. The patient has no specific complaints. There may be a feeling of general malaise, which is often attributed to overwork and other reasons.

There are several stages (phases) in the development of Hashimoto's thyroiditis:

• The immune system suddenly begins to produce antibodies against thyrocytes. But there are no pronounced violations of the functionality of the thyroid gland. In response to the attack of antibodies, it actively releases its hormones into the blood. This phase can last for several years.
• Gradual destruction of thyroid tissues and its hyperactivity lead to depletion of the function. For some time, the level of thyroid hormones stabilizes. A state is coming.
• There is an accumulation of thyroid hormones in the blood. Destroyed cells also get there, the production of antibodies increases, thyroid tissues are destroyed. Excess thyroid causes the development of temporary.
• The period of pronounced The number of cells that synthesize hormones decreases, the thyroid gland gradually loses its activity.

At increased production thyroid hormones develop signs of thyrotoxicosis:

• weight loss;
• excessive sweating;
• arterial hypertension;
• osteoporosis;
• cardiopalmus;
• nervousness, increased excitability;
• diarrhea.

During the attack of the immune system on the thyroid gland, its tissues are destroyed, and a lot of thyroxine is released into the body. This is the main reason that with Hashimoto's thyroiditis, a person may have temporary bursts of thyrotoxicosis, and after it comes a hormone deficiency.

Symptoms:

• weight gain;
• constipation;
• increased fatigue;
• trembling in the limbs;
• pain in the joints;
• puffiness;
• reduction in the number of heartbeats;
• depressive states.

The chronic course of AIT leads to the appearance. Deficiency of thyroid hormones ceases to be fixed by receptors. Accordingly, the function of the organ decreases even more, the development of hypothyroidism increases.

Note! Hashimoto's thyroiditis can present with a wide range of symptoms. It all depends on the stage of the disease, the degree of cell damage. Patients may have signs of hypothyroidism or thyrotoxicosis. For a long time, the course of AIT can be latent. A common symptom is constant fatigue.

Possible consequences

If Hashimoto's thyroiditis is not treated, then the progression of dystrophic processes in the thyroid gland will lead to disruptions in the work of most organs and systems.

Complications of AIT:

• increased cholesterol levels, and subsequently disruption of the cardiovascular system;
• depletion of the central nervous system, which may result in mental disorders depression, memory problems;
• decreased libido;
• menstrual irregularities.

Diagnostics

In order to identify Hashimoto's thyroiditis, you need to turn to. The doctor will prescribe a set of laboratory tests and instrumental studies after questioning the patient and examining the thyroid gland.

Laboratory research:

• thyrotropin test;
• blood on , ;
• immunogram;
• availability determination.

To visualize the state of the organ, it is carried out. The study helps to identify the presence of seals, nodes, changes in the size of the body. To exclude a malignant process, a fine-needle biopsy is performed and the material is examined for the presence of atypical cells.

How to prepare for the exam and what do the research results show? We have an answer!

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Effective Treatments

There is no single protocol for the treatment of Hashimoto's thyroiditis today. The disease cannot be completely cured. The therapy strategy includes constant monitoring of the patient's condition, conducting tests, as well as taking medications to normalize hormonal levels and relieve symptoms of AIT. Expectant management is chosen in the absence of excess or deficiency of thyroid hormones and the normal functioning of the thyroid gland. When medical treatment is carried out.

In the case of hypothyroidism is prescribed. For this, synthetic analogues of thyroxine (L-thyroxine or) are used. Treatment can last from several months, in some cases lifelong use of hormones is required. The dosage of the drug may vary depending on the results of the analysis for TSH.

In addition to hormonal drugs for autoimmune thyroiditis, immunomodulators are recommended. Immunosuppressants (Prednisolone), which reduce immune inflammation, are practically not used today with Hashimoto's thyroiditis.

To reduce the number of antibodies, treatment is supplemented with NSAIDs:

• Diclofenac;
• Indomethacin.

In the later stages of the disease, sometimes resort to surgical intervention. Operations are carried out with a significant increase in the size of the gland, when it compresses neighboring organs or there is a risk of malignancy of the pathological process. But the operation will not solve the issue with the impact of the immune system on the cells of one's own body. And in most cases, after the intervention, the autoimmune process is even more activated. Patients develop a persistent insufficiency of thyroid-stimulating hormones, and their synthetic analogues will have to be taken for life.

Hashimoto's thyroiditis is a pathology of an autoimmune nature, which is practically not amenable to complete cure. If the disease is detected in a timely manner, then due to adequate therapeutic measures, it is possible to avoid the rapid progression of deformation and atrophy of the thyroid gland tissues, and to normalize the level of hormones. It is very important to constantly monitor the state of the gland and not disregard any signs of its dysfunction.

You can learn more about what Hashimoto's thyroiditis is, about the symptoms and stages of development of the pathological process, as well as about the treatment options for the disease after watching the following video:

Autoimmune thyroiditis (AIT, Hashimoto's thyroiditis, Hashimoto's goiter, Hashimoto's disease)- this is an inflammation of the thyroid tissue caused by autoimmune causes, which is very common in Russia. This disease was discovered exactly 100 years ago by a Japanese scientist named Hashimoto, and since then has been named after him (Hashimoto's thyroiditis). In 2012, the global endocrinology community widely celebrated the anniversary of the discovery of this disease, since from that moment endocrinologists have the opportunity to effectively help millions of patients around the planet.

Autoimmune thyroiditis - causes

Cause of autoimmune thyroiditis lies in the malfunction of the patient's immune system. With autoimmune thyroiditis, which occurs most often in women, the immune system, which normally provides "police" functions in the body and destroys foreign cells and organisms, begins to show aggression towards its own organ - the thyroid gland. The tissue of the thyroid gland is impregnated with leukocytes, the activity of which leads to the development of inflammation of the gland - thyroiditis (it is called autoimmune thyroiditis to emphasize that the cause of the disease is a malfunction of the body's own immune system). Over time, due to inflammation, some of the thyroid cells die, and the survivors begin to be insufficient to produce the required amount of hormones. Hormonal insufficiency develops - hypothyroidism.

Symptoms of autoimmune thyroiditis (AIT)

Symptoms of autoimmune thyroiditis it is easy to confuse with the everyday state of many of our compatriots: the patient is worried about weakness, drowsiness, fatigue, depression, mood deterioration, and sometimes swelling. Figuratively speaking, life begins to lose its colors. Many patients with autoimmune thyroiditis are also concerned about the slowing down of mental activity (“not collecting their thoughts”), hair often actively falls out.

Diagnosis of AIT

Diagnosis of autoimmune thyroiditis(its name is often abbreviated to three letters - AIT) is established if the patient has three so-called "big" signs: characteristic changes in the structure of the thyroid tissue during ultrasound examination, an increase in the blood titer of antibodies to thyroid tissue (antibodies to thyroperoxidase, antibodies to thyroglobulin), as well as an increase in the level of the hormone TSH and a decrease in the level of the hormones T4 and T3 in the blood. It is important to note that the diagnosis of "Autoimmune thyroiditis" should not be established in cases where the level of hormones is within the normal range. If there is no level up blood TSH(at least) or an increase in the level of TSH in combination with a decrease in the level of T3, T4 (in the most severe cases) - it is impossible to make a diagnosis of autoimmune thyroiditis (AIT). The conclusions “Autoimmune thyroiditis, euthyroidism” that occur quite often are incorrect, because they confuse doctors and often lead to unreasonable prescribing of thyroid hormone preparations to the patient.

Autoimmune thyroiditis on ultrasound of the thyroid gland

At ultrasound examination in AIT, there is usually a decrease in the echogenicity of the gland and the appearance of pronounced diffuse changes. Translating into “human” language, we can say that with autoimmune thyroiditis, the thyroid gland looks dark on the screen of the ultrasound machine and has a very heterogeneous structure - in some places the tissue is lighter, in others it is darker. Often doctors ultrasound diagnostics found in Hashimoto's disease in thyroid tissue and nodes. It should be noted that often these seals are not real nodes and are simply foci with a pronounced inflammatory process, they are also called "pseudo nodes". Most often, a qualified ultrasound doctor can distinguish a pseudonode in autoimmune thyroiditis from a nodule, but in some cases this is not easy to do. That is why doctors often write a conclusion something like this: “Signs of AIT. Nodes (pseudo-nodes?) of the thyroid gland”, to emphasize their uncertainty in assessing the nature of the changes. If formations with a diameter of 1 cm or more are detected in the thyroid tissue against the background of autoimmune thyroiditis, the patient is recommended to undergo a biopsy to clarify their nature. In some cases, after receiving the results of the study, it becomes clear that the examined node is a pseudo-node against the background of AIT (the cytologist's answer is usually short in such cases: "Autoimmune thyroiditis" or "Hashimoto's thyroiditis"). At the same time, against the background of autoimmune thyroiditis, it is possible to identify nodes of the colloidal (benign) structure, and malignant neoplasms.

Treatment of autoimmune thyroiditis

Treatment of the cause of autoimmune thyroiditis- Improper functioning of the immune system - currently impossible, since the suppression of the immune system leads to a decrease in the body's defense against viruses and bacteria, which can be dangerous. That is why doctors have to treat not the cause of autoimmune thyroiditis, but its consequence - a lack of hormones, or rather one hormone - thyroxine, which is produced by the thyroid gland from iodine that comes with food. A revolution in the treatment of AIT happened when doctors were able to use thyroid hormones freely. Luckily for us, pharmacists have synthesized an exact copy of the human hormone thyroxine, which does not differ at all from the original. If AIT and the associated lack of hormones are detected, the endocrinologist prescribes artificial thyroxine to the patient, which allows the hormone levels to return to normal. When administered correctly, thyroxine does not cause any side effects. The only inconvenience of such treatment is that it should be continued throughout the patient's life, because once started, autoimmune thyroiditis (AIT) never goes away, and the patient needs drug support all the time.

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