Does autoimmune thyroiditis always lead to hypothyroidism? Autoimmune thyroiditis of the thyroid gland: causes, symptoms and treatment Climatic conditions with aitis and hypothyroidism

One of the most important organs in the human body, is the thyroid gland. It contains the entire supply of iodine that enters the body, produces the necessary hormones, which in turn help the metabolism to function properly and affect the development of cells. However, like all other organs, the thyroid gland can suffer from exposure various diseases, and the most common of them is hypothyroidism against the background of autoimmune thyroiditis.

Subclinical hypothyroidism caused by autoimmune thyroiditis leads to an increase in TSH, which is a consequence of the reaction of the pituitary gland to a malfunction of the thyroid gland. As a result, surviving cells thyroid gland begin to work hard, maintaining a sufficient level of thyroid hormone. Due to such a reaction of the body, no symptoms may even appear that indicate a violation. That is why this type of hypothyroidism is called subclinical.

The body's response to disease

Since the thyroid gland affects all organs and systems in the body, symptoms can also appear with different parties. A sufficient amount of iodine is necessary for good organ performance. However, if the body feels a lack of it for quite a long time, then this can lead to a decrease in the rate of growth and cell division, which causes negative changes in the gland, as well as nodular formations.

Nodular goiter with AIT phenomena of subclinical hypothyroidism can be formed due to many reasons, such as:

lack of iodine;
pollution and toxins;
viral infections;
constant stress;
smoking;
long period of admission medicines;
genetics.

Periodically visiting an endocrinologist, you can monitor the condition, as well as the health of the thyroid gland. Thanks to this, it will be possible to recognize any manifestations of disorders and begin immediate treatment. Treatment options include the following:

proper use of radioactive iodine;
the use of drugs that stop the production of thyroids;
surgical intervention.

Autoimmune thyroiditis and hypothyroidism

AIT is sometimes called Hashimoto's thyroiditis. With such a diagnosis, the immune system begins to destroy the proteins of the thyroid gland, which is why it is destroyed. Primary hypothyroidism against the background of autoimmune thyroiditis can develop due to genetic or acquired disorders of the thyroid gland. However, this outcome can be prevented.

Symptoms of AIT hypothyroidism

With autoimmune thyroiditis, there may be no obvious symptoms. The disease progresses slowly and progresses to hypothyroidism. However, in most cases, one of the characteristic signs may be the appearance of a goiter, which can grow and increase, and other manifestations of the disease will result. If a nodular formation has arisen in the tracheal area, then it will interfere with breathing and swallowing, but most often the discomfort is felt simply from touching or when wearing scarves and ties.

Some symptoms of the disease can be expressed as follows:

insomnia;
disorders in the digestive system;
anxiety;
fatigue;
sudden changes in weight;
pain in the body, muscles, joints;
mood changes and depression.

Diagnosis of AIT

By undergoing regular examinations by a specialist, you can monitor the condition of the thyroid gland and identify more early stages various deviations from the norm of its work. An endocrinologist may identify the following:

deviations from the norm in the size of the body;
based on a blood test, you can determine the level of thyroglobulin, thyroperoxidase and antibodies, as well as their ratio;
a biopsy will help detect lymphocytes and macrophages;
by using radioisotope research one can see diffuse absorption in the enlarged thyroid gland.

Treatment of AIT hypothyroidism

In cases where there is an increase in the size of the organ, the endocrinologist will prescribe the patient therapy with the help of hormones. Artificial hormones, such as levothyroxine, help fight the shrinking thyroid. However, if drug treatment is not effective, then the attending physician may advise partial or complete removal of the gland.

If the patient was diagnosed with autoimmune thyroiditis subclinical hypothyroidism, then doctors can prescribe the hormone L-thyroxine or iodomarin, and after a month - TSH.

Some doctors are of the opinion that if the presence of thyroid antibodies is observed in autoimmune thyroid, then it is necessary to begin immediate treatment with small doses of hormones, such as those produced by the thyroid gland. Most practitioners advise using the drug levothyroxine if the level of TSH is within the normal range. This drug helps to resist the development of the disease, even suspend it. The reason for this result is that the level of antibodies and the content of lymphocytes are significantly reduced, which means that inflammation also disappears.

Treatment with hormonal therapy has a number of significant advantages. Of course, a person suffering from this disease must understand their dependence on drugs for the rest of their lives. However, this fact should not cause concern, since the treatment involves saturating the body with the missing hormones that the thyroid gland itself can no longer produce. Thanks to treatment with hormones, the following changes will soon be observed:

restoration of the thyroid gland;
absence of ailments;
relief comes very quickly, thanks to which the person suffering from the disease can return to normal life very quickly;
after three months, you can restore the level of hormones;
the dose of the drug does not change throughout the course, if there is no fact of pregnancy or significant changes in weight;
the cost of medicines also makes treatment quite affordable.

Treatment of subclinical AIT

For the treatment of this disease, no significant features are required, the main task of the therapy being carried out is to maintain thyroid hormones at the proper level. Such treatment is carried out as follows:

drugs are prescribed that contain hormones produced by the thyroid gland itself;
treatment of the underlying cause of the disease;
daily maintenance of the balance of the body, with the help of vitamins, as well as minerals;
proper nutrition. Since the metabolism is disturbed, due to simple rules diet, you can support the health and proper functioning of the gland.

If you take a closer look at the diet for healthy eating It is important to exclude the following foods:

sugar;
reduce water intake to 600 ml per day;
reduce the intake of fats: vegetable and butter, oily fish, nuts, avocados;
soy products.

In a diet that will help counter hypothyroidism, you need to include the following foods:

fresh vegetables and fruits;
beef, turkey and other poultry meat;
seafood, because it is they that contain the most a large number of iodine;
meat broths;
natural coffe.

Advanced forms of the disease are much more difficult to treat, especially since the outcome can have very serious consequences, such as coma and disruption of other organs. In addition, prevention is always much more best method than the actual treatment of the disease. However, unfortunately, on this moment it is possible to prevent only those types this disease, which are caused by an insufficient content of iodine entering the body. In order to prevent the development of pathology inside the womb, a pregnant woman must pass necessary tests and timely take measures to combat the disease.

The main factor in the occurrence of autoimmune thyroiditis- violation immune system. It manifests itself as a family disease. In the families of patients, there are other pathologies of an autoimmune nature. May occur after childbirth.

The precipitating factors include: chronic infections of the nasopharynx, caries; infections; yersiniosis (transmitted from livestock, dogs, rodents); contamination of soil, air and water with chlorine, fluorine, nitrates; radiation and solar exposure; stressful situations; prolonged, uncontrolled use of iodine-containing drugs or hormones; treatment with interferon drugs for blood diseases; injuries and surgeries thyroid gland.

Iodine is important in quantities exceeding the physiological norm. This applies to food (red food colorings, preservatives, iodine additives in flour, salt), but more often to medicines and dietary supplements.

The classification of the forms of Hashimoto's goiter includes latent, hypertrophic, atrophic.

The disease progresses several stages- euthyroid, subclinical, thyrotoxic,.

Signs of the disease found with significant destruction of the gland. Apart from clinical manifestations hypothyroidism (weakness, impaired thermoregulation, drowsiness, low arterial pressure) its consequence may be infertility. If, however, conception has occurred, then during gestation it has an adverse effect on the mother and child.

Most patients are at the subclinical and euthyroid stage They don't know they have thyroiditis. At this time, the thyroid gland retains its size, is not painful, the hormonal background is not disturbed. In the first years of the disease, autoimmune thyroiditis is usually manifested by hyperthyroidism. More commonly found in children: tendency to tearfulness, anxiety, agitation; increased irritability, aggressiveness; accelerated heartbeat; increase in the upper pressure indicator; sweating, poor heat tolerance; trembling of the eyelids, fingers; weight loss.

With hypertrophic form signs of compression of neighboring tissues come to the fore. Patients experience difficulty breathing, swallowing, hoarseness, short-term bouts of dizziness or fainting.

Before the onset of hypothyroidism, autoimmune thyroiditis is difficult to identify. Diagnosis includes: general blood test, blood immunology; blood hormones; ultrasound; . To confirm chronic autoimmune Hashimoto's thyroiditis, the simultaneous presence of the most important signs is needed: antibodies to thyroid peroxidase exceeding 34 IU / l, hypoechogenicity on ultrasound and symptoms of hypothyroidism.

Treatment is reduced only to compensation for violations of the formation of hormones.. Thyreostatics (Mercazolil, Espa-carb) are not used for hashitoxicosis, since hyperthyroidism is associated with the destruction of the thyroid gland, and not with increased thyroxine synthesis. With palpitations, tachycardia, increased pressure, hand trembling, the beta-blocker Anaprilin is indicated.

With the development of hypothyroidism replacement therapy is given levothyroxine (L-thyroxine,). To reduce the antibody titer, selenium (Cefasel) is added to the treatment for three months. Glucocorticoids (Prednisolone, Dexamethasone) are used for exacerbation of inflammation. With mild inflammatory process use nonsteroidal drugs (Voltaren, Indomethacin). For large sizes, an operation is performed to remove the gland.

Read more in our article about autoimmune thyrotoxicosis, its manifestations and treatment.

Read in this article

Reasons for the development of autoimmune thyroiditis

The main factor in the occurrence of this disease is a violation of the immune system, which begins to perceive the cells of its thyroid gland as foreign and produce antibodies against them. Autoimmune thyroiditis manifests itself as a family disease. Patients and their blood relatives have antibodies to enzymes (thyroid peroxidase) and that are involved in the formation of hormones - thyroxine and triiodothyronine.

In addition, in the families of patients there are other pathologies of an autoimmune nature - type 1 diabetes mellitus, rheumatoid arthritis, hepatitis, pernicious anemia, vitiligo. The mere presence of antibodies is not a guarantee of development active process. Therefore, even with a genetic predisposition, exposure to a provoking factor is necessary. The role of such reasons is proved:

chronic infections of the nasopharynx, especially tonsillitis, sinusitis, caries;
acute viral infections, especially hepatitis;
intestinal infectious diseases, yersiniosis (transmitted from livestock, dogs, rodents);
pollution of soil, air and water with chlorine, fluorine, nitrates (stimulate the activity of T and B lymphocytes responsible for cellular immunity and formation of antibodies).
radiation and solar exposure;
stressful situations;
prolonged, and especially uncontrolled use of iodine-containing drugs or hormones;
treatment with interferon drugs for blood diseases;
trauma and thyroid surgery.

Recent studies on the significance of these factors have shown that an important, and perhaps the main one, is the use of iodine in quantities exceeding the physiological norm. This applies to food (red food colorings, preservatives, iodine additives in flour, salt), but more often to medicines and dietary supplements.

It should be noted that self-treatment or prevention of iodine deficiency with iodine or Lugol's solution is extremely dangerous. Similar conditions can also occur when the dose of multivitamins is exceeded, long-term use of Kordaron.

Autoimmune thyroiditis can occur after childbirth. Its development is associated with the activation of the body's defenses after a period of oppression during pregnancy. If the patient does not have a hereditary predisposition, then it can stop spontaneously. There is also a painless ("mute, silent") variant of the disease that is not associated with pregnancy or any other known cause.

Hashimoto goiter classification

Depending on the severity of symptoms and changes in the thyroid gland, the disease can have several clinical forms.

Latent

Antibodies are found in the blood, but there are no signs of changes in the functioning of the thyroid gland. Possible erased symptoms of a slight increase or decrease in the formation of hormones. During the study, there may be a slight increase in the size of the organ, seals are not detected.

Hypertrophic

With the development of goiter, there may be a uniform growth of tissues - a diffuse increase or nodes form against its background (diffuse-nodular form). Sometimes a node is found in unchanged tissue (). IN initial stage there is an excess synthesis of hormones (hyperthyroidism,), but in most patients the function does not change (euthyroidism) or decreases (hypothyroidism).

With the progression of autoimmune inflammation, the thyroid tissue is attacked by antibodies and killer lymphocytes, which leads to its destruction. During this period, the condition of patients worsens, and the formation of hormones decreases, a hypothyroid state develops with a decrease in metabolic processes in organism.

atrophic

The most severe form, since the function of the organ is significantly reduced due to the massive destruction of thyroid cells. Its size decreases, and hypothyroidism becomes persistent. It is more common in older patients and with radiation exposure at a young age.

Stages of the disease

The disease goes through several stages in its development. They are not always present in the patient. Possible monophasic for a long period.

Euthyroid

The work of the thyroid gland is normal. This phase of autoimmune thyroiditis lasts several or decades, and can last a lifetime.

subclinical

It begins with an exacerbation due to a massive attack of T-lymphocytes. These cells intensively enter the thyroid gland and begin the destruction of its tissue. In response, the pituitary gland intensively produces thyroid-stimulating hormone (TSH) and thus stimulates the production of thyroxine, maintaining its normal level.

thyrotoxic

With extensive damage to cells, hormones from them enter the bloodstream. This is accompanied by symptoms of thyrotoxicosis (tachycardia, weight loss, sweating, hand tremors). Together with hormones, parts of the follicles also enter the circulatory network. They act as antigens and provoke the formation of antibodies to their own cells.

Hypothyroid

What is terrible autoimmune thyroiditis

In Russia, Ukraine and Belarus, Hashimoto's thyroiditis affects from 4 to 12% of the population, depending on the region. As the environment becomes more polluted, its prevalence increases. Difficulty early detection disease is due to the fact that more than one year or even a decade passes from the moment of autoimmune damage to complications. Signs of the disease are detected with significant destruction of the gland, when the patient loses the ability to form hormones.

In addition to the clinical manifestations of hypothyroidism (weakness, impaired thermoregulation, drowsiness, low blood pressure), infertility can be its consequence. Moreover, it occurs not only with an explicit variant of the disease (manifest), but also with a hidden (subclinical) variant.

If, with severe manifestations, the patient cannot become pregnant due to ovulation disorders, then subclinical hypothyroidism is accompanied by habitual miscarriages. An overreaction of the immune system often explains infertility in endometriosis.

If, however, conception has occurred, then during gestation, hypothyroidism has an adverse effect on the expectant mother and child. This manifests itself in such complications:

the threat of premature birth;
preeclampsia ( high blood pressure, edema, convulsive syndrome);
detachment of the placenta;
slowdown in intrauterine development of the fetus;
bleeding after childbirth;
violations of the heart;
anemia.

Detachment of the placenta

The newborn has pathologies of the nervous and skeletal system, slow heartbeat. The combination of autoimmune thyroiditis and thyroid cancer is not common, but possible.

Symptoms of pathology in adults and children

Most patients in the subclinical and euthyroid stages of the disease are unaware of the presence of thyroiditis. At this time, the thyroid gland retains its size, is not painful, the hormonal background is not disturbed. In some patients, nonspecific signs may appear that do not lead them to a doctor:

discomfort in the neck
sensation of a lump in the throat,
fast fatiguability,
general weakness,
flying pains in the joints.

In the first years of the disease, autoimmune thyroiditis is usually manifested by hyperthyroidism. It is called hashitoxicosis. More often found in children in the form of:

tendency to tearfulness, anxiety, agitation;
increased irritability, aggressiveness;
accelerated and increased heartbeat;
increase in the upper pressure indicator (high systolic and pulse);
sweating, poor heat tolerance;
trembling of the eyelids, fingers;
weight loss.

Autoimmune thyroiditis in children

This stage is short and, unlike toxic goiter, does not lead to the appearance eye symptoms(bulging eyes, increased glare of the eyes, expansion of the palpebral fissure). In the future, the function of the thyroid gland weakens on average by 5% every year. Phase Relative normal operation lasts a long time, and only with the development of hypothyroidism can autoimmune thyroiditis be suspected.

In the hypertrophic form, signs of compression of neighboring tissues come to the fore. Patients have difficulty breathing, swallowing, hoarseness of voice, short-term bouts of dizziness or fainting. In the case of severe hypothyroidism, patients note:

apathy, lethargy, drowsiness;
constant chilliness;
memory loss;
swelling of the face, legs;
sustained increase in body weight;
hair loss, increased fragility of nails;
dry skin;
drop in blood pressure and slow heart rate.

Watch the video about autoimmune thyroiditis:

Analysis for hormones and other diagnostic methods

Before the onset of hypothyroidism, autoimmune thyroiditis is difficult to identify. To make a diagnosis, take into account:

manifestations of the disease;
laboratory and instrumental methods research;
the presence of such pathologies in blood relatives.

When examining a patient, they find:

general blood test - increased lymphocytes;
blood immunology - antibodies to thyroglobulin, thyroperoxidase, thyroxine, triioditronine;
blood hormones - with an increase in TSH, hypothyroidism is detected. If thyroxine is normal, then it is subclinical, and when it decreases, it is obvious;
Ultrasound - sizes are reduced or increased depending on the shape, echogenicity is reduced;

In order to confirm chronic autoimmune Hashimoto's thyroiditis, the most important features must be present simultaneously: antibodies to thyroid peroxidase greater than 34 IU/L, hypoechogenicity on ultrasound, and symptoms of hypothyroidism. None of these criteria alone provides grounds for an affirmative diagnosis.

Treatment of acute and chronic forms

There is no specific therapy for the disease that would prevent its further progression. Despite the understanding of the causes and mechanisms of development of autoimmune thyroiditis, its treatment is reduced only to compensation for disorders in the formation of hormones.

Thyreostatics (Merkazolil, Espa-carb) are not used for hashitoxicosis, since hyperthyroidism is associated with the destruction of the thyroid gland, and not with increased thyroxine synthesis. With palpitations, tachycardia, increased pressure, hand trembling and sweating, the beta-blocker Anaprilin is indicated.

Taking into account the survey data, hormone intake can be started already at the subclinical stage and during the period of euthyroidism in minimum dose. Such therapy inhibits the formation of TSH and the progression of autoimmune destruction. To reduce the antibody titer, selenium (Cefasel) is added to the treatment for three months.

Glucocorticoids (Prednisolone, Dexamethasone) are used during exacerbation of inflammation, which most often occurs against the background of viral or bacterial infections during the autumn-winter period. With a mild inflammatory process, nonsteroidal drugs (Voltaren, Indomethacin) are used. If the goiter reaches large sizes, then patients undergo an operation to remove the gland.

Prognosis for patients

With timely detection of the disease, it is possible to compensate for thyroid dysfunction and achieve satisfactory well-being of patients. Despite the fact that antibodies continue to be produced throughout life, in many cases it is possible to reduce their number and prevent massive destruction of cells.

It is possible to maintain good performance for 10-15 years, subject to constant monitoring of the state of hormone production.

In women, if antibodies to thyroid peroxidase are detected during pregnancy, hypothyroidism may develop, and postpartum autoimmune thyroiditis may relapse in the future. In every third patient, this process leads to a persistent low activity of the thyroid gland, requiring the use of levothyroxine.

Autoimmune thyroiditis occurs with a hereditary predisposition. When the immune system malfunctions, antibodies to thyroid cells are formed in the body. They gradually destroy the follicles, leading over time to hypothyroidism.

Clinical manifestations may be absent until a persistent decrease in organ function. Diagnosis requires the presence of antibodies in the blood, ultrasound signs and symptoms of thyroid hormone deficiency. For treatment, symptomatic and substitution therapy is used.

Today, many are familiar with the manifestations of fatigue, weight gain, hair loss and skin changes. At the same time, all these symptoms can be a manifestation of subclinical hypothyroidism. Read more about what hypothyroidism is and how it should be treated.

What is Primary Subclinical Hypothyroidism?

Subclinical (hidden) hypothyroidism means the initial stage of the disease, which is characterized by damage to the functioning of the thyroid gland, but its symptoms do not manifest themselves clearly enough. According to statistics, subclinical hypothyroidism is recorded in 20% of women over 50 years old.

Primary hypothyroidism manifests itself as sharp decline hormones in the blood as a result of pathological processes of the thyroid gland.

This disease occurs quite often. Its opposite is hyperthyroidism, on the contrary, an increase in the hormonal level of the thyroid gland. Manifest or severe hypothyroidism syndrome is recorded in 2% of the population, and subclinical or mild disease occurs in 12% of people. Most often, the primary form of hypothyroidism occurs in women from 18 to 44 years old, and over 45 years old. Hypothyroidism is dangerous because it proceeds secretly, therefore timely diagnosis difficult. The primary stage of hypothyroidism does not show specific symptoms. Often, a person with no thyroid problems may have overt manifestations of hypothyroidism. Most often, inflammations of an autoimmune nature occur in female half population.

Provocateurs of primary hypothyroidism are the causes caused by:

Lack of iodine in the body, causing low hormone production;
Negative impacts of internal and external factors;
Prolonged and uncontrolled use of certain medical preparations, for example, adrenal hormone, lithium, vitamins of group A and others;
Inflammatory processes;
Removal or resection of the thyroid gland;
hereditary predisposition;
Improper nutrition;
Medical treatment with the use of radioactive iodine;
Hypoplasia or atrophy of the gland.

Often it is impossible to determine the exact reason why primary hypothyroidism develops. This form of the disease is called idiopathic hypothyroidism. It should be borne in mind that there is no direct relationship between hormonal deficiency and the severity of symptoms. For example, some may have no obvious symptoms of the disease in overt hypothyroidism, and some may have severe symptoms, even in the subclinical stage of the disease.

Features of the subclinical form of hypothyroidism

Subclinical hypothyroidism is a latent form of the disease. The course of its initial stage may not manifest itself at all. Dysfunction of the ovaries or adrenal glands can also cause a violation of the production of the iodine component by the thyroid gland. The clinic of the disease will be identical to the manifest form.

It include:

Autoimmune thyroiditis;
Congenital disorders in the formation of the thyroid gland;
Deficiency of iodine, which comes with food and drink;
An operation performed on the thyroid gland, during which the entire organ or part of it was removed;
Long process of drug treatment;
Treatment of oncology in the neck area;
consequences of radioiodine therapy.

Also, the suppression of the production of thyroxine and triiodothyronine contributes to a large release into the blood of cortisol, the stress hormone. Another disease can develop due to various chronic diseases and drugs used in their treatment.

Symptoms of subclinical hypothyroidism

Medical treatment for subclinical hypothyroidism is not always necessary. The early stages can be treated with simple lifestyle and dietary improvements. Unfortunately, often the disease is diagnosed already in the manifest form, due to the fact that in the early stages, there are often no characteristics illness. This means that such a form is already more difficult to cure.

Symptoms of subclinical hypothyroidism include:

Poor cold tolerance constant feeling permafrost;
Decreased body temperature due to slow metabolism;
Drowsiness and lethargy;
Excessive fatigue and feeling of weakness even after rest;
The manifestation of slowness in the commission of actions;
Weight gain against the background of reduced appetite;
The secretion of colostrum from the mammary glands;
apathy;
Decreased or absent sexual activity.

Constant stress and states of depression also appear, there is a decrease in concentration and absent-mindedness.

Treatment of subclinical hypothyroidism

In order to avoid lifelong dependence on the use of hormonal drugs, with a diagnosis of subclinical hypothyroidism, you need to act in a timely manner, strive to improve your health and the health of the thyroid gland.

One of the most suitable options for protecting the thyroid gland is to support the adrenal glands.

Regular healthy sleep per day should take at least 7-8 hours. Proper rest is not only very beneficial for the body, but can also help reduce stress levels. Physical exercise will also help relieve stress and support your thyroid.

People suffering from hypothyroidism are more likely to take subscriptions to classes:

yoga;
dancing;
swimming;
Jogging or walking.

The Mediterranean diet includes fresh organic vegetables and fruits, protein foods (in particular cold-blooded fish, meat and poultry that do not contain hormones and antibiotics), healthy vegetable oils (for example, olive, vegetable oil and avocado oil), grain and bean dishes. You can also consume soy products cooked in fermented form, although some reviews do not recommend eating soy. Avoid large amounts of processed foods, trans fats, white flour products, sugar, and caffeine. It is important to take additional nutrients. These include vitamins B2,3,6, C, E, A and D, even copper, zinc, iodine, tyrosine and selenium, as well as fish fat, it is useful to take in tic cases, for example, Iodomarin. Using herbs to support the thyroid gland, which include ashwagandha, bacopa monnieri, hops, coleus forskohlii, and sage.

Autoimmune thyroiditis: subclinical hypothyroidism

The most common thyroid disease is autoimmune thyroiditis (AIT or Hashimoto's thyroiditis). This disease is the most common cause of hypothyroidism. In young people and adolescents, this disease is less common.

The most susceptible to autoimmune thyroiditis are:

Women who have reached the age of 30-50;
Women after pregnancy;
Men who have reached the age of 40-65 years.

Autoimmune thyroiditis does not have pronounced symptoms, and may even not manifest itself for many years. With this disease, there are no painful sensations, so it is difficult to make a prognosis of the disease and often the disease turns into HAIT - its own chronic form. The only sign that analyzes can show is an elevated titer of AT-TPO.

This symptom is manifested, for example, when lymphocytes penetrate into the thyroid gland, while developing lymphocytic infiltration of the thyroid gland.

So the army of lymphocytes harms the cells of the thyroid gland (thyrocytes), which are responsible for the production of hormones. The reduction of these cells leads to the fact that the thyroid gland cannot cope with its functions. Due to the lack of thyrocytes, the body cannot be supplied with the necessary number of hormones. A drop in their blood levels leads to the development of symptoms of hypothyroidism.

Autoimmune thyroiditis (AIT) is a chronic inflammatory disease of the thyroid gland, which is one of thethe most common autoimmune disorders and most common cause hypothyroidism, that is, a decrease in the amount of thyroid hormones.

Numerous conflicting studies are often the subject of speculation among alternative medicine advocates offering dubious treatments for this disease. An endocrinologist tells more about AIT and methods for its diagnosis and treatment.

What is known about AIT and how to diagnose it?

The incidence of autoimmune thyroiditis depends by age (more common in ages 45-55), gender (4-10 times more common in women than men) and race (more common in Caucasians). In addition, there is the so-called secondary AIT, not included in these statistics, which develops as a result of taking a number of immunotherapeutic drugs. Cases of thyroiditis have been described on the background of takinginterferon-alpha during treatment viral hepatitis C, as well as after the use of anticancer drugs -checkpoint inhibitors .

In AIT, antibodies produced by the immune system begin to take thyroid cell proteins as foreign, which can lead to tissue destruction. Autoantibodies produced by the body attack thyroperoxidase (anti-TPO), a key enzyme in the synthesis of thyroid hormones, and thyroglobulin (anti-TG), from which the hormones thyroxine (T4) and triiodothyronine (T3) are directly synthesized.

AIT was first described over 100 years ago, but, like most autoimmune diseases, the exact mechanisms of its development have not yet been established. It is known that its development is considered as a violation of T-cell immunity caused by the interaction of genetic predisposition and environmental factors.

The diagnosis of AIT is usually made in connection with a dysfunction of the thyroid gland based on the presence of anti-TPO and/or anti-TG in the blood. Although the immunological blood test is very sensitive, in some patients (up to 15%), antibodies can undefined , which does not exclude the presence of the disease. It is also worth noting that the assessment is always based on a qualitative sign (positive/negative titer), and not on the absolute values of anti-TPO and anti-TG, therefore, constant monitoring of their blood levels during treatment does not make sense, since it does not does not improve outcomes. Sometimes used in diagnostics ultrasonography(ultrasound) of the gland, in which characteristic changes can be observed. The need for routine ultrasound in AIT raises a number of questions, since with the obvious presence of autoantibodies and a decrease in thyroid function, additional information we don't get. The main disadvantage of the "extra" ultrasound is the misinterpretation of the data, which in some cases leads to unnecessary pseudonode biopsies.

In itself, the presence of antibodies in the blood is only a marker of the disease. ait has no bright severe symptoms, and treatment becomes necessary with the development of hypothyroidism. It is important to distinguish overt hypothyroidism, when there is a decrease in the concentrations of thyroid hormones (T3 and T4) and an increase in thyroid-stimulating hormone (TSH), as well as subclinical hypothyroidism, when thyroid hormones are within the reference values, but an increase in TSH is noted.

Hypothyroidism usually has a gradual onset with subtle signs and symptoms that may progress to more severe symptoms over months or years. In hypothyroidism, there are complaints of increased sensitivity to cold, constipation, dry skin, weight gain, hoarseness, muscle weakness, irregular menstruation. In addition, the development of depression, memory impairment and worsening of the course is possible. concomitant diseases.

Subclinical hypothyroidism is most often diagnosed based on laboratory screening of thyroid function. These patients may present with non-specific symptoms (fatigue, weakness, decreased concentration, hair loss), which are difficult to associate with thyroid dysfunction and do not always improve with administration replacement therapy thyroid hormones. Many endocrinologists disagree: to treat or not to treat subclinical hypothyroidism? Currently, the guidelines state that the prescription of substitution therapy depends on a number of factors : degree of increase in TSH (more or less than 10 mIU / l), age, presence of symptoms and concomitant pathology.

Classical treatment of hypothyroidism

The goal of the treatment of AIT from the standpoint of evidence-based medicine is the correction of hypothyroidism. For many years sodium salt L-thyroxine (levothyroxine sodium, a synthetic form of the T4 hormone) is considered the standard of care. Taking levothyroxine is enough to correct hypothyroidism, since T3 is formed from it in the tissues of the body under the action of its own enzymes (deiodinases). This treatment is effective for oral administration, the drug has a long half-life, which allows it to be taken once a day, and leads toRelieve signs and symptoms of hypothyroidism in most patients.

Replacement therapy with levothyroxine has three main goals:

selection of the correct dosage of the hormone;
elimination of symptoms and signs of hypothyroidism in patients;
normalization of TSH (within laboratory norms) with an increase in the concentration of thyroid hormones.

Some patients who are being treated for hypothyroidism still feel that levothyroxine therapy is not effective enough. But correction of therapy (including an increase in dosage) should be carried out, first of all, according to the level of TSH in the blood, and not only according to the presence of subjective complaints of the patient, which may be a manifestation of concomitant diseases or be explained by other reasons. An excess of hormonal drugs can lead to drug-induced thyrotoxicosis, which is especially dangerous for the elderly.

Often, the presence of non-specific symptoms (fatigue, weakness, hair loss, and others) makes patients turn to representatives of alternative medicine, who recommend, for example, the determination of reverse T3 (pT3, a biologically inactive form of the T3 hormone) or calculation of the T3 / pT3 ratio. But the use of these indicators is not justified, since they are not standardized and cannot be adequately interpreted, which is confirmed, for example, recommendations American Thyroid Association.

Alternative treatments for AIT

There are several popular but unhelpful alternative approaches to the treatment of AIT, which we will discuss below.

Extracts and combined treatment

Some pseudo-experts recommend the use of animal extracts from the thyroid gland, which contain a mixture of thyroid hormones and their metabolites, instead of replacement therapy with levothyroxine. There are no qualitative data on the long-term results and benefits of this treatment compared to classical therapy. There is also potential harm from such treatment, associated with an excess amount of triiodothyronine (T3) in serum and a lack of safety data. In addition, it is not uncommon to see recommendations for the addition of liothyronine (synthetic T3) to levothyroxine therapy based on the assumption that it can improve patients' quality of life and reduce symptoms. However, international recommendations note the need to avoid the use of combined treatment, given the conflicting results of randomized trials comparing this therapy with levothyroxine monotherapy, and the lack of data on the possible consequences of such treatment.

dietary supplements

The unexplored influence of the environment on thyroid function raises many other questionable ideas about treatment. The most commonly talked about are iodine, selenium, vitamin D, and various dietary restrictions (for example, a gluten-free diet or special autoimmune protocols). Before considering each of these “ways”, it is worth noting that almost always their effect on anti-TPO and anti-TG levels is studied without evaluating the effect on significant outcomes, such as hormone levels in the blood, disease progression, mortality, and so on.

Let's look at individual examples. Many studies have noted that excess iodine is associated with the induction of thyroid autoimmunity, that is, an increased risk of AIT. For example, a 15 year oldobservational study , which tracked the effects of voluntary iodine prophylaxis in Italy, found that thyroid autoantibody levels nearly doubled during follow-up, as did cases of AIT. INDanish population study DanThyr , which examined data from 2200 people at baseline and 11 years later, showed that the most pronounced increase in TSH was observed in areas with high iodine intake and was associated with the presence of anti-TPO in the blood. Mechanisms include, for example, an increase in the more immunogenic iodinated thyroglobulin. IN other works there is a U-shaped relationship between iodine intake and AIT. Anyway,recommended daily dose iodine intake for adults is 150 mcg / day and 250 mcg / day during pregnancy and lactation, it should not be exceeded. When treating concomitant AIT hypothyroidism with hormonal drugs, patients are not prescribed nutritional supplements with iodine, since it is already present in the molecule of thyroid hormones, including those of synthetic origin.

Selenium is very popular among fans of dietary supplements. As a justification, they actively cite the results of studies and meta-analyses. But if you understand, then, firstly, the data are contradictory: some meta-analyses demonstrate the positive effect of selenium in reducing the level of anti-TPO and anti-TG, and other indicate the absence of such an effect. At the same time, all meta-analyses indicate that anti-TPO is a surrogate marker of disease activity and there is no reason for the regular use of selenium supplements in the treatment of patients with AIT, since the presence of circulating autoantibodies in the blood should not be the basis for making clinical decisions. Representatives of alternative medicine omit this fundamentally important fact, speaking only about the decrease in antibodies, and doing, by and large, the treatment of numbers on paper. This is not to mention that patients treated with selenium may havehigher risks development diabetes 2nd type, and possibleside effects from selenium overdose include hair loss, anorexia, diarrhea, depression, liver and kidney toxicity, and respiratory failure. Taking all these factors into account, the American Thyroid Association specifically notes in its guidelines for the diagnosis and treatment of thyroid disorders during pregnancy that selenium supplementationnot recommended for the treatment of anti-TPO-positive women during pregnancy.

Another actively studied topic is the relationship between vitamin D and autoimmune diseases, including AIT. Here there is similar story : significant decrease anti-TPO and anti-TG titers are found in those who took vitamin D. It is worth noting a number of limitations in these studies: most were not , included a small number of subjects with different function thyroid gland and varying baseline blood levels of 25(OH)D (the precursor of vitamin D that is analyzed) in the blood, which can lead to biased results. In addition, we again do not know whether the administration of vitamin D affects the level of thyroid hormones, the course of the disease and its outcomes. Obviously, the elimination of vitamin D deficiency is an important task, but not in the context of the treatment of AIT. Moreover, representatives of alternative medicine often prescribe vitamin D supplements at initially normal values.

diets

Separately, I would like to say a few words about the so-called autoimmune protocol - a diet that is promoted for various autoimmune diseases. The essence of the diet is the exclusion of certain foods (cereals, legumes, nightshade, dairy products, eggs, coffee, alcohol, nuts, seeds) that allegedly violate the microflora gastrointestinal tract and intestinal permeability, which leads to the development of diseases. Instead, vegetables, fruits, game meats, organic and unprocessed meats are introduced into the diet. It should be noted right away that it has not been carried out, so there is no reason to talk about the benefits of this diet for any autoimmune diseases. But such a diet is absolutely not balanced in terms of healthy eating. There are only isolated pilot studies in small groups of patients. Consider the only thing (!) study of patients with AIT. It included 17 people, the study lacked blinding, randomization and control group. The results show an improvement in the quality of life based on the questionnaire SF-36 , while neither the effect on thyroid hormones nor on the level and level of antibodies was studied. Also published by one study on the effect of a gluten-free diet in AIT. It also lacked blinding and randomization, but included a control group. In both groups, no effect on TSH and thyroid hormone levels was obtained.. Thus, there is no reason to use these diets. in the treatment of AIT.

Conclusion

Certainly required further research to study the pathogenesis and approaches to treatment in AIT. However, at present, the only adequate treatment is substitution hormone therapy(for the correction of hypothyroidism), and there is no reason to recommend any dietary supplements or special diets to patients.

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Autoimmune thyroid diseases most often have a hereditary predisposition. This is a state when the cells of their own immune system begin to perceive certain types of proteins as foreign and destroy them.

As a result, the tissues of the organ are destroyed and cannot synthesize the required amount of hormones, which leads to a hypothyroid state. The latter may also occur for other reasons not related to errors in the immune system.

It is important to understand that autoimmune thyroiditis is a disease, and hypothyroidism is a condition in which the body does not synthesize the right amount of hormones.

In the photo on the right are healthy follicles, and on the left - destroyed by lymphocytes

Relating to organs internal secretion, it is located in the lower part of the neck and is located approximately on the same parallel with the clavicle bones. This is a small soft formation, consists of parenchyma and follicles, the latter exhibit synthetic activity.

They also accumulate a certain proportion of thyroid hormones, the supply of which is sufficient for several months to maintain normal concentrations in the blood, if for some reason the synthesis of thyroxine and triiodothyronine stops. The shape of the thyroid gland resembles a butterfly, consists of two lobes, which are connected by an isthmus. In the pathology of immune processes, a significant number of lymphocytes and other immunocompetent cells are concentrated in the parenchyma, which destructively affect the tissues of the organ, thus worsening its work.

It can be both temporary and permanent. This is a condition of a person in which a lowered hormonal level is recorded, which negatively affects health and well-being.

In special cases, quite serious consequences are possible, for example, deterioration of cardiac activity. In the case of AIT, depending on its causes and the development of the disease, gland tissues may or may not recover, so hypothyroidism will be temporary or permanent.

Associated with violations of their own defense mechanisms, are quite rare (in 3-4%). Representatives of the weaker sex suffer from this disease several times more often than men, which is primarily due to hormonal features female body. Children get sick less often, mostly the first signs of an abnormal condition begin to appear after 20 years.

The note. In women, during or after pregnancy, the functioning of the thyroid gland may be disrupted, and very often pathological process are autoimmune disorders. In most, after a certain time, functionality is completely restored, and in some, chronic hypothyroidism develops, so it is important to monitor the level of hormones in the blood, especially when there is a hereditary predisposition.

Causes

The main factor in the development of the disease is genetic predisposition, and quite often deviations in the work of several organs are observed immediately or in turn (goiter, alopecia, arthritis, and others), but the main reason lies in autoimmune disorders. In the thyroid gland, negative processes at the beginning can be hidden and last for quite a long time.

Sometimes even a person lives a full life, not knowing about the presence of abnormal processes. For a long time, healthy cells will intensively secrete all necessary substances, in exchange for those affected by the disease. But more often, sooner or later, the disease manifests itself in the form of an appropriate clinical picture.

Note. In the development of autoimmune thyroiditis, a stage in which hormonal levels decrease is preceded by a state of hyperthyroidism due to the release of hormones stored in healthy follicles.

Regardless of the rapidity of pathogenesis, there are fewer functionally active cells in the thyroid gland, which inevitably leads to a hypothyroid state. But if a person has genes in the genome that activate the disease, then they alone will not be enough.

To trigger pathogenesis, additional factors must be present, for example, such:

inflammatory processes in the thyroid gland caused by infectious agents;
physical injury or surgery;
lack of iodine in the body;
hormonal changes in women during pregnancy and after it.

In medicine, AIT is considered the main cause of hypothyroidism, but besides it, there are other factors that provoke a decrease in the activity of the thyroid gland. They are briefly listed in the table below, and you can learn more about these problems if you watch the video in this article.

Table. Factors that provoke hypothyroidism:

Cause	A comment
	Autoimmune thyroiditis leads to anatomical destruction of the thyroid gland, which entails a decrease in secretory activity. It is considered the main cause of hormonal (T3 and T4) deficiency.
	Certain thyroid diseases (cancer, Graves' disease and others) may be treated, but after that it cannot function fully.
	After a complete or partial resection, the number of tissues and follicles is reduced, so it is natural that the secretion decreases.
	Long-term use of hormone therapy, drugs that suppress thyroid hypersecretion, as well as drugs containing lithium, may have side effects in the form of inhibition of the synthesis of thyroxine and triiodothyronine.

Clinical picture

Autoimmune thyroiditis leads to different hormonal conditions, but later two outcomes are possible - either the amount of thyroid substances in the blood will return to normal, or their deficiency will be felt. In the latter case, if the doctor does not prescribe hormone replacement therapy, then the patient's health will deteriorate markedly.

Naturally, the connection between AIT and hypothyroidism is obvious, but in certain cases it may not be. Depending on the stage of the disease, the hormonal background constantly changes.

The onset, as a rule, is latent (subclinical form). As soon as the infiltration of lymphocytes into the tissues increases, and the follicles begin to collapse, the hyperthyroid phase begins, because if there is a violation cell structures hormones are released.

Moreover, it is important here not to make a mistake in the diagnosis and to correctly determine the cause, which does not consist in cell hypersecretion, therefore, drugs to inhibit the synthesis of hormones are not used, firstly, because it is meaningless, and secondly, such therapy can lead to inhibition of synthesis, which at the onset of the hypothyroid phase, it will further lower the hormonal level.

Thus, at the beginning of the disease, the symptoms will be characteristic of hyperthyroidism:

weight loss;
signs of hypertension;
trembling in the muscles of the limbs and others.

The latter, with sufficient destruction of the cells of the organ, are replaced by other signs:

constipation,
weight gain, depression,
women have menstrual irregularities;
impaired mental activity: memory suffers, speech may change, mental work is more difficult, etc.;
constant fatigue syndrome and other symptoms characteristic of a low content of hormones in the blood.

Note. The development of a stable form of hypothyroidism is a complication (consequence) of autoimmune thyroiditis.

Symptoms can vary and have individual characteristics and manifestations. The state of goiter is recorded with a certain frequency. Thyroid enlargement can be different character- from weak to strongly pronounced.

In the first case, a person does not feel anything, or the signs are so small that he does not pay attention to them. In the second, patients complain of neck discomfort, which can be painful, making life very difficult.

At the same time, the gland is sensitive to palpation, it is difficult for a person to swallow, and if the trachea is compressed, then, perhaps, he will experience certain problems when breathing. If there are too many aggressive cells in relation to the thyroid gland in the blood, then a person may fall into a state of depression or anxiety, the patient sleeps rather poorly.

Diagnostics

The endocrinologist should learn from the patient all the nuances of the symptoms. Further, the instruction involves conducting a physical examination of the patient, measuring pressure and temperature, and conducting laboratory tests.

With a clearly fried increase in the organ or the presence of nodular formations, they can be determined even with palpation. In this case, it is important to check the tissues for the possible presence of an oncological process.

Diagnostics includes:

general and biochemical blood test, in the latter case, the presence and concentration of antibodies to thyrotropic components are determined;
ultrasound measures the size of the thyroid gland, the state of its parenchyma and neoplasms;
histological analysis of tissues carried out by fine needle biopsy, which allows us to examine cellular composition, get an idea of the degree of infiltration of macrophages into the parenchyma;
if necessary, it is possible to conduct radioisotope analysis, which shows diffuse absorption of radiating elements, which indicates a violation of synthesis in certain areas of the organ.

AIT treatment

In the presence of goiter, which is determined visually and aesthetically unpleasant, as well as discomfort, hormone therapy, for example, levothyroxine, which helps to reduce the size of the organ, can be prescribed to patients. The operation is performed in case of too large goiter, and also if the proposed drug therapy does not bring the desired result.

In most cases, with an increase in hormonal levels in autoimmune thyroiditis, no medications are prescribed. medications, especially if the TSH analysis remains normal. But there are a number of experts who believe that the occurrence of negative symptoms and an increase in antibodies are already signs in which therapy should be started with low doses of hormonal drugs.

They are based on data from recent studies by American scientists, which showed that the early administration of hormonal drugs (levothyroxine sodium) can slow down or even stop the progression of the disease and prevent hypothyroidism from developing. In addition, selenium preparations are used, which helps the body with autoimmune disorders and reduces the amount of aggressive antibodies to the thyroid gland.

Nevertheless, in most cases, after passing through all phases of AIT, stable hypothyroidism is established in patients, so they are forced to take hormone replacement therapy for life. In this case, a person must completely reconsider his lifestyle.

Adjustment of nutrition, adherence to a certain diet, maintaining a healthy lifestyle and avoiding bad habits have a positive effect on the course of the disease and help reduce the intake medications. The medicine and dose should be chosen by the attending physician. In the process of monitoring and periodic diagnosis, therapy is subject to adjustment.