Autoimmune thyroiditis is a pathology that affects mostly older women (45-60 years old). The pathology is characterized by the development of a strong inflammatory process in the area of the thyroid gland. It occurs due to serious disruptions in the functioning of the immune system, as a result of which it begins to destroy the thyroid cells.
Exposure to the pathology of elderly women is explained by X-chromosomal abnormalities and the negative effect of estrogen hormones on the cells that form the lymphoid system. Sometimes the disease can develop in both young people and young children. In some cases, pathology is also found in pregnant women.
What can cause AIT, and can it be recognized independently? Let's try to figure it out.
What it is?
Autoimmune thyroiditis is an inflammation that occurs in the tissues of the thyroid gland, the main cause of which is a serious failure in the immune system. On its background, the body begins to produce an abnormal large amount of antibodies that gradually destroy healthy thyroid cells. Pathology develops in women almost 8 times more often than in men.
Causes of AIT
Hashimoto's thyroiditis (pathology got its name in honor of the doctor who first described its symptoms) develops for a number of reasons. The primary role in this issue is given to:
- regular stressful situations;
- emotional overstrain;
- excess iodine in the body;
- unfavorable heredity;
- the presence of endocrine diseases;
- uncontrolled intake of antiviral drugs;
- negative influence of the external environment (it can be a bad environment and many other similar factors);
- malnutrition, etc.
However, do not panic - autoimmune thyroiditis is a reversible pathological process, and the patient has all the chances to improve the functioning of the thyroid gland. To do this, it is necessary to reduce the loads on its cells, which will help reduce the level of antibodies in the patient’s blood. For this reason, timely diagnosis of the disease is very important.
Autoimmune thyroiditis has its own classification, according to which it is:
- Painless, the reasons for the development of which until the end have not been established.
- Postpartum. During pregnancy, the immunity of women is significantly weakened, and after birth, the baby, on the contrary, is activated. Moreover, its activation is sometimes abnormal, because it begins to produce an excessive amount of antibodies. Often, the result is the destruction of the “native” cells of various organs and systems. If a woman has a genetic predisposition to AIT, she needs to be extremely attentive, and carefully monitor her health after childbirth.
- Chronic. In this case, it is a genetic predisposition to the development of the disease. It is preceded by a decrease in the production of hormones of organisms. This condition is called primary hypothyroidism.
- Cytokine-induced. Such thyroiditis is a consequence of the administration of interferon-based drugs used in the treatment of hematogenous diseases and hepatitis C.
All types of AIT, except the first, are manifested by the same symptoms. The initial stage of the development of the disease is characterized by the occurrence of thyrotoxicosis, which, if late diagnosis and treatment, can turn into hypothyroidism.
Stages of development
If the disease was not detected in a timely manner, or for any reason it was not treated, this may be the reason for its progression. Stage AIT depends on how long it has developed. Hashimoto disease is divided into 4 stages.
- Eutheroid phase. For each patient, it has its own duration. Sometimes it may take several months to move the disease to the second stage of development, in other cases it may take several years between phases. During this period, the patient does not notice any special changes in his state of health, and does not consult a doctor. Secretory function is not impaired.
- At the second, subclinical, stage, T-lymphocytes begin to actively attack the follicular cells, leading to their destruction. As a result, the body begins to produce a significantly smaller amount of the hormone St. T4. Eutheriosis persists due to a sharp increase in the level of TSH.
- The third phase is thyrotoxic. It is characterized by a strong jump in the hormones T3 and T4, which is explained by their release from the destroyed follicular cells. Their entry into the blood becomes a powerful stress for the body, as a result of which the immune system begins to rapidly produce antibodies. When the level of functioning cells falls, hypothyroidism develops.
- The fourth stage is hypothyroid. Thyroid functions can recover themselves, but not in all cases. It depends on the form of the disease. For example, chronic hypothyroidism can last for quite a long time, going into the active stage, replacing the remission phase.
The disease can be in one phase, or go through all the above stages. It is extremely difficult to predict exactly how pathology will proceed.
Symptoms of autoimmune thyroiditis
Each form of the disease has its own characteristics of manifestation. Since AIT does not pose a serious danger to the organism, and its final phase is characterized by the development of hypothyroidism, neither the first, but the second stage have any clinical signs. That is, the symptomatology of pathology, in fact, is combined from those abnormalities that are characteristic of hypothyroidism.
We list the symptoms characteristic of thyroid autoimmune thyroiditis:
- periodic or permanent depressive state (a purely individual symptom);
- memory impairment;
- concentration problems;
- constant drowsiness or feeling tired;
- a sharp jump in weight, or a gradual increase in body weight;
- worsening or complete loss of appetite;
- slow pulse;
- cold hands and feet;
- a breakdown even with good nutrition;
- difficulties in performing ordinary physical work;
- inhibition of reaction in response to the effects of various external stimuli;
- fading of hair, their fragility;
- dryness, irritation and flaking of the epidermis;
- decrease in sexual desire, or its complete loss;
- violation of the menstrual cycle (development of intermenstrual bleeding, or complete cessation of menstruation);
- swelling of the face;
- yellowness of the skin;
- problems with facial expressions, etc.
In the postpartum, mute (asymptomatic) and cytokine-induced AIT, the phases of the inflammatory process alternate. In the thyrotoxic stage of the disease, the manifestation of the clinical picture occurs due to:
- dramatic weight loss;
- sensations of heat;
- increased sweating intensity;
- feeling unwell in stuffy or small rooms;
- trembling fingers;
- drastic changes in the psycho-emotional state of the patient;
- increased heart rate;
- episodes of hypertension;
- deterioration of attention and memory;
- loss or decrease in libido;
- rapid fatigue;
- general weakness, which even full rest does not help to get rid of;
- sudden bouts of increased activity;
- menstrual problems.
The hypothyroid stage is accompanied by the same symptoms as the chronic one. Symptoms of thyrotoxicosis are typical for postpartum AIT in the middle of 4 months, and the detection of symptoms of hypothyroidism at the end of 5 - at the beginning of 6 months of the postpartum period.
With painless and cytokine-induced AIT, no specific clinical signs are observed. If the ailments, however, appear, they have an extremely low degree of severity. If asymptomatic, they are detected only during a preventive examination in a medical institution.
What autoimmune thyroiditis looks like: photo
The photo below shows how the disease manifests itself in women:
Before the appearance of the first warning signs of pathology, it is almost impossible to reveal its presence. In the absence of ailments, the patient does not consider it appropriate to go to the hospital, but even if he does, it will be almost impossible to identify pathology with the help of tests. However, when the first adverse changes in the work of the thyroid gland begin to occur, a clinical study of a biological sample will immediately identify them.
If other family members are suffering or have previously suffered from similar disorders, this means that you are at risk. In this case, visit a doctor and undergo preventive research as often as possible.
Laboratory tests for suspected AIT include:
- complete blood count, which establishes the level of lymphocytes;
- a hormone test required to measure serum TSH;
- an immunogram that establishes the presence of antibodies to AT-TG, thyroperoxidase, as well as thyroid thyroid hormones;
- fine-needle biopsy necessary to establish the size of lymphocytes or other cells (their increase indicates the presence of autoimmune thyroiditis);
- Ultrasound diagnosis of the thyroid gland helps to establish its increase or decrease in size; With AIT, a change in the structure of the thyroid gland occurs, which can also be detected during an ultrasound scan.
If the results of an ultrasound examination indicate an autonomous current test, but clinical tests disprove its development, then the diagnosis is considered doubtful and does not fit into the patient's medical history.
What will happen if not treated?
Thyroiditis can have unpleasant consequences that vary for each stage of the disease. For example, in a patient with a hyperthyroid stage, the heart rhythm (arrhythmia) may be disturbed, or heart failure may occur, and this is already fraught with the development of such a dangerous pathology as myocardial infarction.
Hypothyroidism can lead to the following complications:
- premature abort pregnancy;
- inability to bear fruit;
- congenital hypothyroidism in children;
- deep and prolonged depressions;
With myxedema, the person becomes hypersensitive to any changes in temperature downward. Even a banal flu, or another infectious disease, which was transferred in this pathological condition, can cause hypothyroid coma.
However, you should not worry too much - such a deviation is a reversible process, and is easily treatable. If you choose the right dosage of the drug (it is appointed depending on the level of hormones and AT-TPO), then the disease over a long period of time may not remind you of yourself.
Autoimmune thyroiditis treatment
AIT treatment is carried out only at the last stage of its development - with hypothyroidism. However, in this case, certain nuances are taken into account.
Thus, therapy is carried out exclusively for manifest hypothyroidism, when the level of TSH is less than 10 IU / l, and St. T4 reduced. If the patient suffers from a subclinical form of pathology with TSH of 4-10 IU / 1 l and with normal indicators of St. T4, in this case, treatment is carried out only if there are symptoms of hypothyroidism, as well as during pregnancy.
Today, levothyroxine-based drugs are the most effective in the treatment of hypothyroidism. A feature of such drugs is that their active substance is as close as possible to the human hormone T4. Such tools are absolutely harmless, so they are allowed to take even during pregnancy and HB. Drugs practically do not cause side effects, and, despite the fact that they are based on the hormonal element, they do not lead to an increase in body weight.
Levothyroxine-based drugs must be taken “isolated” from other drugs, as they are extremely sensitive to any “foreign” substances. Reception is carried out on an empty stomach (half an hour before meals or use of other drugs) with the use of copious amounts of fluid.
Calcium preparations, multivitamins, iron supplements, sucralfate, etc., should be taken no earlier than 4 hours after taking levothyroxine. The most effective means based on it are L-thyroxin and Eutiroks.
Today, there are many analogues of these drugs, but it is better to give preference to the originals. The fact is that they have the most positive effect on the patient's body, while analogues can only bring a temporary improvement in the patient's health.
If from time to time you switch from originals to generics, then you should remember that in this case, you will need to adjust the dosage of the active ingredient - levothyroxine. For this reason, every 2-3 months it is necessary to take a blood test to determine the level of TSH.
Nutrition with AIT
Treatment of the disease (or a significant slowdown in its progression) will give better results if the patient avoids food that is harmful to the thyroid gland. In this case, it is necessary to minimize the frequency of consumption of products containing gluten. Under the ban fall:
- flour dishes;
- bakery products;
- fast food, etc.
At the same time you should try to eat foods enriched with iodine. They are particularly useful in the fight against the hypothyroid form of autoimmune thyroiditis.
With AIT, it is necessary to take the issue of protection of the organism against the penetration of pathogenic microflora with maximum seriousness. You should also try to clear it from the pathogenic bacteria that are already in it. First of all, you need to take care of cleansing the intestines, because it is in it that active reproduction of harmful microorganisms occurs. To do this, the patient's diet should include:
- fermented milk products;
- Coconut oil;
- fresh fruits and vegetables;
- lean meat and meat broths;
- different types of fish;
- sea kale and other algae;
- germinated cereals.
All products from the list above strengthen the immune system, enrich the body with vitamins and minerals, which, in turn, improves the functioning of the thyroid gland and intestines.
Important! If there is a hyperthyroid form of AIT, it is necessary to completely eliminate all foods that contain iodine from the diet, since this element stimulates the production of hormones T3 and T4.
When AIT is important to give preference to the following substances:
- selenium, which is important for hypothyroidism, as it improves the secretion of the hormones T3 and T4;
- group B vitamins that help improve metabolic processes and help keep the body in good shape;
- probiotics important for maintaining intestinal microflora and preventing dysbiosis;
- Adaptogenic plants that stimulate the production of T3 and T4 hormones in hypothyroidism (Rhodiola rosea, Reishi mushroom, ginseng root and fruits).
What is the worst thing to expect? The prognosis of the treatment of AIT is generally quite favorable.If persistent hypothyroidism occurs, the patient will have to take levothyroxine-based drugs for the rest of his life.
It is very important to monitor the level of hormones in the patient's body, therefore, once in six months, you must undergo a clinical blood test and an ultrasound scan. If during ultrasound a knotty seal in the area of the thyroid is noticed, this should be a good reason for consulting an endocrinologist.
If during the course of an ultrasound examination, an increase in nodules was observed, or their intensive growth is observed, the patient is prescribed a puncture biopsy. The obtained tissue sample is examined in the laboratory in order to confirm or deny the presence of a carcinogenic process. In this case, an ultrasound scan is recommended every six months. If the node has no tendency to increase, then ultrasonic diagnostics can be performed once a year.