Update: October 2018
The thyroid gland is an organ of internal secretion, one of the most important
regulators of metabolic processes occurring in the body
person It is very sensitive to external and internal
impacts. Violation of his work affects immediately the state
integumentary tissue, weight, cardiac activity, ability
get pregnant and bear the child; it can be seen “from afar”, looking at
change in behavioral reactions and speed of thinking.
20-30% of all thyroid disease is a disease under
name “autoimmune thyroiditis.” Autoimmune thyroiditis
thyroid is an acute or chronic inflammation of the tissue
organ associated with the destruction of its cells by its own immune
by the system. The disease is more common in women; a long time goes by
no visible symptoms, so that it can only be suspected
routine ultrasound and the detection of antibodies in the blood
peroxidase gland. Treatment подбирает эндокринолог, ориентируясь на
stage of the process. Autoimmune thyroiditis можно вылечить как
completely and control its activity by
постоянного приема препаратов: все зависит от вида diseases.
The disease has a benign course.
Deciphering the name
The word “autoimmune” refers to a situation where inflammation
causes the same immune system, making an attack on the body
(in this case, on the thyroid gland). Why it happens?
All cells – and microbial, and “relatives” for the body must
�”Introduce yourself”. To do this, on their surface, they expose
�”Identification mark” in the form of special, specific proteins. Similar
the proteins are decided to be called “antigens”, and produced by the immune
system for their elimination other proteins – “antibodies”. Immune
cells in the blood vessels every second approach to
each cell and check it for danger to the body precisely by
such autoantigens, verifying them with their “list”. Once
the immune system stops doing it normally (due to
impairment of the quality of lymphocytes
�”Army”), there are tumors, because in the process of division in any tissue
“abnormal” (atypical) cells appear. But речь сейчас не об
Even before the period of birth of a person
lymphocytes undergo specific training, as a result of which
get a “list” of antigens of their cells, past which they pass
and do not produce antibodies. But не все наши органы (или их отделы) в
norm have “permitted” antigens. In this case, the body surrounds
their barrier to special cells that prevent lymphocytes from coming up and
check “identification marks”. Such a barrier is surrounded by:
thyroid gland, lens, male sexual organs; similar to
protection is built around a child growing up in the uterus.
With разрушении – временном или постоянном – барьера вокруг
thyroid gland and autoimmune thyroiditis occurs. Blame for this genes
that tell lymphocytes increased aggressiveness. Get sick more often
women, because estrogen, unlike male hormones,
affect the immune system.
Covering nearly a third of all thyroid disease,
Autoimmune thyroiditis occurs in 3-4% of all people on Earth. With
this, for the above reasons, the disease is more common
women, and the incidence rate increases with age. So, патологию
can be found in every 6-10th sixty year old lady, whereas
of the children are sick 1-12 per 1000.
The autoimmune thyroiditis category includes several
- Chronic autoimmune thyroiditis or Hashimoto disease. Exactly
it is often called simply “autoimmune thyroiditis” and
we will consider it as a disease with classical stages. it
a disease based on a genetic cause. Its course is
chronic but benign. To maintain normal
quality of life will have to constantly take drugs
hormone replacement therapy.
Hashimoto disease is also called lymphomatous goiter, because
iron increases due to edema caused by massive
attacks its tissue with lymphocytes. Often there is a combination of this
pathologies with other autoimmune diseases if not in this
person, then in this family. So, тиреоидит Хашимото часто
combined with type I diabetes, rheumatoid arthritis,
lesion of the occipital cells of the stomach, autoimmune inflammation
- Postpartum thyroiditis: thyroid inflammation develops
approximately 14 weeks after delivery. It is connected with a special
reaction of the immune system: during pregnancy it has to be
depressed so as not to destroy the child (the fetus is alien
at its core), and after giving birth, it may be redundant
- The painless form of autoimmune thyroiditis. it заболевание с
unexplained cause, but the mechanism of development is identical
- Cytokine-induced form. It develops with
�“Bombarding” of the thyroid with cytokine substances that appear
in the body in large quantity when long
treatment препаратами интерферона – инъекционными «Лафероном»,
�”Viferon” (viral hepatitis C is usually treated before the outcome in
cirrhosis, some blood diseases).
Depending on the degree of enlargement of the gland, there is another
classification of autoimmune thyroiditis. Based on this,
the disease can be:
- Latent: thyroid may be slightly enlarged or
be normal. The level of hormones and, accordingly, the function of the gland is not
- Hypertrophic: the size of the body is increased or completely
(diffuse form), or in one / several places (nodal
- Atrophic: size reduced, number reduced
hormones produced. it – гипотиреоз при аутоиммунном
To develop any of the autoimmune thyroiditis,
only one defect in the genes encoding the activity of the immune
system, a little. As a starting factor, which man
considers the cause of his illness, can make:
- transferred flu, less often – other respiratory viral
diseases, as well as mumps and measles;
- receiving large amounts of iodine;
- chronic infection in the body: chronic tonsillitis,
untreated caries, chronic sinusitis;
- living in poor environmental conditions when in the body
gets a lot of chlorine or fluorine;
- selenium deficiency in soil in the region of residence
- ionizing radiation;
- psycho-emotional stress.
Stages and symptoms
Hashimoto’s thyroiditis is divided into several stages. One smoothly
goes to another.
Hashimoto disease begins with the fact that immune cells begin
�“See” thyroid cells, thyrocytes. it для них –
alien structures, so they decide to attack the thyrocytes and with
using chemicals dissolved in the blood, call with this
aiming towards one’s fellows. They attack thyrocytes,
producing antibodies against them. The latter may be different
quantity. If there are few of them, some of the gland cells die,
поддерживается эутиреоидная фаза болезни, уровни всех
hormones are not changed, there are symptoms only due to an increase in
- thyroid becomes visible;
- it can be felt, while it is determined;
- it becomes difficult (like a “lump in the throat”) to swallow, especially hard
- a person gets tired of doing less work than before.
The same symptoms of autoimmune thyroiditis are observed in
субклиническую фазу diseases. In the gland at this time
the number of cells decreases, but those that are
must be at rest. This is due to thyrotropic
If there are too many thyroid stimulated antibodies,
thyrotoxic phase. Withзнаки ее следующие:
- fast fatiguability;
- irritability, tearfulness, anger;
- �Hot flushes;
- perceived palpitations;
- tendency to diarrhea;
- decrease in sexual desire;
- difficult to be in a hot climate;
- violation of the menstrual cycle.
If a disease occurs in a child, at this stage most often
It is noteworthy that he becomes very thin and not
gaining weight, despite the increased appetite.
With уничтожении антителами большого объема рабочей зоны железы
the last phase of autoimmune thyroiditis occurs – hypothyroidism. Him
- depression, apathy;
- slow speech and reaction;
- weight gain with poor appetite;
- skin becomes pale, swollen, yellowish and dense
(not going to fold);
- puffy face;
- the person freezes quickly;
- hair falls out stronger;
- hoarse voice;
- menses rare and scanty;
- brittle nails;
- joint pain.
In a child, hypothyroidism is manifested by weight gain, deterioration
memory, it becomes more phlegmatic, worse remembers the material.
If the disease develops at an early age, mental development
far behind the due.
In this case, symptoms appear at week 14 after delivery.
- weight loss;
They can intensify up to the appearance of a feeling of heat, sensation
heart palpitations, insomnia, fast mood changes,
trembling limbs. By the end of 4 months after delivery (approximately
5 weeks after the first signs appear) symptoms appear
hypothyroidism that is often attributed to postpartum
It is characterized by hyperthyroidism, which flows in mild form:
slight irritability, sweating, increased heart rate.
it все относят на счет переутомления.
Against the background of the injection of “Alveron”, “Viferon” or
Other interferon symptoms may occur as increased
and reduced thyroid function. Usually они выражены
Autoimmune thyroiditis and fertile functions
Autoimmune thyroiditis на субклинической, эутиреоидной и
thyrotoxic stages do not interfere with conception, which cannot be said about
hypothyroidism stages, because thyroid hormones affect
ovarian function. If at this stage to carry out adequate treatment
synthetic hormones, then the pregnancy will come. At the same time there is
the risk of its miscarriage, as antibodies to iron, the production of
which does not depend on the amount of “L-thyroxin” (or
�”Eutiroksa”) adversely affects the ovarian tissue. But the situation
corrected subject to progesterone replacement therapy,
which will keep the pregnancy.
A woman with thyroiditis must be observed by an endocrinologist at
during the entire period of gestation. When hypothyroid state in this
period he should increase the dose of thyroxine (the need for thyroid
hormones of two organisms – mother and child – increases by
40%). Otherwise, if in the mother’s body during pregnancy
small amounts of thyroid hormones persist, the fetus may
develop severe pathology, sometimes incompatible with life. Or he
born with congenital hypothyroidism, which is equivalent to severe
mental retardation and metabolic disorders.
What is needed for the diagnosis
If autoimmune thyroiditis is suspected
diagnostics. A blood test for hormones:
- T3 – common and free,
- T4 – common and free,
If TSH is elevated, and T4 is normal, this is a subclinical stage,
if at elevated TSH the level of T4 decreases, it means that
the first symptoms should appear.
The diagnosis is established on the basis of the totality of such
- Increased level of antibodies to the thyroid enzyme –
thyroid peroxidase (AT-TPO) in the analysis of venous blood.
- Ultrasound of the thyroid is determined by its hypoechogenicity.
- Снижены концентрации T3, T4, повышен уровень TTG.
Only one indicator does not allow to make such a diagnosis.
Even an increase in AT-TPO only suggests that
There is a predisposition to autoimmune damage to the gland.
If thyroiditis is nodular, a biopsy of each node is performed with
the purpose of visualizing signs of thyroiditis, as well as to exclude
Different stages of thyroiditis – various complications. So,
hyperthyroid stage may be complicated by cardiac arrhythmia
insufficiency and even provoke myocardial infarction.
Hypothyroidism can cause:
- habitual miscarriage;
- congenital hypothyroidism in a born child;
- myxedema, which looks like the intolerance of the least
cold, constant sleepiness. If in this state enter
sedatives get severely stressed or get sick
infectious disease, it is possible to provoke hypothyroid
Fortunately, this condition is well treatable and, if
take drugs in a hormone level and AT-TPO
dose, you can not feel the presence of a long time
Диета при аутоиммунном тиреоидите
The diet should be normal in calories (energy
worth at least 1500 kcal), and it is better if you calculate it by
Mary Shomon: (weight * 25) minus 200 kcal.
The amount of protein should be increased to 3 g per kg of body weight, and
saturated fats and digestible carbohydrates – limit. There is a need
every 3 hours.
What you can eat:
- vegetable dishes;
- baked red fish;
- fish fat;
- liver: cod, pork, beef;
- milk products;
Salty, fried, spicy and smoked dishes, alcohol are excluded.
and seasonings. Water – not more than 1.5 l / day.
We need unloading – once a week or 10 days – days on juices and
Treatment аутоиммунного тиреоидита полностью медикаментозное,
зависит от стадии diseases. It is appointed at any age and
does not stop even during pregnancy, of course, if there is
indications. His goal is to maintain the level of thyroid hormones on
level of physiological values (their control is carried out once
in 6 months, the first control – in 1.5-2 months).
В стадии эутиреоза treatment не проводится.
How to treat the stage of thyrotoxicosis, the doctor decides. Usually
thyreostatics such as Mercazolil are not assigned.
Treatment проводится симптоматически: при тахикардии назначаются
beta-blocker drugs: Atenolol, Nebivolol, Anaprilin,
severe psycho-emotional excitability – sedatives.
If a thyrotoxic crisis occurs, therapy is carried out in
the hospital with glucocorticoid injection hormones
(“Dexamethasone”, “Prednisolone”). The same drugs are administered if
autoimmune thyroiditis is combined with subacute thyroiditis, but
treatment проводится в домашних условиях.
In the hypothyroidism stage, synthetic T4 (thyroxin) is administered under
called “L-thyroxin” or “Eutirox” and if there is a shortage
triiodothyronine, its analogues created in the laboratory. Dosage
thyroxine for adults – 1.4-1.7 mcg / kg of body weight, in children – up to 4
mcg / kg
Thyroxine children are prescribed if there is an increase in TSH and
normal or reduced T4 levels if iron is increased by 30
or more percent of the age norm. If she is enlarged, her
the structure is heterogeneous, with no AT-TPO, iodine is assigned
in the form of potassium iodide at a dosage of 200 µg / day.
When the diagnosis of autoimmune thyroiditis is established man
living in an area with iodine deficiency, apply physiological
iodine doses: 100-200 mcg / day.
Pregnant L-thyroxin is prescribed if TSH is more than 4 mU / L. If
they are only AT-TPO, and TSH is less than 2 honey / l, thyroxin is not
applied, but the TSH level is monitored every trimester. With
The presence of AT-TPO and TSH 2-4 IU / l L-thyroxin is needed in prophylactic
If thyroiditis is nodular, in which cancer cannot be excluded, or
if the thyroid squeezes the neck, making it more difficult
дыхание, проводится оперативное treatment.
Если treatment начато вовремя, до гибели более 40% клеточной массы
thyroid gland, the process can be controlled and the prognosis –
If женщины уже развивался тиреоидит после родов, вероятность
its appearance after the next birth – 70%.
A third of cases of postpartum thyroiditis is transformed into
chronic form with the development of persistent hypothyroidism.
It is not possible to prevent the transfer of a defective gene. But
to control the function of your own thyroid gland, according to plan
(especially if there is a tendency to gain weight, or, conversely, to
худобе), раз в 1 год, стоит, сдавая кровь на T4 и TTG. Optimal
also undergo an ultrasound gland every 1-2 years.
Especially you need a planned examination on the subject of T4, AT-TPO and TSH
in the event of pregnancy. These tests are not included in the list.
compulsory research, so the direction you need to ask
independently, at the endocrinologist.
Автор: Кривега Мария Салаватовна врач-реаниматолог