Hashimoto's (autoimmune) thyroiditis What we need to know

03.05.2023

Autoimmune thyroiditis

Also known as Hashimoto's thyroiditis, Hashimoto's goiter, chronic lymphocytic thyroiditis.

Table of Contents

Thyroid disease is an autoimmune disease that causes a deficiency in the production and activity of thyroid hormones. Rarely, hyperthyroidism may develop - an excess of hormones and increased activity.

Autoimmune disease is an autoaggressive process directed by the immune system against its own cells and tissues. In Hashimoto's thyroiditis, the autoantibodies produced attack the thyroid cells. In this process, the gland is damaged, which hinders its proper work and the process of hormone synthesis. Hypothyroidism develops as a result. Since the thyroid gland participates in the regulation of energy processes in the body, the results of its damage are reflected in almost all tissues and organs and are manifested by the symptom complex characteristic of the disease.

Hashimoto's disease is 4-10 times more common in middle-aged women, although cases are also common in teenagers and young girls. The risk of developing the disease increases in the presence of a family history or other autoimmune diseases (celiac disease, lupus, rheumatoid arthritis, Sjogren's disease, type I diabetes).

Symptoms

Often the disease progresses slowly over years. Existing symptoms are explained by stress, hectic lifestyle and other factors, which is why the disease often remains unnoticed.

Symptoms of the disease:

General weakness and fatigue
Apathy
Increased sensitivity to cold
Drowsiness
Weight gain
Dry skin
Constipation
muscle weakness
Soreness of muscles and tendons
Irregular and/or excessive menstrual bleeding
Enlarged thyroid gland (goiter)
Facial swelling
Brittleness of nails
hair loss

Low levels of thyroid hormones affect mood and mental function as well:

Memory and concentration problems
Depression

Hoarseness, slurred speech - can also accompany hypothyroidism.

Hypothyroidism also causes:

bradycardia (slowing of heart rate)
increasing the frequency of breathing
Changes in blood pressure (increasing tendency noted)
increase of cholesterol in the blood

reasons

The basis of the disease is the antibodies produced by the immune system against its own tissues, which damage the target cells, which leads to the disruption of the organ's function.

Autoimmune diseases are multifactorial and the mechanism of their development is related to:

Genetic factors (congenital predisposition)
Viral diseases (hepatitis C), other infections
radiation exposure of the environment
Side effects of iodine-containing medications (eg, iodine-containing medications used to treat arrhythmias)
interaction of these factors

risk factors

Gender - more common in women
Age – more common in middle age
Having other autoimmune diseases - such as rheumatoid arthritis, type 1 diabetes, lupus - increases the risk of Hashimoto's thyroiditis
Genetics and family history – a family history of thyroiditis or other autoimmune diseases increases the risk of developing this disease
Pregnancy - compression of the immune system during pregnancy can cause the development or exacerbation of Hashimoto's disease.
Increased intake of iodine - an excess of iodine in the diet may contribute to the development of Hashimoto's disease in people predisposed to autoimmune diseases.
Irradiation - due to the influence of the radiation environment, the disease may become infected or aggravated.

Complications

The hormonal imbalance associated with Hashimoto's disease gives rise to a number of diseases:

Goiter is a compensatory enlargement of the thyroid gland, caused by a decrease in the production of thyroid hormones. It can cause discomfort on the front surface of the neck when swallowing or breathing.
Cardiac complaints - hypothyroidism often leads to disturbances in heart function and rhythm. There is also an increase in low-density lipoproteins (LDL), which is a risk factor for cardiovascular diseases. arterial hypertension.
Mental health problems, such as depression, tend to worsen as Hashimoto's disease progresses.
Reproductive dysfunction - in women, hypothyroidism can cause decreased libido, ovulation and menstrual cycle disorders. Men also experience decreased libido, erectile dysfunction, and a decrease in the number of spermatocytes.
Complicated pregnancy – hypothyroidism in pregnant women may end in premature termination of pregnancy or premature birth. In addition, the mother's untreated hypothyroidism may be the cause of various disorders of the child's intellectual development (autism, retardation of mental development, speech, etc.).
Myxedema is a rare condition resulting from untreated hypothyroidism. It is characterized by drowsiness, changes in consciousness. Myxedema coma may develop under the influence of cold, sedative drugs, infection and other factors. Ixedema requires urgent medical intervention.

Diagnosis

Diagnosis of the disease is based on clinical, anamnestic, instrumental and laboratory research data.

From the laboratory studies, the diagnostic minimum is: thyroxine - T4, triiodothyronine - T3, thyroid stimulating hormone - TSH; Also anti-TPO test for thyroperoxidase antibodies.

TSH – thyroid-stimulating hormone – is a pituitary hormone that reacts to the low concentration of thyroid hormones in the blood and stimulates the function of the gland through the increased secretion of TSH. A high concentration of TSH in the blood indicates hypothyroidism and vice versa.

T4 - thyroxine - is one of the main hormones of the thyroid gland. Its decrease is observed during hypothyroidism and leads to an increase in TSH concentration.

Naturally produced thyroxine is converted into another thyroid hormone, T3, into triiodothyronine.

Antibody test

In Hashimoto's disease, the immune system actively produces antibodies against thyroperoxidase (TPO). It is an enzyme that binds iodine to thyroid globulin (protein) and actively participates in the formation of thyroid hormone. Most people with Hashimoto's disease have high titers of anti-TPO antibodies.

Antibodies to thyroid globulin (anti-TG) may also develop, which is also an important marker in the diagnostics of autoimmune thyroiditis.

Research Results

In case of suspicion of Hashimoto's disease, if antibodies are not detected, it is necessary to conduct an ultrasound examination of the gland, which specifies the size of the gland and also other reasons that may cause an increase in the thyroid gland and clinical manifestations - nodules, inclusions, etc.

A high level of antibodies against thyroperoxidase or thyroglobulin confirms the diagnostics of autoimmune thyroiditis. A high titer of antibodies is an indicator of an acute process.

Treatment

Treatment of hypothyroidism associated with Hashimoto's gout involves T4 hormone replacement therapy. The decision on the dosage and tactics of treatment is made by a specialist based on laboratory-instrumental data.

In order to monitor the effectiveness of the treatment, laboratory control is necessary.

When to see a doctor?

If you have long-term weakness and fatigue that cannot be explained by other reasons
you are strong
You have difficulty concentrating and memory problems
You have unexplained weight gain
Facial swelling
Brittle nails and hair loss
Depressed mood
Changes in heart rhythm
arterial hypertension
Constipation
Muscle weakness and pain

Before the above-mentioned complaints appear, the disease may be asymptomatic. It is important to conduct regular preventive examinations, which allows for early detection of the disease, timely treatment and better results.