How to treat chronic thyroiditis. Classification of autoimmune thyroiditis. Instrumental studies of the thyroid gland

- inflammatory lesion thyroid gland acute, subacute, chronic, autoimmune. Shows a feeling of pressure painful sensations in the neck, difficulty swallowing, hoarseness. In acute inflammation, abscess formation is possible. The progression of the disease causes diffuse changes in the gland and a violation of its functions: first, the phenomena of hyperthyroidism, and later - hypothyroidism, requiring appropriate treatment. Depending on the clinical features and currents secrete acute, subacute and chronic thyroiditis; by etiology - autoimmune, syphilitic, tuberculosis, etc.

ICD-10

E06

General information

- inflammatory lesion of the thyroid gland of an acute, subacute, chronic, autoimmune nature. Manifested by a feeling of pressure, pain in the neck, difficulty swallowing, hoarseness. In acute inflammation, abscess formation is possible. The progression of the disease causes diffuse changes in the gland and a violation of its functions: first, the phenomena of hyperthyroidism, and later - hypothyroidism, requiring appropriate treatment.

Thyroiditis may be based on a different mechanism and causes of occurrence, but the entire group of diseases is united by the presence of an inflammatory component that affects the thyroid tissue.

Classification of thyroiditis

In its practice, clinical endocrinology uses the classification of thyroiditis, based on the peculiarities of the mechanism of their development and clinical manifestations. There are the following forms of thyroiditis: acute, subacute and chronic. Acute thyroiditis can spread to the whole lobe or the entire thyroid gland (diffuse) or proceed with partial damage to the lobe of the gland (focal). In addition, inflammation in acute thyroiditis may be purulent or non-purulent.

Symptoms of thyroiditis

Acute thyroiditis

With a purulent form acute thyroiditis observed inflammatory infiltration thyroid gland with subsequent formation of an abscess (abscess) in it. The zone of purulent fusion is switched off from secretory activity, however, more often it captures an insignificant part of the gland tissue and does not cause sharp violations hormonal secretion.

Purulent thyroiditis develops acutely - with high temperature(up to 40 ° C) and chills. Are celebrated sharp pains on the anterior surface of the neck with a shift to the back of the head, jaws, tongue, ears, aggravated by coughing, swallowing and head movements. Intoxication is rapidly growing: there is severe weakness, weakness, aching muscles and joints, headache, and tachycardia is increasing. Often the patient's condition is assessed as serious.

Palpation is determined by local or diffuse enlargement of the thyroid gland, severe pain, dense (at the stage of infiltrative inflammation) or softened (at the stage of purulent fusion and abscess formation) consistency. There is hyperemia of the skin of the neck, a local increase in temperature, an increase and soreness of the cervical lymph nodes. The non-purulent form of acute thyroiditis is characterized by aseptic inflammation of the thyroid tissue and proceeds with less severe symptoms.

Subacute thyroiditis

The course of subacute thyroiditis can be bright pronounced signs inflammation: febrile body temperature (38 ° C and above), pain in the anterior surface of the neck with irradiation to the jaw, neck, ear, weakness, increasing intoxication. However, more often the development of the disease is gradual and begins with malaise, discomfort, moderate soreness and swelling in the thyroid gland, especially when swallowing, tilting and turning the head. The pain is aggravated by chewing hard food. Palpation of the thyroid gland usually reveals an increase and soreness of one of its lobes. Neighboring lymph nodes are not enlarged.

Subacute thyroiditis in half of the patients is accompanied by the development of mild or moderate thyrotoxicosis. Patient complaints are associated with sweating, palpitations, tremors, weakness, insomnia, nervousness, heat intolerance, joint pain.

An excess amount of thyroid hormones secreted by the gland (thyroxine and triiodothyronine) has an inhibitory effect on the hypothalamus and reduces the production of the hormone-regulator thyrotropin. Under conditions of thyrotropin deficiency, there is a decrease in the function of the unchanged part of the thyroid gland and the development of hypothyroidism in the second phase of subacute thyroiditis. Hypothyroidism is usually not prolonged and severe, and with the attenuation of inflammation, the level of thyroid hormones returns to normal.

The duration of the stage of thyrotoxicosis (acute, initial) in subacute thyroiditis is from 4 to 8 weeks. During this period, pain in the thyroid gland and neck, a decrease in the accumulation of radioactive iodine by the gland, and thyrotoxicosis phenomena are noted. IN acute stage thyroid hormone stores are depleted. As the intake of hormones into the blood decreases, the stage of euthyroidism develops, characterized by a normal level of thyroid hormones.

In cases of severe thyroiditis with a pronounced decrease in the number of functioning thyrocytes and depletion of the reserve of thyroid hormones, the stage of hypothyroidism with its clinical and biochemical manifestations may develop. The course of subacute thyroiditis is completed by the recovery stage, during which the structure and secretory function of the thyroid gland are finally restored. The development of persistent hypothyroidism is rare, in almost all patients who have had subacute thyroiditis, thyroid function is normalized (euthyroidism).

Chronic fibrous thyroiditis

The course of chronic fibrous thyroiditis for a long time may not cause disturbances in well-being with a slow, gradual progression of structural changes in the thyroid tissue. Most early manifestation fibrous thyroiditis is difficulty swallowing and a feeling of "lump in the throat". In the advanced stage of the disease, breathing, swallowing, speech disorders, hoarseness of the voice, and choking while eating develop.

Palpation is determined by a significant uneven enlargement of the thyroid gland (tuberosity), its compaction, inactivity when swallowing, dense "woody" consistency, painlessness. The defeat of the gland is, as a rule, diffuse in nature and is accompanied by a decrease in its functional activity with the development of hypothyroidism.

Compression of neighboring structures of the neck causes a compression syndrome, manifested by headache, visual disturbances, tinnitus, difficulty in swallowing, pulsation cervical vessels, respiratory failure.

Specific thyroiditis

Specific thyroiditis includes inflammatory and structural changes thyroid tissue of the thyroid gland with its tuberculous, syphilitic, mycotic lesions. Specific thyroiditis is chronic course; in cases of accession of a secondary infection become acute.

Complications of thyroiditis

Purulent inflammation of the thyroid gland in acute thyroiditis, occurring with the formation of an abscess, is fraught with an autopsy purulent cavity into the surrounding tissues: mediastinum (with the development of mediastinitis), trachea (with the development of aspiration pneumonia, lung abscess). The spread of a purulent process to the tissues of the neck can cause the development of phlegmon of the neck, damage to blood vessels, hematogenous spread of infection to meninges(meningitis) and brain tissue (encephalitis), the development of sepsis.

The neglect of subacute thyroiditis causes damage to a significant number of thyrocytes and the development of irreversible thyroid insufficiency.

Diagnosis of thyroiditis

In all forms of thyroiditis, changes in the general blood test are characterized by signs of inflammation: neutrophilic leukocytosis, shift leukocyte formula to the left, an increase in ESR. acute form thyroiditis is not accompanied by a change in the level of thyroid hormones in the blood. In subacute course, an increase in the concentration of hormones is noted first (the stage of thyrotoxicosis), then their decrease occurs (euthyroidism, hypothyroidism). Ultrasound of the thyroid gland reveals its focal or diffuse enlargement, abscesses, nodes.

Thyroid scintigraphy specifies the size and nature of the lesion. In the stage of hypothyroidism with subacute thyroiditis, there is a decrease in the absorption of iodine radioisotopes by the thyroid gland (less than 1%, at a rate of 15–20%); in the stage of euthyroidism with the restoration of the function of thyrocytes, the accumulation of radioactive iodine normalizes, and in the stage of recovery, due to an increase in the activity of regenerating follicles, it temporarily increases. Scintigraphy with fibrous thyroiditis allows you to detect the size, fuzzy contours, altered shape of the thyroid gland.

Treatment of thyroiditis

In mild forms of thyroiditis, one can limit oneself to the observation of an endocrinologist, the appointment of non-steroidal anti-inflammatory drugs to relieve pain, symptomatic therapy. With severe diffuse inflammation, apply steroid hormones(prednisolone with gradual dose reduction).

In acute purulent thyroiditis, the patient is hospitalized in the department of surgery. Active antibiotic therapy(penicillins, cephalosporins), vitamins B and C, antihistamines(mebhydrolin, chloropyramine, clemastine, cyproheptadine), massive intravenous detoxification therapy ( saline solutions, reopoliglyukin). When an abscess is formed in the thyroid gland, it is surgically opened and drained.

Treatment of subacute and chronic thyroiditis is carried out with thyroid hormones. With the development of a compression syndrome with signs of compression of the structures of the neck, they resort to surgical intervention. Specific thyroiditis is cured by treating the underlying disease.

Forecast and prevention of thyroiditis

Early treatment of acute thyroiditis ends with complete recovery of the patient in 1.5-2 months. Rarely, after suffering purulent thyroiditis, persistent hypothyroidism may develop. Active therapy of subacute thyroiditis can achieve a cure in 2-3 months. Running subacute forms can last up to 2 years and take chronic. Fibrous thyroiditis is characterized by long-term progression and development of hypothyroidism.

To prevent thyroiditis, the role of prevention of infectious and viral diseases is great: hardening, vitamin therapy, healthy eating and lifestyle. It is necessary to carry out timely sanitation of chronic foci of infection: treatment of caries, otitis, tonsillitis, sinusitis, pneumonia, etc. Compliance with medical recommendations and prescriptions, preventing self-reduction of the dose of hormones or their cancellation will avoid recurrence of subacute thyroiditis.

ICD-10 code

The most commonly diagnosed inflammatory disease of the thyroid gland is called thyroiditis. That it is the most common thyroid disease in the world and the second most diagnosed among all diseases endocrine system(after diabetes), according to WHO publications. However, there are no exact statistics, since the disease has a complex etiology. Some scientists believe that up to 50% of the population suffers from thyroiditis.

Thyroiditis of the thyroid gland - what is it?

Under the general name "thyroiditis" is a group of inflammatory diseases of the thyroid gland. As a result of inflammation of the tissues of the gland, the production of thyroid hormones first increases significantly, hyperthyroidism occurs, and then the inflamed gland produces them less than normal (hypothyroidism occurs).

In some cases, the inflammatory process affects a small part of the thyroid gland, which rarely happens, the entire lobe (most often) or the entire gland. With a complicated course of thyroiditis, suppuration occurs, it can break through under the skin, which is fraught with the penetration of pus into the blood and the development of sepsis.

Important. The most common thyroiditis is autoimmune (Hashimoto's). In this form, the body healthy tissue the thyroid gland begins to perceive as foreign and produces antibodies to it.

At initial examination it is quite difficult to establish the type and cause of thyroiditis of the thyroid gland. What it is, can be said with accuracy only after a series of analyzes.

Causes

Most common causes thyroiditis is called infectious diseases: tuberculosis, syphilis, influenza, hepatitis A, measles, etc.

Some scientists consider endemic goiter to be one of the causes of thyroiditis.

In autoimmune forms, the cause is a malfunction of the immune system. This form of thyroiditis occurs more frequently in women than in men. The most likely age range is considered to be 40-50 years. However, doctors are increasingly fixing the disease in people much younger than this age.

Among the causes of inflammatory processes in the thyroid gland are also called:

• prolonged stay in a territory with a high radioactive background;
• frequent irradiation of the head;
• living in a territory poor in iodine;
• eating too much iodine;
• frequent colds and infectious diseases, etc.

Types, forms of thyroiditis and their symptoms

Thyroiditis has many classifications according to various characteristics:

• Depending on the etiology, there are: syphilitic, septomycotic, tuberculous and other types.
• By age, it can be divided into juvenile, senile, postpartum, etc.
• The inflammation can be classified as autoimmune thyroiditis or as fibrotic.

The most widely used classification according to the course of the disease: acute, subacute and chronic.

acute form

This form of thyroiditis occurs rarely, it is considered the most severe, it can affect both the entire gland and part of it. In this disease, there is an increase The lymph nodes on the neck.

Acute thyroiditis can be purulent and non-purulent (aseptic).

Acute purulent thyroiditis

An abscess develops in the thyroid gland. At the same time, the body temperature rises to 39 ⁰С. It hurts the patient to swallow. The pain intensifies when turning the neck and head, gives to the back of the head, ears, jaw. There is a severe headache and irritability against the background of general intoxication of the body.

The thyroid gland itself becomes dense at first, and then, after the formation of an abscess, soft, swollen and painful. Pain occurs when touching the organ.

Important. With purulent thyroiditis, the patient's condition in most cases is assessed as extremely severe.

Acute non-purulent thyroiditis

With this type of thyroiditis, suppuration does not occur, only inflammation in a certain area of ​​\u200b\u200bthe thyroid gland. Symptoms of non-purulent acute thyroiditis are less pronounced. The patient's condition is assessed as moderate.

Subacute form

This form of thyroiditis is characterized by a slow, gradual increase in symptoms. At first, pain in the neck is insignificant. When swallowing, only discomfort occurs. Gradually, the symptoms intensify: the pain becomes severe, radiates to the ears, jaw, nape, it is more and more difficult to swallow, the body temperature rises to 38 ⁰С, while (not always) the cervical lymph nodes increase.

The course of the disease is long: up to 1.5–2 months. In the study of the hormonal background, a decrease in radioactive iodine in the body, thyrotoxicosis, and a decrease in the level of hormones are found.

Subacute thyroiditis responds well to treatment, usually ends with recovery.

Chronic form

It has a very long flow period: up to 6-8 months. The most common chronic form is autoimmune thyroiditis (Hashimoto's thyroiditis). It affects about 6, and according to some data up to 15 times more often women than men.

However chronic inflammation thyroid gland in men, the symptoms are more pronounced. With a long course, there is a decrease in body temperature, a slowdown metabolic processes in the body, memory loss, lethargy, fatigue, bad dream, digestive disorders, reduced fertility.

With invasive fibrous goiter (Riedel's disease), inflammation of the thyroid gland also proceeds chronically. Some scholars are of the opinion that chronic form almost always occurs when various kinds endemic goiter.

More about the symptoms

Important! In the initial stage of the disease, thyroiditis symptoms are blurred, they can be characteristic of diseases of other organs of the neck, as well as other diseases of the thyroid gland. Acute thyroiditis is most pronounced.

Among common symptoms thyroiditis of the thyroid gland:

• enlargement of the thyroid gland or part of it;
• redness of the skin of the throat;
• pain when swallowing and turning the head.

At acute inflammation thyroid symptoms will appear sharply:

• pain in the neck, even when turning the head;
• problems with swallowing;
• fever, chills;
• enlargement of the cervical lymph nodes.

In subacute thyroiditis, symptoms appear gradually, pain in the neck increases slowly. There is a constant headache, weakness, sweating and a feeling of heat. There is a tremor of the fingers. The skin over the thyroid gland turns red, swells, the thyroid gland is painful on palpation.

In chronic autoimmune thyroiditis, the symptoms described above are accompanied by weight loss, tachycardia, tinnitus, and pain in the back of the head.

Autoimmune inflammation of the thyroid gland in women has less pronounced symptoms, in men the disease is acute, the symptoms are pronounced.

Treatment of inflammation of the thyroid gland

Treatment of thyroiditis has several directions:

• it is important to restore the hormonal balance, if it is disturbed. For this purpose, treatment with thyrostatics (Merkazolil, Thiamazole) is carried out.
• Non-steroidal anti-inflammatory drugs for thyroiditis (Metindol, Voltaren, Indomethacin) will help relieve inflammation, reduce swelling and soreness of the gland.
• Corticosteroid drugs (Prednisolone) for thyroiditis are used in case of development of its subacute form. They relieve inflammation, swelling and pain well.
• Vitamin complexes, immunity stimulants, adaptogens are also prescribed.

Acute purulent thyroiditis treatment will require surgery. Here, if an abscess occurs, it is opened and drained. In parallel, intensive detoxification therapy and antibiotic injections are prescribed.

With autoimmune inflammation of the thyroid gland in women, treatment is carried out for a long time. Often appointed hormonal preparations thyroid for life.

In case of development of compression of the neck organs in chronic or subacute thyroiditis, prompt removal glands (thyroidectomy).

About folk remedies

Traditional medicine also offers its own recipes on how to treat thyroiditis. The most common are rubbing with goiter infusions. For this use alcohol infusion green pine cones or extracts of their collection of herbs: cocklebur, celandine, chamomile and meadowsweet.

Juice therapy is also used; lemon, beet and carrot juices are used to treat pathology.

Autoimmune thyroiditis (AIT)- chronic inflammation of the thyroid tissue, which has an autoimmune genesis and is associated with damage and destruction of the follicles and follicular cells of the gland. In typical cases, autoimmune thyroiditis has asymptomatic course, only occasionally accompanied by an increase in the thyroid gland. Diagnostics autoimmune thyroiditis is carried out taking into account the results clinical analyzes, Ultrasound of the thyroid gland, data of histological examination of the material obtained as a result of a fine needle biopsy. Treatment of autoimmune thyroiditis is carried out by endocrinologists. It consists in correcting the hormone-producing function of the thyroid gland and suppressing autoimmune processes.

ICD-10

E06.3

General information

Autoimmune thyroiditis (AIT)- chronic inflammation of the thyroid tissue, which has an autoimmune genesis and is associated with damage and destruction of the follicles and follicular cells of the gland. Autoimmune thyroiditis accounts for 20-30% of all thyroid diseases. Among women, AIT occurs 15-20 times more often than among men, which is associated with a violation of the X chromosome and with the effect of estrogen on the lymphoid system. Patients with autoimmune thyroiditis are usually in their 40s and 50s, although more recently the disease has been seen in young adults and children.

Classification of autoimmune thyroiditis

Autoimmune thyroiditis includes a group of diseases that have the same nature.

• Chronic autoimmune thyroiditis(lymphomatous, lymphocytic thyroiditis, obsolete - Hashimoto's goiter) develops as a result of progressive infiltration of T-lymphocytes into the parenchyma of the gland, an increase in the number of antibodies to the cells and leads to the gradual destruction of the thyroid gland. As a result of a violation of the structure and function of the thyroid gland, the development of primary hypothyroidism (decrease in the level of thyroid hormones) is possible. Chronic AIT has a genetic nature, can manifest itself in the form of family forms, be combined with other autoimmune disorders.
• Postpartum thyroiditis most common and most studied. Its cause is excessive reactivation of the body's immune system after its natural suppression during pregnancy. With the existing predisposition, this can lead to the development of destructive autoimmune thyroiditis.
• Painless thyroiditis is an analogue of postpartum, but its occurrence is not associated with pregnancy, its causes are unknown.
• Cytokine-induced thyroiditis may occur during treatment with interferon drugs in patients with hepatitis C and blood diseases.

Such variants of autoimmune thyroiditis, such as postpartum, painless and cytokine-induced, are similar in the phase of the processes occurring in the thyroid gland. At the initial stage, destructive thyrotoxicosis develops, subsequently turning into transient hypothyroidism, in most cases ending in the restoration of thyroid function.

In all autoimmune thyroiditis, the following phases can be distinguished:

• Euthyroid phase diseases (without dysfunction of the thyroid gland). It can last for years, decades, or a lifetime.
• Subclinical phase. In the case of disease progression, mass aggression of T-lymphocytes leads to the destruction of thyroid cells and a decrease in the amount of thyroid hormones. By increasing the production of thyroid-stimulating hormone (TSH), which overstimulates the thyroid gland, the body manages to maintain normal production of T4.
• thyrotoxic phase. As a result of an increase in T-lymphocyte aggression and damage to thyroid cells, existing thyroid hormones are released into the blood and thyrotoxicosis develops. In addition, destroyed parts of the internal structures of follicular cells enter the bloodstream, which provoke further production of antibodies to thyroid cells. When, with further destruction of the thyroid gland, the number of hormone-producing cells falls below critical level, the content of T4 in the blood decreases sharply, the phase of apparent hypothyroidism begins.
• hypothyroid phase. It lasts about a year, after which the restoration of thyroid function usually occurs. Sometimes hypothyroidism remains persistent.

Autoimmune thyroiditis can be monophasic (have only thyrotoxic or only hypothyroid phase).

According to clinical manifestations and changes in the size of the thyroid gland, autoimmune thyroiditis is divided into forms:

• Latent(there are only immunological signs, there are no clinical symptoms). The gland is of a normal size or slightly enlarged (1-2 degrees), without seals, the functions of the gland are not disturbed, sometimes they can be observed moderate symptoms thyrotoxicosis or hypothyroidism.
• Hypertrophic(accompanied by an increase in the size of the thyroid gland (goiter), frequent moderate manifestations of hypothyroidism or thyrotoxicosis). There may be a uniform increase in the thyroid gland throughout the volume (diffuse form), or the formation of nodes (nodular form) can be observed, sometimes a combination of diffuse and nodal forms. Hypertrophic form autoimmune thyroiditis may be accompanied by thyrotoxicosis in the initial stage of the disease, but usually the function of the thyroid gland is preserved or reduced. As the autoimmune process in the thyroid tissue progresses, the condition worsens, thyroid function decreases, and hypothyroidism develops.
• atrophic(the size of the thyroid gland is normal or reduced, according to clinical symptoms- hypothyroidism). It is more often observed in the elderly, and in young people - in the case of exposure to radioactive irradiation. The most severe form of autoimmune thyroiditis, due to the massive destruction of thyrocytes, the function of the thyroid gland is sharply reduced.

Causes of autoimmune thyroiditis

Even with hereditary predisposition, for the development of autoimmune thyroiditis, additional unfavorable provoking factors are necessary:

• transferred acute respiratory viral diseases;
• foci of chronic infection (on the palatine tonsils, in the sinuses of the nose, carious teeth);
• ecology, excess of iodine, chlorine and fluorine compounds in the environment, food and water (affects the activity of lymphocytes);
• prolonged uncontrolled use of drugs (iodine-containing drugs, hormonal drugs);
• radiation exposure, prolonged exposure to the sun;
• traumatic situations (illness or death of loved ones, job loss, resentment and disappointment).

Symptoms of autoimmune thyroiditis

Most cases of chronic autoimmune thyroiditis (in the euthyroid phase and the phase of subclinical hypothyroidism) long time is asymptomatic. The thyroid gland is not enlarged, painless on palpation, the function of the gland is normal. Very rarely, an increase in the size of the thyroid gland (goiter) can be determined, the patient complains of discomfort in the thyroid gland (feeling of pressure, coma in the throat), easy fatigue, weakness, joint pain.

The clinical picture of thyrotoxicosis in autoimmune thyroiditis is usually observed in the first years of the development of the disease, is transient, and as the functioning thyroid tissue atrophies, it passes for some time into the euthyroid phase, and then into hypothyroidism.

Postpartum thyroiditis usually presents with mild thyrotoxicosis at 14 weeks postpartum. In most cases, fatigue general weakness, weight loss. Sometimes thyrotoxicosis is significantly pronounced (tachycardia, a feeling of heat, excessive sweating, limb tremor, emotional lability, insomnia). The hypothyroid phase of autoimmune thyroiditis appears on the 19th week after childbirth. In some cases, it is combined with postpartum depression.

Painless (silent) thyroiditis is mild, often subclinical thyrotoxicosis. Cytokine-induced thyroiditis is also usually not accompanied by severe thyrotoxicosis or hypothyroidism.

Diagnosis of autoimmune thyroiditis

Before the onset of hypothyroidism, it is quite difficult to diagnose AIT. Endocrinologists establish the diagnosis of autoimmune thyroiditis according to the clinical picture, data laboratory research. The presence of autoimmune disorders in other family members confirms the likelihood of autoimmune thyroiditis.

Laboratory studies for autoimmune thyroiditis include:

• general analysis blood- an increase in the number of lymphocytes is determined
• immunogram- characterized by the presence of antibodies to thyroglobulin, thyroperoxidase, the second colloid antigen, antibodies to thyroid hormones of the thyroid gland
• determination of T3 and T4(general and free), serum TSH levels. Raise TSH level when the content of T4 is normal, it indicates subclinical hypothyroidism, elevated level TSH with a reduced concentration of T4 - about clinical hypothyroidism
• Thyroid ultrasound- shows an increase or decrease in the size of the gland, a change in structure. The results of this study complement the clinical picture and other laboratory findings.
• fine needle biopsy of the thyroid gland- allows you to identify a large number of lymphocytes and other cells characteristic of autoimmune thyroiditis. It is used in the presence of evidence of a possible malignant degeneration of a nodular formation of the thyroid gland.

Criteria for the diagnosis of autoimmune thyroiditis are:

• increased levels of circulating antibodies to the thyroid gland (AT-TPO);
• ultrasound detection of hypoechogenicity of the thyroid gland;
• signs of primary hypothyroidism.

In the absence of at least one of these criteria, the diagnosis of autoimmune thyroiditis is only probabilistic. Since an increase in the level of AT-TPO, or hypoechogenicity of the thyroid gland, by itself does not yet prove autoimmune thyroiditis, this does not allow to establish accurate diagnosis. Treatment is indicated for the patient only in the hypothyroid phase, so there is usually no urgent need for a diagnosis in the euthyroid phase.

Treatment of autoimmune thyroiditis

Specific therapy for autoimmune thyroiditis has not been developed. Despite modern achievements medicine, endocrinology does not yet have effective and safe methods corrections autoimmune pathology thyroid gland, in which the process would not progress to hypothyroidism.

In the case of the thyrotoxic phase of autoimmune thyroiditis, the appointment of drugs that suppress the function of the thyroid gland - thyrostatics (thiamazole, carbimazole, propylthiouracil) is not recommended, since with this process there is no hyperfunction of the thyroid gland. For severe symptoms cardiovascular disorders use beta-blockers.

With manifestations of hypothyroidism individually prescribed replacement therapy thyroid preparations of thyroid hormones - levothyroxine (L-thyroxine). It is under control clinical picture and serum TSH levels.

Glucocorticoids (prednisolone) are indicated only with the simultaneous course of autoimmune thyroiditis with subacute thyroiditis, which is often observed in the autumn-winter period. To reduce the titer of autoantibodies, non-steroidal anti-inflammatory drugs are used: indomethacin, diclofenac. They also use drugs for the correction of immunity, vitamins, adaptogens. With hypertrophy of the thyroid gland and severe compression of the mediastinal organs by it, surgical treatment is performed.

Forecast

The prognosis for the development of autoimmune thyroiditis is satisfactory. With timely treatment, the process of destruction and decrease in thyroid function can be significantly slowed down and a long-term remission of the disease can be achieved. Satisfactory health and normal performance of patients in some cases persist for more than 15 years, despite the occurrence of short-term exacerbations of AIT.

Autoimmune thyroiditis and elevated titer of antibodies to thyroperoxidase (AT-TPO) should be considered as risk factors for future hypothyroidism. In the case of postpartum thyroiditis, the likelihood of its recurrence after next pregnancy in women it is 70%. About 25-30% of women with postpartum thyroiditis later have chronic autoimmune thyroiditis with a transition to persistent hypothyroidism.

Prevention

If autoimmune thyroiditis is detected without impaired thyroid function, it is necessary to monitor the patient in order to detect and promptly compensate for manifestations of hypothyroidism as soon as possible.

Women who are carriers of Ab-TPO without changes in thyroid function are at risk of developing hypothyroidism in the event of pregnancy. Therefore, it is necessary to monitor the condition and function of the thyroid gland as early dates pregnancy and after childbirth.

ICD-10 code

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

Autoimmune thyroiditis - causes

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

Symptoms of autoimmune thyroiditis (AIT)

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

Diagnosis of AIT

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

Autoimmune thyroiditis on ultrasound of the thyroid gland

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

Treatment of autoimmune thyroiditis

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

• Purulent thyroiditis

  Purulent thyroiditis - a bacterial inflammatory disease of the thyroid gland

• Riedel's thyroiditis

  Riedel's thyroiditis is a rare disease characterized by replacement of the parenchymal tissue of the thyroid gland. connective tissue with the development of symptoms of compression of the neck organs

• Pituitary dwarfism (dwarfism)

  Pituitary dwarfism or dwarfism is a syndrome that is characterized by a sharp lag in growth and physical development associated with absolute or relative insufficiency growth hormone

• Subacute thyroiditis (de Quervain's thyroiditis)

  Subacute thyroiditis is inflammatory disease thyroid gland, arising after the transferred viral infection and flowing with the destruction of thyroid cells. Most often, subacute thyroiditis occurs in women. Men suffer from subacute thyroiditis much less often than women - about 5 times.

• Autoimmune polyglandular syndrome

  Autoimmune polyglandular syndrome - a group of endocrinopathies, which is characterized by the involvement of several endocrine glands in the pathological process as a result of their autoimmune damage

• Panhypopituitarism

  Panhypopituitarism is clinical syndrome which develops due to destructive processes in the adenohypophysis, accompanied by a decrease in the production of tropic hormones, which entails a disruption in the functioning of most glands internal secretion

• Chronic adrenal insufficiency

  Adrenal insufficiency (adrenal cortex insufficiency) is one of the most serious illnesses endocrine system, which is characterized by a decrease in the production of hormones by the adrenal cortex (glucocorticoids and mineralocorticoids)

• Classes of devices for performing ultrasound of the thyroid gland

  Description of the different classes of ultrasound equipment used for thyroid ultrasound

• Hormone T3

  Hormone T3 (triiodothyronine) is one of the two main thyroid hormones and the most active of them. The article describes the structure of the T3 hormone molecule, a blood test for the T3 hormone, types of laboratory parameters (free and common hormone T3), interpretation of test results, as well as where it is better to donate thyroid hormones

• Hormone T4

  Hormone T4 (thyroxine, tetraiodothyronine) - all information about where the hormone T4 is produced, what effect it has, what blood tests are done to determine the level of the hormone T4, what symptoms occur when the level of the hormone T4 decreases and increases

• Endocrine ophthalmopathy (Graves' ophthalmopathy)

  Endocrine ophthalmopathy (Graves' ophthalmopathy) - a disease of the behind-the-eye tissues and muscles eyeball autoimmune nature, which occurs against the background of the pathology of the thyroid gland and leads to the development of exophthalmos, or bulging eyes, and the complex eye symptoms

• Diffuse euthyroid goiter

  diffuse euthyroid goiter- this is a general diffuse enlargement of the thyroid gland, visible to the naked eye or detected by palpation, characterized by the preservation of its function

• Hypothyroidism

  Hypothyroidism is a condition characterized by a lack of thyroid hormones. With the long-term existence of untreated hypothyroidism, the development of myxedema is possible (" mucous edema”), in which swelling of the patient's tissues develops in combination with the main signs of thyroid hormone deficiency.

• Thyroid diseases

  At present, the study of thyroid diseases is given such serious attention that a special section of endocrinology has been singled out - thyroidology, i.e. thyroid science. Doctors involved in the diagnosis and treatment of thyroid diseases are called thyroidologists.

• Thyroid hormones

  Thyroid hormones are divided into two distinct classes: iodithyronins (thyroxine, triiodothyronine) and calcitonin. Of these two classes of thyroid hormones, thyroxine and triiodothyronine regulate the body's basal metabolism (the level of energy consumption that is necessary to maintain the body's vital functions in a state of complete rest), and calcitonin is involved in the regulation of calcium metabolism and bone tissue development.

Autoimmune thyroiditis is an autoimmune disease that is the main cause of hypothyroidism.

With this disease, the thyroid gland is significantly inflamed, and its hormone production is low. This gradually leads to the development of hypothyroidism. This is an immune disease because immune system The body produces antibodies that attack thyroid tissue. Traditional medicine methods cannot cure autoimmune thyroiditis, but the treatment of autoimmune thyroiditis folk remedies gives good result. Some people are completely cured of the disease, while others alleviate symptoms, improve well-being and prolong years of life.

Causes of the disease

Autoimmune thyroiditis can be caused by the following factors:

The presence chronic infections in the human body (sinusitis, caries).

Early transferred viral (infectious) disease.

Any psychological trauma (stress, disappointment, loss).

Unfavorable ecology.

Poor nutrition and living conditions.

Uncontrolled use of various medicines(self-medication).

Radiation radiation or prolonged exposure to the open sun.

Diabetes mellitus.

hereditary predisposition.

The disease is most often diagnosed in people in middle age (30-50 years). In women, it is found several times more often due to a certain tendency. Symptoms vary depending on the stage of the disease. We will study the treatment of autoimmune thyroiditis with folk remedies below.

Consider the symptoms in more detail.

Early stage

Symptoms of autoimmune thyroiditis early stage are characterized by:

• pale skin;
• brittle nails;
• thinning hair;
• pain in the muscles;
• an increase in body weight;
• fatigue;
• joint pain;
• constipation;
• cold intolerance;
• depressions.

This is how autoimmune thyroiditis of the thyroid gland manifests itself at an early stage. Treatment with folk remedies will be as effective as possible.

late stage

Symptoms of autoimmune thyroiditis late stage are characterized by:

• decline taste sensations and smell;
• dry skin;
• irregular periods;
• slow speech;
• swelling of the face, arms and legs;
• sore throat;
• eyebrow loss.

This happens at a late stage of autoimmune thyroiditis. Symptoms, treatment with folk remedies are often interrelated.

Common symptoms regardless of stage

These signs distinguish autoimmune thyroiditis, regardless of the stage:

• loss of appetite;
• stiffness in the joints;
• muscle atrophy;
• muscle pain and cramps;
• dry hair;
• swelling in other parts of the body;
• drowsiness;
• hair loss;
• decreased coordination of body movements.

We examined the main signs of a disease called "autoimmune thyroiditis of the thyroid gland." Treatment with folk remedies is very popular lately.

Diagnosis of the disease

Autoimmune thyroiditis is defined as:

A general blood test for the level of lymphocytes.

Immunogram for the presence of antibodies to thyroglobulin.

Ultrasound of the thyroid gland.

Thyroid biopsy (fine-needle) to detect a large number of lymphocytes, which may indicate the presence of the disease.

So you can identify autoimmune thyroiditis, hypothyroidism.

Treatment with folk remedies must necessarily be long.

In conventional medicine, hypothyroidism is treated with hormone replacement therapy. synthetic hormones thyroid for the rest of your life. This is due to the fact that the thyroid gland cannot fully produce hormones (T3 and T4), and the body really needs them.

The disease is most often characterized by:

• An increase in antibodies against the thyroid gland.
• Detection on ultrasound of an enlarged gland.
• primary hypothyroidism.

If one of the criteria is missing, the diagnosis is likely but not certain.

Diagnosis of this disease is not always reliable, the results of several tests may vary. It happens that in the real absence of the disease, people are prescribed hormonal drugs. They drink them, thereby disrupting the functioning of the thyroid gland completely. That is, at first there was no illness, but now there is. And people have to take hormones throughout their lives. Treatment of autoimmune thyroiditis with folk remedies in a more gentle way affects the body.

If a person has already started taking hormonal drugs, it will be much more difficult to cure him. Unlike those who did not take these medicines or those who were treated with traditional medicine. The usual scheme of drug treatment suggests the impossibility of refusing them, as happens in the treatment of diabetes mellitus, high cholesterol, mental disorders and cancer diseases.

The signs of autoimmune thyroiditis can be controlled naturally in several ways. In the absence of a specific method of treatment that can completely rid a person of the disease, there are folk remedies. They are very good at helping people who have been suffering from this disease for a long time.

Consider what is the diagnosis of autoimmune thyroiditis with nodulation treatment with folk remedies.

Treatment of autoimmune thyroiditis with coconut oil

Coconut oil is one of nature's most powerful healers. It is necessary to enrich the diet of a person suffering from autoimmune thyroiditis or hypothyroidism with it daily. This will help to remove many symptoms, improve well-being.

Coconut oil is saturated fat, it contains mainly medium chain fatty acids or medium chain triglycerides. They are great for boosting metabolism, increasing basal body temperature, reducing weight, and boosting energy.

Triglycerides are half composed of It is one of the most important fatty acids that creates and maintains immune defense organism. Differs extremely positive impact to the thyroid gland.

Coconut oil is also rich in other fatty acids that are equally beneficial. They are able to maintain human health at the highest level.

Linoleic acid is often used in the manufacture of drugs for weight loss. It's polyunsaturated fatty acid, is sold as a food supplement in capsules. It is called It refers to necessary for the body fats for weight loss.

Don't forget about oleic acid. It is an omega-9 unsaturated fatty acid found in coconut and olive oil. It is also highly recommended for autoimmune thyroiditis. Oleic acid increases high-density lipoproteins, reduces low-density lipoproteins. This is good and bad cholesterol.

Given autoimmune disease use of at least four tablespoons is indicated coconut oil per day. If this amount seems too large, then you can start with two spoons. Then gradually the dose should be increased.

The diet of a person with hypothyroidism or thyroiditis must be carefully considered. Many foods worsen the condition, but if you eat only healthy food, your health will improve markedly. This is the treatment of autoimmune thyroiditis with folk remedies.

Let's consider in more detail what is useful to eat.

The use of essential oils

In autoimmune thyroiditis are indicated for use the following types essential oils:

Peppermint;

Spearmint;

Carnation.

They can be applied to the surface of the skin, as well as applied special drug for evaporation (diffuser). With it, you can regularly inhale the aromas of oils.

Application of Bach colors

Symptoms of autoimmune thyroiditis and hypothyroidism are controlled by treatment with flower essences. The three most commonly used are:

• Wild rose essence. It only takes a couple of drops of essence to mix with a little water. This composition must be drunk once a day. At regular use fatigue will pass and depression, which are associated with autoimmune thyroiditis.
• Elm essence. You just need to mix a couple of drops with water. Then drink this composition. Once a day, not more often, the essence is used. This perfectly restores well-being in this disease.
• Essence of wild apple tree. Good for cleansing the body. The recipe is the same - two drops of wild apple essence and water. Drink during the day.

milk thistle

Milk thistle tea can be made. The plant is also called milk thistle. It is used to relieve intoxication of the body. Toxins are eliminated through daily use one cup of this tea. Especially if a person has chronic autoimmune thyroiditis. Treatment with folk remedies will be very helpful.

Apples and pears for thyroiditis

With the help of pears, you can control the level of hormones in the body. This was noticed in ancient China. Pears have a good effect especially on the female half of humanity. balance hormonal background and apples. They are best consumed together in the form of pear-apple puree or freshly squeezed juice.

We have considered autoimmune thyroiditis.

Treatment with folk remedies is not limited to this. There are a large number of recipes that can help with this disease.