Symptoms, signs, diagnosis and treatment of thyroiditis Hashimoto.
[Autoimmune thyroiditis (AIT), chronic lymphocytic thyroiditis, Hashimoto goiter]
Hashimoto thyroiditis is a chronic autoimmune inflammatory disease of the thyroid gland with lymphocytic infiltration. The clinical picture includes a painless enlargement of the thyroid gland in combination with symptoms of hypothyroidism. Diagnostics include the determination of the presence of high titers of antibody to thyroid peroxidase. Long-term, lifelong therapy with thyroxin is usually indicated.
It is believed that Hashimoto's thyroiditis is the main cause of primary hypothyroidism in North America. It is 2 times more common among women. There is an increase in the detection of the disease with age and in patients with chromosomal abnormalities, such as Turner syndrome, Down syndrome, and Kleinfelter. As a rule, a family history of thyroid pathology is detected.
Hashimoto's thyroiditis, as Graves disease, sometimes associated with autoimmune disorders, such as Adtsisona disease (adrenal insufficiency), diabetes type 1, hypoparathyroidism, vitiligo, premature graying of hair, trans-nitsioznaya anemia, connective tissue diseases (rheumatoid arthritis, systemic lupus erythematosus, Sjogren syndrome), Schmidt syndrome (Helldisone disease and secondary hypothyroidism). There may be an increase in cases of thyroid neoplasms, especially lymphomas. Pathophysiologically, widespread lymphocytic infiltration with lymphoid follicles and fibrous scarring take place.
Symptoms, signs of thyroiditis Hashimoto diagnosis
Patients complain of a painless enlargement of the thyroid gland or a feeling of "coma" in the throat. Examination reveals a goiter that is painless, smooth or granular on palpation, immobile and more dense in texture than a healthy thyroid gland. Many people have symptoms of hypothyroidism, less often there is a clinical picture of hyperthyroidism.
Laboratory examination includes determining levels of T, TSH,titer of thyroid autoantibodies; In the early stages of the disease, TSH and T levels are normal and only a high level of antibodies to thyroid peroxidase and, what is less characteristic, antithyroid-globulin antibodies are observed. The accumulation of radioactive iodine by the thyroid gland may be increased, possibly due to defects in the mechanism of the organization of iodine, together with the gland that continues to capture iodine. Later, patients develop hypothyroidism with a decrease in T, reduced accumulation of radioiodine with thyroid tissue and increased TSH. Laboratory studies for other autoimmune pathologies of the thyroid gland are justified only in the case when there are clinical signs of these diseases.
Treatment of Hashimoto Thyroiditis
Sometimes the state of hypothyroidism is short-lived, but most patients need long-term (lifelong) hormone replacement therapy, usually L-thyroxin, in a dose of 75 to 150 mg / day.
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