Thyroiditis chronic autoimmune

Thyroiditis chronic autoimmune

Chronic autoimmune thyroiditis is a thyroiditis that is traditionally manifested by goiter and symptoms of hypothyroidism. Significantly increased risk of thyroid cancer. The predominant age is 40-50 years. Women are observed 8-10 times more often.

Etiology and pathogenesis

• • An inherited defect in the function of T-suppressors (140300, association with the DR5, DR3, B8, R loci) leads to stimulation by T-helpers of the production of cytostimulating or cytotoxic antibodies to thyroglobulin, the colloidal component and the microsomal fraction with the development of primary hypothyroidism, an increase in the production of TSH and ultimately goiter
  • Depending on the predominance of the cytostimulating or cytotoxic action of AT, hypertrophic, atrophic, or focal forms of chronic autoimmune thyroiditis are distinguished.
  • Hypertrophic. Association with H1A-B8 and -DR5, predominant production of cytostimulating AT
  • Atrophic. Association with H1A-DR3, preferential production of cytotoxic AT, TSH receptor resistance
  • Focal. Damage to one lobe of the thyroid gland. The ratio of AT may be different.

Pathological anatomy. Abundant infiltration of the stroma of the gland with lymphoid elements, incl. plasma cells. The clinical picture is determined by the ratio of cytostimulating or cytotoxic AT

• • Thyroid enlargement is the most common clinical manifestation
  • Hypothyroidism at the time of diagnosis is found in 20% of patients, but in some it develops later. During the first months of the disease, hyperthyroidism can be observed.

Diagnostics

• • High titers of antithyroglobulin or antimicrosomal antibodies
  • The results of thyroid function tests can vary.

Treatment:

Drug therapy

• • Levothyroxine sodium (L-thyroxine) at the initial dose of 25 or 50 mcg / day with further correction until the serum TSH content decreases to the lower limit of normal. It is indicated even with normal thyroid function, tk. often reduces the size of the goiter
  • Mercazolil, propranolol (anaprilin) ​​- with clinical manifestations of hyperthyroidism.

precautionary measures. Levothyroxine should be used with caution in elderly patients with concomitant coronary artery disease, heart failure or tachycardia, and also (especially at the beginning of treatment) with arterial hypertension, adrenal insufficiency, with severe or prolonged hypothyroidism.

Drug Interactions

• • Levothyroxine reduces the effects of insulin and oral antidiabetic agents, enhances the effect of indirect anticoagulants
  • Diphenin salicylates, neodicoumarin, furosemide (in high doses), clofibrate increase the level of levothyroxine in the blood
  • Cholestyramine reduces the absorption of levothyroxine.

Associated pathology. Other autoimmune diseases (for example, pernicious anemia or rheumatoid arthritis).

Synonyms

• Hashimdto’s disease
• Goiter Hashimoto
• Thyroiditis Hashimdto
• Goiter lymphomatous
• Lymphadenoid goiter
• Thyroid blastoma, lymphadenoid
• Lymphocytic goiter See also ICD hypothyroidism. E06.3 Autoimmune thyroiditis