Subacute thyroiditis of the thyroid. Anatomy of the thyroid gland. General symptoms of inflammation

The term thyroiditis includes diseases in which inflammation occurs. thyroid gland. These diseases differ in symptoms, features of occurrence and course. Before treating thyroiditis, it is worth understanding what form of the disease the patient and the doctor are faced with.

Treatment for these diseases will also vary depending on the degree of dysfunction of the thyroid gland. Violations not related to endocrine system.

Before starting treatment, an examination will be required. Which should accurately determine the type of disease, because only after this the treatment will be as effective and safe as possible. Currently, there are several types of thyroiditis.

Table No. 1. Main thyroiditis and their features:

Important: treatment of this disorder is carried out only after examination, as prescribed and under the supervision of an endocrinologist, since self-medication can aggravate the patient’s condition

How to treat thyroiditis of the thyroid gland will be decided by the attending physician. Depending on the type of thyroiditis, treatment is aimed at one or another factor contributing to the development of thyroiditis (etiological and pathological therapy), as well as correction hormonal levels that arose during the underlying disease.

Medications for the treatment of thyroiditis

Conservative methods of treating thyroid disorders are carried out using several groups of drugs, each group is aimed at relieving a particular problem.

Thyroid drugs

Representatives:

• L-thyroxine.
• Levothyroxine.
• Euthyrox.
• Triiodothyronine.
• Thyroidin.
• Thyrotome.
• Novotiral

They carry a dose of thyroid hormones. Hormone replacement therapy is the main way to treat autoimmune thyroiditis at the stage.

At first, minimal doses are prescribed, and the dosage is increased every three weeks. The size of the individual dose depends on many factors that determine whether the drug will be lifelong.

Glucocorticosteroids

Representative - Prednisolone. Contains adrenal hormones. Works as a powerful anti-inflammatory agent that helps prevent the formation of antibodies to the thyroid gland.

Allows you to relieve intoxication of the body, relieve pain, affect work metabolic processes in organism. Treatment begins with high dose, gradually, every six days, the dosage is reduced to a maintenance level. The drug should not be discontinued abruptly; the dose and number of uses are reduced gradually.

Antibiotics

Representatives:

• Cephalosporins.
• Penicillin drugs.
• Other agents with antibiotic activity.

The wide range of effects of these groups makes it possible to destroy the pathogenic pathogen that provokes the development of acute purulent form thyroiditis.

Nonsteroidal anti-inflammatory drugs

Representatives:

• Methindol.
• Indomethacin.
• Indovis.
• Indotard.
• Indobene.

Fights inflammatory processes in the tissues of the thyroid gland. Reduces the likelihood of developing antibodies to the thyroid gland, relieves pain in the thyroid gland area if present pain syndrome. The standard course of treatment is 5 days, the maximum allowable is 7 days.

Local painkillers

Representative – Diclofenac ointment. Compresses on the thyroid area will help relieve inflammation and eliminate pain.

Beta blockers

Representatives:

• Propranolol.
• Inderal.
• Anaprilin.
• Obzidan.

The drugs help eliminate arrhythmia, reduce arterial pressure, reduce tremors, eliminate headaches. Normalize heart rhythms and improve blood supply to the vessels of the head.

For patients suffering from thyroiditis, they help cope with heart problems, increased heartbeat and other heart problems due to hypothyroidism. The reception begins with no large doses, a gradual increase is possible.

Immunomodulators

Representatives:

• Levamisole;
• Decaris.

Modulate work immune system, stop producing antibodies to your own thyroid gland. Have an effect general strengthening immunity.

Antihistamines

Representatives:

• Tavegil;
• Diazolin;
• Loratadine.

The drugs help relieve tissue swelling, which helps to quickly cure inflammation of the affected thyroid gland. Depending on the instructions, they can be taken once or twice a day. Photos and videos in this article will demonstrate the variety of drugs for the treatment of thyroiditis.

Treatment of thyroiditis

Important: with timely treatment of autoimmune thyroiditis, the prognosis is quite favorable.

Treatment for each disease will be carried out according to its own scheme, depending on the main point of damage. The stage of the disease at which treatment was started is also important, for example, the answer to the question - how to cure autoimmune thyroiditis will depend on the stage of the disease.

Table No. 2. Types of disease and possible scheme treatment:

Important: synthetic thyroid hormones prescribed for insufficient functioning of the gland provoke a lot of side effects, violations menstrual cycle in young women, problems with the cardiovascular system in people over 45 years of age.

Surgical methods for treating thyroiditis

Important: replacement therapy does not solve the problem - it does not restore the functioning of the organ; over time, the patient needs to increase the dosage.

Surgery may be required if various states thyroid gland.

Opening and draining the abscess

Manipulation is required for acute purulent thyroiditis with the formation of an abscess. Performed using local anesthesia. Damaged tissue is completely removed. The outflow of purulent masses is ensured by installing drainage. Local administration of antiseptic drugs is carried out.

Thyroidectomy or removal of the thyroid gland

Removal surgery is performed for the following indications:

• when combined chronic thyroiditis and second degree gland hypertrophy, surgery is sometimes the only method to treat chronic thyroiditis;
• with pressure from the altered gland on the trachea or esophagus;
• if therapy does not show adequate results and the growth of the affected thyroid gland continues;
• when particularly large nodular formations are detected on the body of the gland or there is a possibility of degeneration of formations from benign to malignant.

Before surgery, a comprehensive examination is necessary. If necessary, treatment is carried out before surgery cardiovascular problems, glucose levels are normalized when they deviate from the norm.

Removal of the gland can be of several types:

• partial removal of the gland– hemithyroidectomy;
• subtotal removal– it preserves the upper parts of the gland;
• total removal of all tissue– strumectomy.

Important: after total removal of the organ, the patient will undergo lifelong hormone replacement therapy due to persistent hypothyroidism.

The thyroid gland is removed in accordance with the following steps:

• the patient is given general anesthesia;
• the doctor makes a transverse incision in the neck;
• the gland is exposed and the surgeon decides on the volume of manipulation;
• blood vessels and skin are sutured;
• The extracted tissues of the damaged gland are sent for histological examination.

Important: for treatment endocrine diseases use of funds is not recommended traditional medicine.

Thyroiditis and folk remedies

Many sick people are afraid classical methods treatment, they begin to wonder whether autoimmune thyroiditis can be cured using traditional medicine. The remedies used in home treatments can have a very strong effect on hormonal metabolism.

It is quite difficult to determine the correct dosage of herbs from which compresses and lotions are made. The active components of a home remedy, if used incorrectly, can aggravate the disease and worsen the patient’s condition or negate all progress from traditional treatment.

Thus, it is not recommended to use traditional methods to treat thyroid diseases. The cost of using an alternative treatment method is too high. Launching pathological process Using an unprofessional approach, you can deprive the patient of the possibility of recovery and the ability to lead a full life.

Diet for thyroiditis

Proper nutrition is one component successful treatment. Special diet- this is what can be used to treat thyroiditis of the thyroid gland, along with a well-chosen medication regimen.

Compliance therapeutic diet will help:

• improve the patient’s condition, a lighter diet eliminates unnecessary stress on the digestive organs;
• bring recovery and normalization of the condition closer, balanced diet will allow medications to be better absorbed by the body, providing maximum impact.

The basis of the diet for thyroid problems is the presence in the diet of what is necessary for normalization hormonal regulation and improving the well-being of the thyroid gland vitamins. So the patient’s food should be saturated with iodine, essential vitamins, calcium and fiber of plant origin.

Must be supported normal level protein while reducing the content of fats and carbohydrates in the diet. In this case, the daily calorie content should be maintained at least 2000 kcal.

Sufficient water consumption is important; it should be at least two liters per day. Diet may have individual characteristics and instructions that their presence should be consulted with the treating endocrinologist before treating thyroid aitis or any other form of this disease.

You can create a healthy diet using the following products:

• seafood, but you need to make sure that there is no excess cholesterol content;
• seaweed;
• meat products with low fat content (turkey, rabbit, veal);
• products with bran;
• cereals;
• fruits and vegetables prepared by any method other than frying;
• dairy products;
• juices with high content vitamins, freshly squeezed.

Prevention of recurrence of the disease

Most people think about the quality of their lifestyle only after receiving a diagnosis or after completing serious treatment. Preventive actions to prevent endocrinological diseases are no different from the standard rules of a healthy lifestyle.

There is nothing complicated about them, but by following them you can protect yourself from a large number of health problems with your own hands and prolong your life.

So, you can protect yourself from the primary or recurrent occurrence of thyroiditis by the following actions:

1. Compliance with the rules of a healthy diet and adequate physical activity.
2. Maintaining sleep and wakefulness.
3. Prevention and timely treatment of respiratory and colds. Vaccinations and seasonal intake of vitamin complexes.
4. Quitting habits that harm the body. Elimination of promiscuity and prevention of sexually transmitted diseases.
5. If you feel unwell or have any complaints, you should contact a specialist and not self-medicate. Uncontrolled use of iodine preparations, antibiotics, and drugs that affect the immune system can provoke the development of a serious disease.
6. It is necessary to protect your body from being in potentially dangerous areas. Avoid places where radiation spreads and where air, water and food are heavily polluted.
7. Preventive examination of all organs and systems. The use of iodine-containing drugs only after they have been prescribed by an endocrinologist.

Any person after undergoing treatment for such a serious disease as thyroiditis needs to consult a specialist. The doctor should issue individual instructions on the recommended lifestyle, based on the amount of therapy performed and the likelihood of relapse of the condition.

Thyroiditis is a condition that requires constant attention on the part of the patient to the function of his thyroid gland. If you suspect it, you should definitely visit an endocrinologist to find out how to treat thyroiditis.

Thyroiditis is an inflammatory process that occurs in the thyroid gland. In modern times, they are the most common endocrine diseases in the world after diabetes mellitus, and autoimmune thyroiditis is the most common autoimmune disease. Scientists suggest that almost half of the population on Earth has one or another pathology of the thyroid gland, although not everyone can be treated.

Let's take a closer look at what kind of disease this is, what causes and symptoms are characteristic of it, and also what is prescribed as treatment for thyroiditis in adults.

Thyroiditis of the thyroid gland: what is it?

Thyroid thyroiditis is a concept that includes a group of disorders associated with inflammation of the thyroid gland. The group of diseases is based on thyroid abnormalities.

The first symptoms are a feeling of a “lump in the throat” and pain when swallowing. Neck pain and fever may also occur. Therefore, many people confuse such signs with and begin to self-medicate, which leads to the opposite effect - the disease becomes chronic.

According to statistics, thyroiditis accounts for 30% of all endocrine diseases. Usually this diagnosis is made to elderly people, but recently the disease has become “younger”, and every year it is increasingly found among people young, including children.

Classification

In its practice, clinical endocrinology uses a classification of thyroiditis based on the characteristics of the mechanism of their development and clinical manifestation.

Depending on the occurrence and course of the disease, different types are distinguished:

• Acute thyroiditis.
• Subacute.
• Chronic fibrous tipreoiditis or Riedel's goiter.
• Autoimmune chronic or Hochimsky thyroiditis.

Any of the forms implies damage to the follicles of the thyroid gland with a pathomorphological picture unique to each of these forms of the disease.

Acute thyroiditis

Acute thyroiditis develops as a result of infection entering the thyroid tissue through the blood (hematogenous). A classic picture of nonspecific inflammation occurs in the gland cells. It can spread to an entire lobe or the entire thyroid gland (diffuse) or occur with partial damage to a lobe of the gland (focal). In addition, inflammation in acute thyroiditis can be purulent or non-purulent.

The diagnosis is usually simple. Difficulties may arise when differential diagnosis between acute thyroiditis and hemorrhage into the thyroid gland (or goiter), in which similar symptoms develop in the first days. Hemorrhage is characterized by a more rapid reverse development of the process and less pronounced general disorders.

The prognosis for life is favorable; more serious as it develops purulent process, if surgical treatment is not undertaken in a timely manner. A possible complication is fibrosis of the thyroid gland with the development of hypothyroidism.

Acute non-purulent thyroiditis can develop after injury, hemorrhage into the thyroid gland, or radiation therapy.

Subacute

Subacute thyroiditis is a viral type of thyroid disease that is accompanied by the destruction of thyroid cells. It appears approximately two weeks after a person has recovered from an acute respiratory viral infection. It could be mumps, measles, etc. It is also generally accepted that the cause is acute thyroiditis may also be the causative agent of cat scratch disease.

Women aged 30-50 years get sick more often (5-6 times than men), 3-6 weeks after the viral infection.

Chronic form (Hashimoto's autoimmune thyroiditis)

Chronic thyroiditis of the thyroid gland may not show symptoms for a long time. Most early sign The disease is considered to be the sensation of a lump in the throat and difficulty swallowing. In the advanced stage of the pathology, respiratory dysfunction and hoarseness develop. Upon palpation, the specialist determines uneven enlargement of the organ and the presence of compactions.

Autoimmune thyroiditis (Hashimoto's goiter) is much more common in women aged 40-50 years (the ratio of affected men to women is 1:10-15). In the genesis of the disease, a congenital disorder in the immunological control system has a certain significance.

In addition, thyroiditis is divided into forms:

• Latent, that is, hidden. The thyroid gland has normal sizes, its functions are not impaired.
• The hypertrophic form is accompanied by the appearance of a goiter of the thyroid gland; the organ is noticeably enlarged in size and develops nodular thyroiditis. Depletion of the gland leads as a consequence to hypothyroidism.
• The atrophic form is characterized by a decrease in the size of the gland and a decrease in the production of hormones.

Causes

The disease often carries family character, that is, the patient’s blood relatives are diagnosed Various types gland lesions, including chronic thyroiditis. In addition to hereditary predisposition, other factors that provoke the disease have been identified:

• transferred , ;
• unfavorable environmental conditions, fluoride, chloride, iodide compounds in excess quantities in water and food consumed by humans;
• chronic infectious diseases in the nose and oral cavity;
• stressful conditions;
• prolonged exposure to sunlight and radioactive rays;
• self-medication with hormonal, iodine-containing drugs.

Symptoms of thyroiditis of the thyroid gland

Most often, the disease proceeds unnoticed, without significant symptoms. Only sometimes do people suffering from one of the forms of thyroiditis complain of slight fatigue, painful sensations in the joints and discomfort in the gland area - compression on nearby organs, a feeling of a coma when swallowing.

Highlight following complaints patients, forcing doctors to suspect the proliferation of the endocrine gland:

• soreness in the place on the neck where the organ should be located, increasing in response to pressure or other types of touch;
• at pressure on vocal cords hoarseness and roughness of the voice will be observed;
• if the gland puts pressure on nearby structures, the person may experience difficulty or pain when swallowing, complain of a feeling as if there is a lump across the throat, difficulty breathing;
• if pressure is applied to nearby vessels, headaches, vision problems, and a feeling of tinnitus may occur.

Complications

Acute thyroiditis can result in the formation of an abscess in the thyroid tissue, which can break through, and it’s good if it comes out. But if pus gets into the surrounding tissue, it can:

• progressive purulent inflammation in the tissues of the neck can lead to damage to blood vessels,
• skidding purulent infection to the meninges and brain tissues,
• development general infection blood infection ().

It is important to differentiate subacute thyroiditis from:

• acute pharyngitis,
• purulent thyroiditis,
• infected cyst of the neck,
• thyroid cancer,
• hemorrhage into the nodular goiter,
• autoimmune thyroiditis and local.

Diagnostics

Diagnosis of thyroiditis requires comprehensive examination thyroid gland (laboratory and instrumental methods) and symptom assessment.

Until problems with the thyroid gland appear, which can be detected through tests, the disease is almost impossible to diagnose. Only lab tests allow us to establish the absence (or presence) of thyroiditis.

Laboratory tests include:

• general blood analysis;
• immunogram;
• level determination thyroid-stimulating hormone, found in blood serum;
• fine needle biopsy;
• Ultrasound of the thyroid gland;

After complete diagnostic examination a specialist can confirm the presence of the disease and prescribe individual treatment. Note that you should not try to get rid of the pathology on your own, because the consequences may not be the most pleasant.

Incorrectly selected therapy can negatively affect general condition health, and the disease will continue to progress in the meantime.

Treatment of thyroiditis in adults

Treatment of thyroiditis should be carried out only as prescribed and under the supervision of an endocrinologist, since self-medication can aggravate the patient’s condition. Depending on the type, treatment is aimed at one or another factor contributing to the development of thyroiditis (etiological and pathological therapy), as well as at correcting the hormonal levels that arose during the underlying disease.

In mild forms of thyroiditis, you can limit yourself to observation by an endocrinologist, prescribing non-steroidal anti-inflammatory drugs to relieve pain, and symptomatic therapy. For severe diffuse inflammation, steroid hormones are used (prednisolone with a gradual dose reduction).

• Acute thyroiditis. In this case, therapy is carried out using antibiotics, as well as treatment-oriented drugs accompanying symptoms. In addition, vitamins (groups B, C) are prescribed. The development of an abscess requires surgical intervention.
• Subacute. To treat this form of the disease, therapy involves the use of hormonal drugs. The symptoms of hyperthyroidism, accordingly, require the prescription of drugs for its separate treatment in combination with this disease.
• Chronic autoimmune thyroiditis. Here treatment, as a rule, is focused on the use of medications, meanwhile, a significant increase in the size of the thyroid gland requires surgical intervention.

Indications for surgical treatment autoimmune thyroiditis is:

• combination of autoimmune thyroiditis with a neoplastic process;
• large goiter with signs of compression of the neck organs;
• lack of effect from conservative therapy for 6 months,
• progressive increase in goiter.

If there are significant changes in work endocrine organ not identified, then patients with thyroiditis need dynamic monitoring by a doctor for timely diagnosis possible complications of the disease and their immediate treatment (usually this applies to hypothyroidism).

Thus, the main thing to remember in order to avoid negative consequences for the thyroid gland is the need to consult a doctor in a timely manner. If this is not done, serious Negative consequences, up to lifelong use of hormonal drugs. If thyroiditis is detected in a timely manner, there is a high probability of its cure.

Folk remedies

Before using any folk remedies, be sure to consult with your attending endocrinologist.

1. Compresses on the thyroid area. Pour 200 g of hot pork lard into 200 g of dry wormwood, leave for 20 minutes, apply warm to the neck area overnight. Recommended daily use within 14 days. Compresses are effective for chronic thyroiditis.
2. Willow leaves (fresh) pour four liters of water and boil over low heat until a creamy brown liquid forms. The decoction is cooled, then applied every night, applied to the neck area, wrapped in film and left until the morning.
3. Reduce painful sensations for thyroiditis, a special vegetable cocktail will help, for it you will need to mix the juice of potatoes, carrots and beets, you need to drink 0.5 liters of it per day.

To prepare tinctures you need to take herbs from various groups, which are created depending on the properties. And so, the fees need to be formed from herbs that:

• regulate the functioning of the thyroid gland (these include: hawthorn, cocklebur, motherwort, gorse and gorse);
• have antitumor properties: sage, marshmallow, sweet clover, celandine, kirkazon, white mistletoe;
• slow down auto immune processes: calendula flowers, St. John's wort, heather, white cinquefoil;
• regulate immune processes in the body: strawberries, nettles, walnut leaves, duckweed, tops and the beet root itself.

Forecast

Early treatment of acute thyroiditis ends full recovery patient after 1.5-2 months. Rarely, persistent hypothyroidism can develop after suffering purulent thyroiditis. Active therapy The subacute form allows for cure in 2-3 months.

Advanced subacute forms can last up to 2 years and become chronic. Fibrous thyroiditis is characterized by many years of progression and development of hypothyroidism.

Prevention

Specific preventive measures There is no information on preventing the development of thyroiditis. But prevention plays an important role in this regard:

• viral and infectious diseases which involves vitamin therapy, hardening, healthy eating and eliminating bad habits.
• It is also necessary to promptly sanitize foci of chronic infections: treatment, caries, etc.

Thyroiditis of the thyroid gland, like any other disease, requires medical care. Therefore, at the first symptoms, be sure to contact an endocrinologist. Take care of yourself and your health!

Various thyroid dysfunctions are one of the most common reasons for patients to turn to specialists.

Recently, doctors often diagnose “chronic thyroiditis”, so many patients are interested in what it is, what are the clinical manifestations of the disease and whether there is an effective treatment for it.

It is worth noting that chronic thyroiditis is a collective concept.

It includes inflammatory diseases of the thyroid gland that are completely different in their etiopathogenetic mechanisms of development, characterized by a long course and requiring differentiated treatment tactics.

According to the modern classification, the following types of disease are distinguished:

• postpartum;
• autoimmune (so-called Hashimoto's chronic thyroiditis);
• fibrous-invasive (Riedel's goiter);
• specific forms (occur in case of generalization of infection with syphilis, tuberculosis, fungal infections).

Causes of the disease

The causes of chronic thyroiditis are very diverse and largely depend on the type of disease. The most common predisposing factors for the development of pathology are:

• dysfunction of the immune system;
• increased ionizing radiation (in particular, previous irradiation of the head and neck area);
• the presence of foci of chronic infection (otitis, sinusitis, tonsillitis, cystitis, pyelonephritis, carious teeth);
• hereditary predisposition to autoimmune and thyroid pathologies;
• prolonged exposure to the sun;
• presence in the anamnesis of allergic diseases;
• bad habits (smoking, alcohol abuse);
• severe psycho-emotional shocks, chronic stress;
• suffered from ARVI, influenza;
• chronic intoxication;
• long-term uncontrolled use of large doses of iodine.

Pathogenesis of the disease

Leading place in the structure chronic inflammation The thyroid gland is occupied by Hashimoto's thyroiditis.

The development of this disease is based on an inadequate immune response when own cells endocrine organ are perceived as a foreign agent.

This leads to destruction of thyroid tissue under the influence of protective antibodies with the development of an inflammatory reaction.

As a result of a decrease in the number of actively functioning thyrocytes, hypothyroidism becomes the outcome of autoimmune thyroiditis.

Postpartum thyroiditis is characterized by similar pathological processes, while trigger mechanism becomes pregnant.

As for Riedel's goiter, it is characterized by the proliferation of connective tissue inside the organ with invasion of the neurovascular bundles and capsule, as a result of which the thyroid gland acquires a “stony” density.

Autoimmune thyroiditis most often occurs in women 40-50 years old. Here you can find out the reasons and possible complications of this disease.

Symptoms

The initial stages of chronic thyroiditis often occur in a latent form, without pronounced clinical manifestations. With him hypertrophic form a slight increase in the size of the thyroid gland may be detected, often not causing the patient any discomfort at all.

In some cases, the onset of the disease is accompanied by a temporary increase in the concentration of thyroid hormones, which is caused by the destruction of follicles. During this period, patients may present the following complaints:

• hypertension;
• tachycardia;
• hyperhidrosis;
• increased fatigue;
• low-grade fever;
• tremor of the limbs;
• irritability;
• dysmenorrhea;
• weight loss, etc.

As the thyroid tissue is destroyed, the symptoms of hypothyroidism come to the fore in the clinical picture of the disease. Among them are:

• bradycardia;
• decreased body temperature;
• apathy, depression;
• muscle weakness;
• slower speech and thinking;
• memory impairment;
• constipation;
• excessive dryness of the skin.

In advanced stages of the disease, especially with Riedel’s goiter, hypertrophic form of thyroiditis, or its combination with neoplasms, compression is possible nearby organs, which is manifested by the following symptoms:

• dysphagia;
• breathing problems;
• hoarseness and change in voice timbre;
• feeling of the presence of a foreign body in the throat.

When the neurovascular bundles of the neck are compressed, unmotivated weakness, tinnitus, tachycardia, and pulsation of the neck veins appear.

The greatest importance should be given to the overall clinical picture, since individual symptoms can occur in a variety of diseases.

Diagnosis and treatment

Detection of chronic thyroiditis seems quite challenging task, because the early stages The diseases are characterized by a latent course and the absence of characteristic changes in laboratory and instrumental studies.

A palpation examination of the thyroid gland can provide certain information: for example, with a hyperplastic autoimmune process, an increase in its size and volume is observed, while with an atrophic process, there is a decrease in their size. In the case of Riedel's goiter, a very dense and immobile gland is palpated, fused with the surrounding tissues.

Great importance in the diagnosis of chronic thyroiditis is attached to ultrasound scanning of the endocrine organ and laboratory tests:

• general blood test;
• determining the content in the blood of specific markers of the autoimmune process - antibodies to thyroid tissue and thyroid peroxidase (TPO); with Riedel's goiter this indicator is normal.
• measuring the level of tri- and tetraiodothyronine, as well as thyroid-stimulating hormone (TSH).

In addition, for differential diagnosis inflammation with other thyroid pathologies are used:

• scintigraphy;
• fine-needle biopsy (if a cancerous tumor is suspected).

If there is a need for radioisotope research occurs in nursing mothers (for example, when diffuse toxic goiter is excluded or confirmed), then breastfeeding should be stopped.

Today the main diagnostic criteria, which allow you to confirm chronic autoimmune thyroiditis of the thyroid gland, serve:

• an increase in organ volume of more than 18 ml in women and 25 ml in men;
• presence of signs of hypothyroidism (according to the results of a hormonal study);
• increase in antibody titer to TPO and thyroid tissue;
• echographic signs of autoimmune thyroiditis (hypoechogenicity of the parenchyma).

Therapy of the disease

It is worth noting that today there is no specific treatment for chronic thyroiditis.

According to available clinical data, attempts to influence autoimmune processes through the use of immunomodulators, immunosuppressants, glucocorticosteroids or plasmapheresis have been unsuccessful and have not stopped the progression of the disease to hypothyroidism.

In those clinical situations when the onset of Hashimoto's thyroiditis, as well as postpartum inflammation of the thyroid tissue, is manifested by transient thyrotoxicosis, the prescription of thyreostatics is not indicated, since painful condition not associated with hyperfunction of the thyroid gland.

In case of severe clinical picture hyperthyroidism, it is possible to carry out symptomatic therapy with beta-blockers to eliminate rapid heartbeat, increased sweating, limb tremors and hypertension.

In the later stages of chronic thyroiditis, hypothyroidism always develops. In this case, treatment tactics involve prescribing hormonal replacement therapy. If for Hashimoto's thyroiditis and Riedel's goiter Levothyroxine must be taken for life, then for postpartum thyroiditis the duration of correction is only 9–12 months, since during this time the disease completely regresses.

Current recommendations regarding the treatment of autoimmune thyroiditis state that hormonal therapy should be carried out only when hypothyroidism is manifested according to the results laboratory research(increase TSH level and a decrease in T4 concentration).

In the subclinical form of the disease (increased thyrotropin levels with normal content in the blood of thyroxine) dynamic observation with repeated analysis of hormones after 3–6 months is indicated.

However, if subclinical hypothyroidism is detected during pregnancy, Levothyroxine should be prescribed immediately.

Surgical treatments are rarely used to correct the disease.

They are relevant only for severe hyperplasia of the thyroid gland, causing compression of the trachea and esophagus, as well as when the inflammatory process is combined with various neoplasms in the thyroid tissue.

Chronic thyroiditis often requires prescription hormone therapy throughout the life of the patient due to developed hypothyroidism.

Therefore, the main task of a specialist is to select correct dose drugs that will maintain TSH levels within the physiological norm.

Conclusion

Obviously, a specialist should study, diagnose and treat the disease, since only a qualified health care can guarantee success in the fight against the disease and contribute to effective prevention development of dangerous complications.

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There are acute, subacute and chronic thyroiditis.

Acute, in turn, can be purulent or non-purulent.

Subacute is also called de Quervain's thyroiditis.

Chronic can be fibrous (Riedel's goiter) and autoimmune (Hashimoto's thyroiditis).
Acute purulent thyroiditis develops against the background of acute or chronic infectious process(tonsillitis, pneumonia, sepsis, etc.).

Subacute thyroiditis develops after viral infections (ARVI, Coxsackie, mumps, etc.). Women aged 30-50 years are more likely to get sick.

Autoimmune chronic thyroiditis is a disease based on autoimmune damage to the thyroid gland; antibodies to various components thyroid gland (normally, antibodies in the human body are produced only in foreign substance). This is the most common inflammatory disease of the thyroid gland. Most often, autoimmune thyroiditis occurs in patients between 40 and 50 years of age, and is ten times more common in women than in men. And recently, more and more young patients and children are suffering from autoimmune thyroiditis.

The cause of chronic fibrotic thyroiditis is unknown. There is a version that Riedel's goiter is the final stage of autoimmune thyroiditis. People who have been observed are at risk of developing the disease. Graves' disease or any form of endemic goiter.

Manifestations of thyroiditis

Acute purulent thyroiditis: pain in the anterior surface of the neck, radiating to the back of the head, lower and upper jaw, aggravated by moving the head and swallowing. Enlarged cervical lymph nodes. Increased body temperature, chills.

Acute non-purulent thyroiditis: manifestations are less pronounced than with acute purulent inflammation of the thyroid gland.

Subacute thyroiditis: pain in the neck area radiating to occipital region, lower jaw, ears, temporal region, weakness, decrease motor activity, increased body temperature. At the onset of the disease (hyperthyroid, acute stage) symptoms of thyrotoxicosis may be observed: increased heart rate, sweating, weight loss, hand tremors. In blood - elevated levels thyroid hormones. Over a long period of time, symptoms may develop (hypothyroid stage), drowsiness, lethargy, lethargy, chilliness, swelling of the face, dry skin, decreased heart rate, and constipation. The thyroid gland is enlarged (often only right lobe), dense, painful. In blood - low content thyroid hormones.
During the recovery stage, thyroid tenderness and thyroid hormone levels disappear.

The disease is prone to recurrence (recurrence), especially with repeated viral infections and hypothermia.

Chronic fibrous thyroiditis: diffuse (widespread), less often focal enlargement of the thyroid gland. The gland is very dense, immobile, and does not move when swallowing.

The progression and spread of the process to the entire gland is accompanied by the development of hypothyroidism. With large gland sizes, symptoms of compression of the neck organs are observed: hoarseness, difficulty swallowing, breathing.

Autoimmune chronic thyroiditis: during the first years of the disease, complaints and symptoms are usually absent. Subsequently, diffuse, sometimes uneven enlargement of the thyroid gland, dense, mobile. When the gland is large, symptoms of compression of the neck organs appear. As the disease develops, changes that destroy the thyroid gland lead to dysfunction of the gland - initially to the phenomena of hyperthyroidism due to the entry into the blood of a large amount of previously produced hormones, later (or bypassing the hyperthyroid phase) - to hypothyroidism. The content of thyroid hormones in the blood is reduced. In diagnosis, determination of the titer of antithyroid antibodies against the own thyroid gland is of great importance.

Complications

Acute thyroiditis can result in the formation of an abscess in the thyroid tissue, which can break through, and it’s good if it comes out. But if pus gets into the surrounding tissues, it can flow into the pericardial space; progressive purulent inflammation in the tissues of the neck can lead to damage to blood vessels, the introduction of purulent infection to the meninges and brain tissue, and even to the development of general blood infection (sepsis). Acute thyroiditis must be treated promptly and thoroughly.
Untreated subacute thyroiditis may result in sufficient damage a large number of thyroid tissue and eventually develop irreversible thyroid failure.

Forecast

With timely and complete treatment, acute thyroiditis ends in recovery and does not remind you of anything else.

Subacute thyroiditis usually ends with complete recovery. True, after treatment, compactions may remain in the thyroid gland, which are regarded as nodes. They do not require medical intervention.

Unfortunately, in the majority of patients with autoimmune thyroiditis, over time, the function of the thyroid gland decreases and hypothyroidism develops, which requires treatment with thyroid hormones. For chronic fibrous thyroiditis, in the presence of symptoms of hypothyroidism, replacement therapy with thyroid hormones; for symptoms of compression of the neck organs, surgical treatment.

For chronic autoimmune thyroiditis - treatment with thyroid hormones. If there is no reduction in goiter during adequate replacement therapy (3-4 months), corticosteroids () are prescribed for 2-3 months. For fast-growing, painful forms of goiter, large sizes of the thyroid gland with symptoms of compression of the neck organs - surgical liver treatment.

What can you do?

When the first symptoms of thyroiditis appear, you should consult an endocrinologist for help. Treatment should be started as early as possible to avoid complications.

Autoimmune thyroiditis (AIT, Hashimoto's thyroiditis, Hashimoto's goiter, Hashimoto's disease) is an inflammation of the thyroid tissue caused by autoimmune causes, 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 world endocrinological community widely celebrated the anniversary of the discovery of this disease, because from this moment on, endocrinologists have 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 is engaged in the destruction of foreign cells and organisms, begins to show aggression towards its own organ – the thyroid gland. The thyroid tissue becomes saturated 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 lack enough to produce the required amount of hormones. Hormonal deficiency develops - hypothyroidism.

Symptoms of autoimmune thyroiditis (AIT)

Symptoms of autoimmune thyroiditis easily confused with the everyday state of many of our compatriots: the patient is worried about weakness, drowsiness, fast fatiguability, depression, worsening mood, sometimes swelling. Figuratively speaking, life begins to lose its colors. Many patients with autoimmune thyroiditis are also concerned about slowing mental activity(“I can’t gather my thoughts”), hair often falls out actively.

Diagnosis of AIT

Diagnosis of autoimmune thyroiditis(its name is often shortened to three letters - AIT) is established if the patient has three so-called “major” signs: characteristic changes in the structure of the thyroid tissue during ultrasound examination, an increase in the blood titer of antibodies to the thyroid tissue (antibodies to thyroid peroxidase, antibodies to thyroglobulin), as well as an increase in the level of the hormone TSH and a decrease in the level of the hormones T4 and T3 in the blood. It is important to note that the diagnosis of Autoimmune Thyroiditis should not be made in cases where hormone levels are within normal limits. If there is no level up Blood TSH(at a minimum) 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 fairly common conclusions “Autoimmune thyroiditis, euthyroidism” are incorrect because they confuse doctors and often lead to the unreasonable prescription of thyroid hormones to the patient.

Autoimmune thyroiditis on ultrasound of the thyroid gland

At ultrasound examination with AIT, there is usually 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 ultrasound machine screen 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 nodes and are simply foci with a pronounced inflammatory process, they are also called “pseudo-nodes”. Most often, a qualified ultrasound physician can distinguish a pseudonodule 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 (pseudonodules?) of the thyroid gland” to emphasize his 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 examined node is a pseudonodule against the background of AIT (the cytologist’s answer in such cases is usually short: “Autoimmune thyroiditis” or “Hashimoto’s thyroiditis”). At the same time, against the background of autoimmune thyroiditis, it is possible to identify both nodes of a colloid (benign) structure and malignant neoplasms.

Treatment of autoimmune thyroiditis

Treatment of the cause of autoimmune thyroiditis– improper functioning of the immune system – is currently impossible, since 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 supplied with food. A revolution in the treatment of AIT occurred when doctors were able to use thyroid hormones freely. Luckily for us, pharmacists synthesized exact copy human hormone thyroxine, completely no different 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 levels to return to normal. At correct appointment Thyroxine does not cause any side effects. The only inconvenience of such treatment is that it should be continued throughout the patient’s life, since once it begins, autoimmune thyroiditis (AIT) never goes away, and the patient constantly requires drug support.

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