Chronic autoimmune thyroiditis, or lymphomatous thyroiditis, is an inflammatory disease of the thyroid gland of autoimmune nature when antibodies and lymphocytes are formed in the human organism and damage the thyroid gland cells. (Normally, antibodies are created as a response to foreign substances).
Autoimmune thyroiditis is diagnosed based on the illness history, individual medical condition. Increased amount of lymphocytes is detected in the general blood analysis along with small amount of leukocytes.
The hormones level of the thyroid gland raises at a hyperthyroidism stage with depression of the gland function, the hormones amount diminishes in blood. Along with that, the level of the hypophysis hormone, thyrotropin, raises. The changes are detected in the immunogram. They find a swollen gland during the ultrasonic examination and its irregularity in case of the ganglion form of thyroiditis. They detect a big amount of lymphocytes and other cells that are typical for autoimmune lymphadenoid thyroiditis with the help of biopsy (examination of a small piece of the thyroid gland tissue with a microscope).
Autoimmune Thyroiditis Treatment
The German endocrinology centers offer a highly efficient treatment of thyroiditis treatment. Hashimoto thyroiditis treatment (medicamental). Thyrostatics (thiamazol, mercazolilum) and beta-adrenoceptor antagonists are prescribed in case of excessive function of the thyroid gland.
Nonsteroidal anti-inflammatory drugs are prescribed to lower the antibodies secretion:
Prognosis for a disease is satisfactory. The disease is slowly progressing. Timely instituted treatment essentially slows down the process and allows achieving long-lasting remission of the disease.
Surgical Treatment of Thyroiditis
Thyroid gland disorders are widely spread, they are the reason of various symptoms. Approximately 115,000 surgeries are performed on the thyroid gland in Germany each year. Many people don’t know about their disease and do not seek treatment because the typical goiter is not always present.
Thorough diagnosis is required to detect the reason and extent of a disease. Diagnosis includes compilation of the disease history (anamnesis), clinical blood test, ultrasonic and radioisotopic examination (scintigraphy) if certain diseases are present. Particular treatment method is recommended based on the data of these examinations.
In case of thyroiditis, open surgical treatment of the thyroid and parathyroid glands are carried out in the specialized surgical centers.
Due to close cooperation with pathologists, an urgent histological examination is possible during the operation with an immediate diagnosis or a planned histological examination with a diagnosis not more than 36 hours later.
Medical services in the field of the thyroid gland surgery in Germany:
We offer you the whole range of surgeries in our center in Berlin that are performed in case of the thyroid and parathyroid glands disorders:
- Any malignant and benign diseases of the thyroid and parathyroid glands, including:
- Surgical treatment in case of Basedow’s disease (autoimmune disease)
- Surgical treatment in case of Hashimoto’s thyroiditis (autoimmune inflammation)
- Repeated surgery (condition after the first surgery)
- Surgical treatment in case of “diving” goiter (spreading into the chest)
- Surgical treatment in case of genetic diseases that affect the thyroid or parathyroid glands
- Primary and secondary hyperfunction of the parathyroid glands
- We have wide experience of surgical procedures on old people and children.
- In case of the appropriate indications, operations are performed using a minimally invasive method with video assistance.
All surgical treatment procedures that are performed on the parathyroid gland involve determining the parathyroid hormone level. The parathyroid hormone is produced by the parathyroid glands. If its concentration in the patient’s blood diminishes after removal of the affected gland, we can resume that the surgery was successful even before its end. This is an important tactical help for a surgeon during long-lasting surgeries.
It is not possible to cover all the aspects of the thyroiditis treatment in Germany. Our medical expert will provide you with all the necessary information and will help to choose the best clinic for the endocrine disorders treatment in Germany. You are welcome to call us in case you have any questions.
Hashimoto's Thyroiditis
Hashimoto's thyroiditis is a chronic form of thyroiditis. In this case, it is a thyroid inflammation, which is caused by the body's immune system. Doctors speak of immunological cause or autoimmune disease. Thyroid inflammation in Graves' disease also belongs to this group of forms. Non-immunological forms of thyroiditis are triggered by bacteria, viruses, drugs or injuries.
Atrophic and hypertrophic Hashimoto's thyroiditis
Physicians mainly distinguish two forms of Hashimoto's thyroiditis:
- In atrophic Hashimoto's thyroiditis (Ord-Thyreoiditis), the thyroid gland shrinks slowly.
- Hypertrophic Hashimoto's thyroiditis (Hashimoto's thyroiditis, etc.) is associated with enlargement of the thyroid and goiter. But it is much less common than the atrophic form.
- The most important task of the thyroid gland is to supply the organism with the so-called thyroid hormones. These hormones are involved in many metabolic functions. The symptoms of chronic thyroid inflammation are correspondingly diverse. Because of this diversity, Hashimoto's thyroiditis is often diagnosed late. Hashimoto is especially common in people with other autoimmune diseases such as diabetes 1.
Hashimoto is currently not curable. However, the deficiency can usually be compensated by a drug therapy with the thyroid hormone L-thyroxine (T4).
Frequency
The frequency of Hashimoto's thyroiditis varies in the literature. Accordingly, the incidence of disease (prevalence) in Germany between 5 and 10 percent of the total population. The number of new cases is given as 70 per 100,000 inhabitants. This results in a number of 5.6 million Germans with Hashimoto. Women are affected up to 10 times as often as men. The peak incidence of Hashimoto's thyroiditis is between 30 and 60 years of age.
Symptoms
Often, Hashimoto's thyroiditis goes unnoticed for many years, as the symptoms usually develop very slowly and, moreover, need not be specific. Rather, it is not uncommon for the first time to complaints such as tiredness or mild discomfort, either barely registered or attributed to other circumstances.
Hashimoto's thyroiditis causes both symptoms of hyperthyroidism and hypothyroidism.
Early symptoms of Hashimoto's thyroiditis
At the onset of Hashimoto's thyroiditis, the thyroid sometimes releases more hormones than normal. In laboratory chemistry, elevated TSH levels as well as decreased levels of fT3 and fT4 indicate this transient episode. Signs of such hyperthyroidism are:
- Tachycardia and palpitations
- Irritability, nervousness, restlessness
- Insomnia and sleep disorders
- Sweats and increased sweating
- Tremble
- Muscle weakness
- Diarrhea
- Increased appetite without gaining weight
- Dry skin, hair loss and brittle nails
- Menstrual disorders
- Sexual aversion or potency disorders
Later symptoms of Hashimoto's thyroiditis
In the further course, the typical symptoms of hypothyroidism set in. In the early stages, physicians speak of a latent hypothyroidism, in the later course of the disease of overt hypothyroidism. Typical symptoms are:
- Goitre
- Performance and concentration weakness, listlessness, discomfort
- Increased need for sleep, tiredness
- Constant freezing and increased sensitivity to cold
- Slowed reflexes
- Weight gain, increased blood lipid levels
- Depressive moods and depression
- Dry skin, pale and cool skin
- Brittle nails, shaggy hair and hair loss
- Rough, hoarse, deep or faded voice
- Edema such as myxedema or eyelid edema
- Muscle weakness, muscle stiffness and muscle aches
- Permanent constipation
- Menstrual disorders
- Sexual aversion and potency disorders
- Dysfunction of the heart and lungs (such as low blood pressure, heart failure or pericardial effusion).
Causes
Cause of Hashimoto's thyroiditis is a false reaction of the body's immune system. Certain defense cells (called T-lymphocytes) are directed against the thyroid tissue and destroy it. Therefore, the disease is also referred to as autoimmune disease. But why the immune system attacks the thyroid is still largely unknown today.
There are some indications that hereditary factors play a role as the cause of Hashimoto's thyroiditis. For example, Hashimoto is more common in first-degree relatives than in the normal population. In addition, Hashimoto occurs frequently in people who suffer from certain - also hereditary - diseases. These are mainly diabetes mellitus type 1 (diabetes), white spot disease (vitiligo) and celiac disease (gluten intolerance). Directly inherited Hashimoto will not: Even if both parents suffer from this form of chronic thyroiditis, their children do not necessarily get sick.
Triggers of Hashimoto's thyroiditis
It is unclear why Hashimoto erupts in hereditary people or not. It is sometimes said that estrogens are said to be positive for the onset of the disease and negative for testosterone. That would also explain the enormous gender distribution in favor of women.
In addition, large quantities of iodine - for example, from dietary supplements or iodized table salt - can trigger the disease. Indeed, in iodine-deficient areas, there are significantly fewer cases of Graves' disease and Hashimoto's thyroiditis than in regions with sufficient iodine supply.
We also talk about viral or bacterial infections as triggers. The main focus is on the hepatitis C virus. Selenium and vitamin B deficiency are other factors that could play a Hashimoto-promoting role.
But all these statements are usually based on observations and not on reliable scientific studies.
Patients sometimes report that the symptoms of Hashimoto's thyroiditis have first appeared in stressful life situations - or become more severe during periods of stress.
Diagnosis
If a thyroid infection is suspected, the concentration of the thyroid hormones fT3 and fT4 in the blood is always determined. These follow a very specific pattern during Hashimoto's thyroiditis.
The detection of Hashimoto's thyroiditis can be comparatively easily performed by a special blood test. Because the immune system produces in the majority of cases for Hashimoto specific antibodies. About 90 percent of all Hashimoto patients develop thyroid peroxidase antibodies and about 50 percent of thyroglobulin antibodies. The diagnosis of Hashimoto's thyroiditis is therefore considered to be certain if in the blood elevated levels of antibodies to the so-called thyroid peroxidase (TPO-AK) and the storage protein thyroglobulin (TG-AK) can be detected.
In about 10 percent of those affected, however, the blood levels of antibodies are unremarkable. In these cases, an ultrasound scan of the thyroid can provide information. By using color Doppler ultrasound, altered thyroid tissue is usually well detected.
As a further diagnostic option, scintigraphy is available to doctors. This nuclear medicine procedure can be used to visualize cell and tissue metabolism processes using radioactively labeled particles. In Hashimoto's thyroiditis, thyroid tissue absorbs less radioactive material than a healthy thyroid gland.
In a thyroid biopsy, thyroid cells are removed with a fine cannula and then examined microscopically in the laboratory. Hashimoto's thyroiditis shows the typical picture of the cell-damaging T-lymphocytes that have invaded the tissue.
Treatment
Hashimoto's thyroiditis is usually not curable. The treatment aims to alleviate or even eliminate the symptoms. Depending on the stage of the disease different treatment approaches come into question.
Treatment of symptoms of hyperthyroidism
Symptoms of hyperthyroidism may be present at the onset or onset of Hashimoto's thyroiditis. In normal hyperthyroidism, these symptoms are treated with so-called antithyroid drugs such as carbimazole, thiamazole and sodium perchlorate. In the case of Hashimoto's thyroiditis, however, these drugs do not work. For particularly severe complaints, non-cardioselective beta-blockers such as carvedilol and propranolol are sometimes used.
Thyroid hormone therapy at Hashimoto
In the course of Hashimoto's thyroiditis, the symptoms of hypothyroidism predominate. The treatment of choice is thyroid hormone therapy or thyroid replacement therapy. In this therapy, the thyroid hormones are replaced in the form of drugs. In many people, it is sufficient to take the thyroid hormone thyroxine (T4). Drug administration of triiodothyronine (T3) is only required if the body transformation of T4 into T3 is disrupted.
The more pronounced the hypothyroidism, the slower and more cautious the hormone replacement treatment should be. Due to severe cardiovascular side effects, it is generally recommended to start with a low dose and then increase it very slowly.
No iodine in Hashimoto's thyroiditis
Unlike in the treatment of hypothyroidism, people with Hashimoto's thyroiditis should not add additional iodine in the form of dietary supplements or iodized table salt. Because iodine can promote thyroiditis and increase the symptoms of hypothyroidism even further.
Completely abstaining from iodine is just as wrong. Because iodine is a vital trace element. An iodine intake of up to 120 micrograms on the normal diet is considered harmless in Hashimoto.
Forecast
Hashimoto's thyroiditis is not curable, according to the current state of medical research. An exception are cases in which the disease was detected very early. These successes are individual cases.
Usually, immunologically-based chronic thyroid inflammation requires lifelong hormone replacement therapy. In most cases, the symptoms can be controlled so that the quality of life is not significantly limited. Hashimoto's thyroiditis, according to current research, has no negative impact on life expectancy.
Prevention
Prevention of Hashimoto's thyroiditis is not possible. To prevent a life-threatening metabolic imbalance (thyrotoxic crisis), you should report it to the doctor and medical staff prior to diagnostic testing with contrast media if you have or suspected hyperthyroidism.
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