What is Hashimoto's Disease?

Hashimoto's thyroid disease is an autoimmune thyroiditis with a large number of lymphocytes in pathology, also known as chronic lymphocytic thyroiditis. The disease was discovered by the Japanese Hashimoto policy in 1912, so it is known as Hashimoto's thyroid disease, or Hashimoto's disease (HT or AIT) for short. Because patients with Hashimoto's thyroid disease present goiter in front of the neck, it is often called clinically Hashimoto's goiter. Hashimoto's disease is an autoimmune thyroid disease. Its pathological and immune changes are similar to Grave's hyperthyroidism, that is, based on genetic defects and genetic susceptibility, due to mental factors, overwork, infection and other stress reactions, environmental pollution, and irrational diet (such as a high iodine diet) Both can cause patients with autoimmune response or aggravate autoimmune response and induce Hashimoto's thyroid disease. Therefore, Grave's hyperthyroidism and Hashimoto's thyroid disease can be transformed accordingly, of course, more Grave's disease is converted to Hashimoto's thyroid disease.

Hashimoto's thyroid disease

Overview of Hashimoto's thyroid disease

The pathogenesis of Hashimoto's thyroid disease is the production of autoantibodies by an autoimmune response. Such as anti-thyroid peroxidase antibody (TPOAb), anti-thyroglobulin antibody (TGAb) antibody and antigen form an immune complex. Cytotoxicity, immune mediation, immune complexes, and lymphocytosis, which depend on antibodies, act on thyroid follicular epithelial cells to form immune inflammation, inflammatory cells swell and form goiters to varying degrees. A small number of patients with Hashimoto's thyroid disease may have no enlarged thyroid. Hashimoto's disease is very high, there are reports in the literature, a general survey of population in a certain area with several antibody tests, found that 5% of patients with HT. In our own long-term clinical work, statistics are made using several indicators of antibody detection and thyroid cytology. It shows that Hashimoto's disease accounts for 38.9% of the total thyroid disease clinics. Therefore, it is recommended that clinicians check T3 for thyroid patients. , T4 must check thyroid antibodies at the same time to avoid missed diagnosis. People with Hashimoto's thyroid disease should also ask their doctors to check for thyroid antibodies.

Clinical manifestations of Hashimoto's thyroid disease

Clinically, we often have young female patients with the characteristics of Hashimoto's thyroiditis. Symptoms may be absent. Typical symptoms of hyperthyroidism include: hand tremor, heat scar, easy sweating, restlessness, palpitations, weight loss, abnormal menstruation, and antithyroid drugs must be used at this time. Patients can also have hypothyroidism. Typical hypothyroidism has the following symptoms: fear of cold, obesity, easy constipation, listlessness, irregular menstruation, etc. The treatment is supplemented with thyroid hormones. Because of the characteristics of Hashimoto's thyroiditis, women are generally more likely to have hypothyroidism when they enter menopause. Therefore, once the above symptoms of hypofunction appear, be sure to ask a doctor to help check.

Hashimoto's thyroid disease treatment principles

Because Hashimoto's thyroiditis is a chronic disease, once you find that the neck is swollen and the diagnosis is accurate, do not take the risk to remove the thyroid enlargement. Because this is easier for patients with Hashimoto's thyroiditis to enter the hypothyroidism early and need to take thyroid hormone for a long time. To deal with Hashimoto's thyroiditis, the correct method should be: exercise more, eat less iodine-containing food, take regular blood tests and receive ultrasound tracking. Patients who have already been treated with drugs should return regularly to make appropriate drug adjustments.

Although Hashimoto's hyperthyroidism has some of the above-mentioned characteristic clinical manifestations, histological examination of Hashimoto's hyperthyroidism is still indispensable. In thyroid biopsy histology, the diagnosis can only be confirmed if there are two histological signs of typical Hashimoto's disease and toxic diffuse goiter. In the same specimen, completely different parts of the two can sometimes exist independently. In most cases, the two overlap. It is usually treated with small doses of antithyroid drugs and appropriate doses of thyroid hormones, and the course of treatment is often longer. Due to low thyroid reserve function, a large amount of antithyroid drugs can easily lead to hypothyroidism. The symptoms of hyperthyroidism can last for many years, and the elderly often develop myxedema. Therefore, surgery and radioactive iodine treatment should not be used for treatment, otherwise permanent hypothyroidism may occur.

Another manifestation of Hashimoto's hyperthyroidism is Hashimoto's and transient hyperthyroidism. Hashimoto's disease is an autoimmune thyroid disease. The pathological change is mainly infiltration of lymphocytes in the thyroid tissue. As a result, the thyroid tissue is damaged, often leading to hypothyroidism. However, when the condition of chronic lymphocytic thyroiditis progresses to a certain stage, thyroid follicles are destroyed due to factors such as immune factors. The thyroid hormones stored in the follicles are released into the blood, increasing the concentration of thyroid hormones in the blood circulation and causing hyperthyroidism . This type of hyperthyroidism is often transient. After the metabolism (depletion) of thyroid hormones released into the bloodstream, the symptoms of hyperthyroidism disappear. Treatment is only symptomatic, and antithyroid drugs are generally not used. Radioactive iodine treatment and surgical treatment are prohibited. There are also a few patients who can develop myxedema from Hashimoto's disease and then convert to Graves 'disease, because Hashimoto's disease, Graves' disease, and myxedema are all autoimmune thyroid diseases. The pathogenesis of the three is similar. Mutual transformation, it is currently believed that the three belong to different clinical types of the same disease.

Diagnosis of Hashimoto's thyroid disease

I. Basic inspection

1. Thyroid function tests vary according to the course of the disease.

(1) Serum T4 and T3 are normal in the early stage, but TSH is increased; serum T4 is decreased in the later stage, T3 is normal or decreased, and TSH is increased.

(2) The thyroid iodine uptake rate is normal or increased in the early stage, but can be inhibited by T3; the iodine uptake rate is reduced in the later stage, and TSH is not increased by injection.

2. Immunological examination of anti-thyroglobulin antibody (TGA) and anti-thyroid microsomal (peroxidase) antibody (TMA) titers significantly increased, both of which are greater than 50% (radio-immunoassay method) diagnostic significance , Can last for several years or more than ten years.

3 In other tests, the erythrocyte sedimentation rate increased to 100mm / h, serum albumin decreased, and r globulin increased.

Second, further inspection

1. SPECT Thyroid scans are evenly or unevenly distributed and can appear as "cold nodules."

2. Pathological examination for patients with atypical clinical manifestations and low or negative antibody titers can be performed by fine needle aspiration cytology or tissue biopsy to confirm the diagnosis.

Third, the main points of diagnosis

1. Middle-aged women with diffuse thyroid enlargement and tough texture should be considered regardless of thyroid function.

2. Serum TGA and TMA titers were significantly increased (> 50%), and the diagnosis was basically confirmed.

3 Atypical clinical manifestations require antibody titers> = 60% for two consecutive times, while those with hyperthyroidism require antibody titers> = 60 for more than six months.

4 The disease needs to be distinguished from thyroid cancer, which is negative for antibodies. The literature reports that the incidence of thyroid cancer in this disease is 5% -17%.

Hashimoto's thyroid disease diet conditioning

It should be eaten lightly, eat fresh vegetables with high vitamins, fruits and nutritious lean meat, chicken, duck, turtle, freshwater fish, shiitake mushroom, white fungus, lily, mulberry and other foods. Avoid hot, humid or irritating foods such as iodine, pepper, lamb, strong tea, coffee. If the symptoms of hypothyroidism occur, in addition to avoiding iodine, it is advisable to eat fresh vegetables and fruits with high vitamins, and it is also advisable to eat shrimp, sea cucumber, walnut meat, wolfberry, yam, and scallion.

Main Hazards of Hashimoto's Thyroid Disease

Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis, is mainly caused by hyperthyroidism or diffuse goiter in the early stages of the disease. Although the disease does not immediately threaten life, it will usually develop into a hepatitis A if not actively treated. Decrease and cause lifelong hormones.

Dr. Jia Chunbao, a well-known expert in treating thyroid diseases in China, pointed out that hypothyroidism will cause the body's metabolism to slow down, leaving people in a sub-health state for a long time. For some women of childbearing age, special attention should be paid to the balance of thyroid hormones during pregnancy, and regular inspections at the hospital to avoid affecting the development of the fetus.

The relationship between Hashimoto's thyroiditis and thyroid cancer is controversial. At present, reports have shown that the incidence of cancer caused by chronic lymphocytic thyroiditis is 12%, sometimes the two are mixed together, and there are focal thyroiditis lesions near the cancer tissue. Woo1swan et al. Believe that there is indeed a small cancer in chronic lymphocytic thyroiditis. Recently, Zhongshan Hospital of Guangzhou found 27 cases of chronic lymphocytic thyroiditis and 1 case each of microcarcinoma, malignant lymphoma and papillary carcinoma. So Hashimoto's thyroiditis has a very strong relationship with cancer.

Main characteristics of Hashimoto's thyroid disease

Hashimoto's thyroiditis has a slow onset, and most of the patients don't feel anything when they develop the disease. A small number of patients with advanced thyroid gland have fibrosis, but they are as hard as stones and often adhere to the surrounding tissues. They can develop progressive symptoms of compression, dyspnea, and swallowing.

Features of Hashimoto's thyroiditis:

1. Patients will have goiter and pain after eating a lot of fishy food. Some people also develop symptoms of hyperthyroidism.

2. Goiter, mostly tenderness, no vascular noise, nodules.

3. Adolescent goiter.

4. Limited myxedema in front of the shin.

5. The symptoms of hyperthyroidism in Hashimoto's thyroiditis patients can be self-healed without taking the medicine. This condition can repeatedly occur.

6. The patient has both hyperthyroidism and hypothyroidism.