What Is Hashimoto's Thyroiditis?
The characteristic of this disease is that high titer antithyroid antibodies can be detected in blood, so it is considered to be a
thyroid Hashimoto's thyroiditis
- Hashimoto thyroiditis, also known as chronic lymphocytic thy-roiditis, is an autoimmune disease.
Causes of Hashimoto's thyroiditis
- The characteristic of this disease is that high titer antithyroid antibodies can be detected in blood, so it is considered to be a
- thyroid
Hashimoto's thyroiditis pathology
- The thyroid gland often presents with moderate diffuse lymphocytic infiltration, with the formation of lymphatic follicles, plasma cell infiltration, and thyroid follicle rupture. Some follicular cells show swelling and eosinophilia, so-called "Askanazy cells". Some patients may be accompanied by myxedema, whose thyroid is small and cannot even be touched. The histological changes of the thyroid are similar to the above, but the fibrous changes are obvious and the cell infiltration is reduced.
Clinical manifestations of Hashimoto's thyroiditis
- Chronic lymphocytic thyroiditis is more common in middle-aged people, but can be affected in any age group. The incidence of women is significantly higher than that of men, about 20: 1. The onset is hidden and slow. Often, goiter is found inadvertently, of medium size. A few patients may have local discomfort or even pain, which is easily confused with subacute thyroiditis. Most goiter is symmetrical, accompanied by the enlargement of the pyramidal lobe, the surface of the gland can be lobulated, tough as rubber, and the thyroid function is more normal, but some patients may be accompanied by hyperthyroidism, seen in young patients, called Hashimoto's hyperthyroidism (Hashitoxicosis), hypothyroidism may occur in the later stage, and a few are myxedema.
- Slow lymphocytic thyroiditis is diffusely enlarged in adolescents with a smooth surface. Most middle-aged patients have only moderately enlarged thyroid glands, medium hardness, less uniformity, and less smooth surfaces. TGA and TMA increase significantly. A small number of patients have a hard thyroid texture that is difficult to distinguish from thyroid cancer or medullary thyroid cancer.
- The disease was only positive for TPOAb at an early stage, without clinical symptoms. The symptoms of hypothyroidism appear later in the course of the disease.
Diagnosis of Hashimoto's thyroiditis
- 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 thyroiditis diagnosis
- Middle-aged women with diffuse goiter, especially with pyramidal lobes, should be suspected of this disease regardless of thyroid function. Further determination of TMA and TGA can assist diagnosis. Potassium perchlorate excretion test is of reference value. Thyroid puncture can be used for histological examination to confirm the diagnosis. It can also be treated with thyroid hormone test. Give thyroid tablets 80 to 160 mg daily. Diagnosis helps. The diagnosis of this disease should be distinguished from patients with thyroid disease such as thyroid cancer, subacute thyroiditis, simple goiter and nodular goiter.
Features of Hashimoto's thyroiditis
- 1. It is more common in middle-aged women, with no obvious symptoms in the early stage, and hypothyroidism in the late stage.
- 2. Moderate diffuse thyroid enlargement, often spreading to cones, solid, lobulated, and generally no pain and tenderness.
- 3. ESR increased, serum gamma globulin increased, and turbidity and flocculent tests were positive.
- 4. The thyroid iodine uptake 131 iodine rate is normal or can be increased, the perchlorate excretion test is positive, the thyroid iodine uptake 131 iodine rate is positive in patients with thyroid tablets or T3 suppression test (suppressable), and the serum TT3 and TT4 are normal or It can be elevated, it can be decreased in the late stage and the serum TSH level can be increased, and tr-ab can be positive in some patients.
- 5. Serum immune complexes increased, igg, iga levels increased, lymphocyte metastasis rate increased, percentage of helper t lymphocytes increased, thyroid autoantibodies (tga, tma) were strongly positive, and titers increased significantly.
- 6. Thyroid fine needle aspiration cytology showed abundant lymphocytes, and plasma cells and hurthle cells were also found.
- 7. The disease is easy to coexist with other autoimmune diseases, such as malignant anemia, systemic lupus erythematosus, rheumatoid arthritis, atrophic gastritis, etc., and also with hyperthyroidism (Hashimoto-hyperthyroidism), Nodular goiter and thyroid cancer coexist. If necessary, make a thyroid biopsy or surgical exploration to confirm the diagnosis.
Hashimoto's thyroiditis treatment
- First, thyroid hormone preparations when the thyroid function is normal or low, thyroid preparations can be used, the effect is good. 80 to 160 mg of thyroid tablets can be taken daily. Or L-thyroxine 0.2-0.4mg, the specific dose should be based on thyroid function, the degree of goiter, the age of the patient and the state of the cardiovascular system. Generally, after 2 to 4 weeks of medication, the symptoms can be improved and the thyroid gland shrinks. At this time, the dose can be appropriately reduced and maintained for 1 to 2 years or even longer.
- Second, if antithyroid drugs are accompanied by hyperthyroidism, antithyroid drugs can be appropriately applied, the dose should not be too large, and monitor thyroid function, adjust the dose in time or discontinue the drug. In addition, according to the degree of hyperthyroidism, an appropriate amount of thyroid tablets can be added to improve the symptoms of goiter and compression.
- 3. Adrenocortical hormone is obvious in patients with goiter, significant compression symptoms, and rapid progress of the disease. It can be considered for the purpose of obtaining better curative effect in a short period of time. Prednisone 30mg daily can be used. The general medication period is 1 to 2 months. After the condition is stable, it is maintained with thyroid tablets.
- If the treatment fails, the diagnosis should be reconsidered, excluding thyroid tumors or lymphomas, and surgical treatment can be used if necessary.
Hashimoto's thyroiditis inheritance
- Hashimoto's thyroiditis is a type of autoimmune disease. Hashimoto's thyroiditis has a genetic tendency, not necessarily inherited. As long as the condition of Hashimoto's thyroiditis can be controlled during pregnancy, it is generally possible to avoid Thyroiditis is passed on to the next generation. Now there will be screening tests for thyroid disease after giving birth. Even if Hashimoto's thyroiditis is inherited, if the child can be found in time, the child will be treated in time.
How to prevent Hashimoto's thyroiditis
- Hashimoto's thyroiditis is an autoimmune disease without special precautions, but usually paying attention to diet to properly balance iodine intake and avoid foods that can cause goiter can play a certain preventive role. The experts of our hospital are invited to give you a detailed introduction below.
- The prevention of Hashimoto's thyroiditis requires diet:
- The diet focus is on high-fiber foods including green leafy vegetables, coarse grains and many fruits, such as celery in vegetables, cabbage, water chestnuts, soy beans in coarse grains, mung beans, oats, jujubes in fruits, dried fruits such as peanuts, which are rich in fiber For patients with Hashimoto's thyroiditis and hyperthyroidism, dietary intake of kelp, seaweed and other seafood products should be temporarily restricted to reduce iodine content in food. Hashimoto's thyroiditis Patients with low thyroid function, such as patients with chronic lymphocytic thyroiditis, should increase the iodine content in food, increase the iodine concentration in the blood, and prepare sufficient raw materials for the synthesis of thyroid hormones.
- Some data show that the clinical manifestations of Hashimoto's disease are complicated, there are many comorbidities, and the preoperative diagnosis rate is low. Therefore, attention must be paid to avoid misdiagnosis. Surgical treatment of Hashimoto's disease is desirable, but its indications must be strictly grasped. The surgical plan should be individualized. As much thyroid tissue as possible should be kept during the operation. Thyroxine replacement therapy should be taken for a long time after surgery to achieve good treatment and prevention effect.
Hashimoto's Thyroiditis
Early Hashimoto's thyroiditis , hyperthyroidism
- When the degree is mild, the patient has only mild symptoms of hyperthyroidism, such as good appetite, easy fatigue, mild insomnia, and irritability. When the degree is severe, there will be obvious symptoms of hyperthyroidism. Good results can be obtained by taking a little medicine for treating hyperthyroidism, but it is also prone to drug-induced hypothyroidism. Some patients "heal" because of the reduction of inflammation and death. Good curative effect and high recurrence rate are the characteristics of this stage.
Middle stage of Hashimoto's thyroiditis , low coexistence of hyperthyroidism
- After repeated and repeated destruction of the thyroid tissue, cells with normal functions gradually decrease, and to a certain extent, symptoms of hypothyroidism appear. There is also a characteristic of this period, patients have symptoms of hyperthyroidism, but laboratory indicators will be slightly higher or normal.
Hashimoto's advanced thyroiditis , hypothyroidism
- Secretion of thyroxine is even more reduced, and clinically it is already hypothyroidism. After thyroid hormone supplementation in Hashimoto's thyroiditis patients, although the laboratory indicators are normal, many people feel uncomfortable from time to time, and sometimes feel hyperthyroidism. It is worth noting that there are also some patients with hyperthyroidism indicators and symptoms of hyperthyroidism due to the exacerbation of infection. Some writings are called "hypothyroidism to hyperthyroidism." Clinically, every occurrence of hyperthyroidism in patients with Joben's thyroiditis indicates a further increase in hypothyroidism.
- During the development of Hashimoto's thyroiditis, it was not that there were no special feelings in the early stage, but these feelings were not valued by patients and did not go to the doctor. Although some patients with Hashimoto's thyroiditis have indicators and symptoms of hyperthyroidism in the early or middle stages, they must not be treated with surgery or isotope, which will make the patient become heavier hypothyroidism very quickly. Hashimoto's thyroiditis may develop symptoms of hyperthyroidism in the early stages and hypothyroidism in the later stages. At the time of diagnosis, some people were diagnosed as "Hashimoto's disease with hyperthyroidism" and "Jobben's disease with hypothyroidism."
- It is necessary to pay attention to the characteristics of Hashimoto's thyroiditis disease in treatment, so as to avoid misdiagnosis. In the early stage, patients with Hashimoto's thyroiditis must be treated as soon as possible, and do not delay the great opportunity of treatment.
Chinese medicine treatment of Hashimoto's thyroiditis
Hashimoto's thyroiditis treatment plan
- Hashimoto's thyroiditis requires life-long thyroid hormone replacement therapy to reduce thyroid hypertrophy and treat hypothyroidism, and occasionally hypothyroidism is transient. The average T4 dose for replacement therapy is 75 ~ 150 g / d.
- Wind-heat phenotype
- Main card: Fever and cold, severe heat and cold, headache, body swollen, sore throat, severe neck pain, adverse turn, bloated and burning pain, painful touch, think of the child, pillow, jaw radiation, dry mouth Dry throat, thirst for cold drinks, cough with little phlegm, spontaneous sweating, fatigue, red tongue, thin yellow fur, and floating pulse.
- Governing Law: Shufengjie table, Qingrejiedu, Liyan analgesic
- 2. Liver depression and fire type
- Main symptoms: bloating, burning and pain, upset and anxiety, pharyngeal obstruction, thirst, drinking, hyper appetite, trembling hands, insomnia, dreaming, fatigue and spontaneous, women see premenstrual bloating, irregular stool, The tongue is red, the moss is thin and yellow, and the veins are numbered.
- Governing Law: Shugan Jieyu, Qinggan Xiehuo
- 3. Yin deficiency and yang hyperactivity
- Main symptoms: bloated and painful, dry mouth and throat, five upsets, dizziness, insomnia, dreams, palpitations, spontaneous sweating, sweating, hoarseness, red tongue, little moss or yellow moss, pulse string count
- Governing Law: Ziyin Qianyang
- 4. Phlegm and Stasis Syndrome
- Main symptoms: bloated and hard, painful pressure, pharyngeal discomfort, dullness in the chest, or cough and sputum, dark tongue, or petechiae, white fur, and heavy pulse.
- Governing method: activating blood and removing stasis, dissolving phlegm
- 5. Spleen and Kidney Yang Deficiency
- Main evidence: bloated, complexion, chills, cold limbs, tired and lazy, appetite and suffocation, limbs floating, hyposexuality, men can see impotence, women can see menstrual loss or amenorrhea, pale tongue, white fur , The pulse is thin
- Governing method: warm spleen and kidney, diuresis and swelling.
- 6. Qi and blood deficiency type
- Main evidence: bloated, complexion, fatigue, weakness and cold, shortness of breath, shortness of breath, dry mouth and phlegm, dizziness, soft waist, insomnia, dreams, pale tongue, thin veins Shen fine.
- Governing Law: Nourishing Qi and Nourishing Blood
Hashimoto 's thyroiditis types of Hashimoto's thyroiditis
- Five types of Hashimoto's thyroiditis
- (1) Pseudohyperthyroidism: A few patients may have clinical manifestations of hyperthyroidism, such as palpitations, sweating, and nervousness, but there is no evidence of hyperthyroidism on thyroid function tests and TGAb and TMAb are positive. This type of patient does not require antithyroid medication, and the symptoms go away on their own.
- (2) Hashimoto's hyperthyroidism: Patients are accompanied by hyperthyroidism, and some cases may have invasive exophthalmos and myxedema. May have typical hyperthyroidism. High circulating antibody titers. Hyperthyroidism in these patients can last for several years, often requiring antithyroid drugs, but the dose should not be too large. Pay attention to the occurrence of drug-induced hypothyroidism. Neither surgical resection nor radionuclide treatment is appropriate and prone to permanent hypothyroidism.
- (3) Exophthalmos type: Infiltrative exophthalmos can occur in this disease, and its thyroid function can be normal, hyperactive or diminished. There was lymphocytic infiltration and edema in the posterior orbital muscle. Both serum TGAb and TMAb were positive.
- (4) Subacute thyroiditis type: A few patients have an acute onset, accompanied by fever, rapid thyroid enlargement, local pain and tenderness, and accelerated erythrocyte sedimentation. (5) Adolescent type: Of the adolescent goiters, Hashimoto's thyroiditis accounts for about 40%. Its thyroid is small, thyroid function is normal, thyroid antibody titer is low, and clinical diagnosis is difficult. Goiter increases rapidly in some patients, which is called adolescent hyperplasia. Some patients may be complicated by hypothyroidism.
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