Autoimmune thyroiditis
| Autoimmune thyroiditis | |
|---|---|
| Classification and external resources | |
| Specialty | endocrinology |
| ICD-10 | E06.3 |
| MeSH | D013967 |
Autoimmune thyroiditis, (or Chronic Autoimmune thyroiditis), is a disease in which the body interprets the thyroid glands and its hormone products T3, T4 and TSH as threats, therefore producing special antibodies that target the thyroid’s cells, thereby destroying it.
It presents with hypothyroidism or hyperthyroidism and the presence or absence of goiters.[1]
Categories of autoimmune thyroiditis
Specialists clinically separate autoimmune thyroiditis into two categories.
1. If goiters are present, it is understood as Hashimoto’s Thyroiditis.
2. If the thyroid is atrophic, but does not present goiters, it is denominated Atrophic Thyroiditis.[1]
If the symptoms of thyroiditis appear in women after giving birth, it is attributed to such and therefore called Postpartum Thyroiditis.[1] The effects of this disease may be permanent but can sometimes be transient. Symptoms may come and go depending on whether the patient receives treatment, and whether the treatment takes effect. Although treatment could be started immediately and may still not have the effect desired.
Signs and symptoms
The symptoms for autoimmune thyroiditis may vary depending on whether it causes hyperthyroidism or hypothyroidism.
Hyperthyroidism
Hyperthyroidism can cause sweating, rapid heart rate, anxiety, tremors, fatigue, difficulty sleeping, sudden weight loss, and protruding eyes.[2]
Hypothyroidism
Hypothyroidism can cause weight gain, fatigue, dry skin, hair loss, intolerance to cold, and constipation.[2]
Genetics
“Thyroid autoimmunity is familial.”[1] The disease is said to be inherited as a dominant trait since it has been reported that as many as fifty percent of the first degree relatives of patients with some type of autoimmune thyroiditis present thyroid antibodies in serum.[1] Some studies have even related it to chromosome 21 because of its high correlation with patients with Down’s syndrome and familial Alzheimer’s disease. Still, this theory is doubted, since patients with Turner’s syndrome also present a high prevalence of autoimmune thyroiditis (up to fifty percent).[1]
High iodine consumption
Autoimmune thyroiditis has a higher prevalence in societies that have a higher intake of iodine in their diet, such as the United States and Japan. Also, the rate of lymphocytic infiltration increased in areas where the iodine intake was once low, but had been given iodine supplementation. “The prevalence of positive serum tests in such areas rises to over 40 percent within 0.5 to 5 years.” [1]
Age
It has been shown that “the prevalence of positive tests for thyroid antibodies increases with age, with a frequency as high as 33 percent in women 70 years old or older.” [1] The mean age of prevalence in women is higher than in men by one year, (58 and 59 years old respectively).
Autoimmune thyroiditis can also affect children. Although it is very rare for children under the age of five but could be common, it can occur, and it accounts for around 40 percent of the cases in adolescents with goiters.
In the case of hypothyroidism, patients over the age of 40 have more chances of developing autoimmune thyroiditis.[1]
Mechanism
Thyroid autoantibodies appear mostly with the presence of lymphocytes in the targeted organ.[1][3] Lymphocytes produce antibodies targeting three different thyroid proteins: Thyroid peroxidase Antibodies (TPOAb), Thyroglobulin Antibodies (TgAb), and Thyroid stimulating hormone receptor Antibodies (TRAb).[1][2] Some patients who are healthy may be positive for more than one of these antibodies. Doctors who attend to such patients will most likely do routine follow-ups on the patient’s health since, even though it is highly unlikely that they will present any thyroid problems, there is still a chance that they will develop some type of dysfunction with time.[2]
Diagnosis
There are various tests that can be made depending on the symptoms the patient presents. Doctors may search for TPOAb when the patient has symptoms that suggest hypothyroidism, or when said patient will be started on a drug therapy associated with risks of developing hypothyroidism,[2] such as lithium or Interferon alfa.[1] This antibody is related to Hashimoto's thyroiditis and Grave’s disease.
They may look for TgAb whenever a thyroglobulin test is performed to see if the antibody is present and likely to interfere. It can also be ordered in regular intervals after the patient has been diagnosed with thyroid cancer, and just like TPOAb, it can be associated with Hashimoto’s thyroiditis.[2]
In the case that the patient presents symptoms for hyperthyroidism, the doctors are more likely to test for TRAb, as well as monitoring the effects of anti- thyroid therapy, also associated with Grave’s disease.[1]
Types
It can refer to:
References
- 1 2 3 4 5 6 7 8 9 10 11 12 13 Dayan, Dayan, Colin M; Dayan, Colin M.; Gilbert H. Daniels (1996). "Chronic Autoimmune Thyroiditis". The New England Journal of Medicine. 335 (2): 99–107. doi:10.1056/nejm199607113350206.
- 1 2 3 4 5 6 "Thyroid Antibodies". Retrieved 4 April 2012.
- ↑ Weetman, A. P.; A. M. McGregor; H. Lazarus; R. Hall (April 1982). "Thyroid Antibodies are Produced by Thyroid- Derived Lymphocytes". Clin Exp Immunol. 48 (1): 196–200. PMC 1536583
. PMID 7044629.