Autoimmune thyreopathies are chronic inflammatory thyroid diseases. They can present as hyperthyroidism or hypothyroidism.
What is autoimmune thyreopathy?
Autoimmune thyreopathies are diseases of the thyroid gland that result in chronic inflammation of the organ. Autoimmune thyreopathies include Hashimoto’s thyroiditis, Ord thyroiditis, and Graves’ disease. According to the effect of the disease on the body, autoimmune thyreopathies are divided into three types. Type 1 refers to a euthyroid metabolic condition. The concentration of thyroid hormones in the body resembles the situation in a healthy person. There is a further subdivision into type 1A with goiter and type 1B without goiter. Type 2 represents a hypothyroid metabolic state, i.e. a deficiency of thyroid hormones. Type 2 is divided into type 2A with goiter and type 2B without goiter. Type 3 of the autoimmune thyreopathies is Graves’ disease. It is subdivided into type 3A with hyperthyroidism (an excess of thyroid hormones), type 3B with euthyroidism, and type 3C with hypothyroidism. Hashimoto’s thyroiditis corresponds to types 1A or 2A. Ord thyroiditis differs from Hashimoto’s disease in the absence of goiter and corresponds to types 1B and 2B.
Causes
Autoimmune thyreopathies result from a malfunction of the immune system. Hashimoto’s or Ord thyroiditis results from improperly mediated T lymphocytes. Antibodies are formed against the thyroid tissue. The disease can occur after viral infections. These include Pfeiffer’s glandular fever or shingles. It also occurs in adrenal cortex dysfunction and polycystic ovary syndrome. A genetic predisposition plays a role in the development of the disease. Excessive iodine intake due to the administration of contrast media can trigger Hashimoto’s disease. In Graves’ disease, autoantibodies are formed that stimulate the production of thyroid hormones. Hyperthyroidism develops. Graves’ disease occurs through a combination of genetic factors and external influences. If predisposed, stress or infections can trigger the disease.
Symptoms, complaints, and signs
In Hashimoto’s and Ord’s disease, symptoms of hypothyroidism occur. Patients have a low body temperature and are sensitive to cold. They are tired, unmotivated, and listless. Depressive moods may occur. Affected individuals describe a change in voice and a feeling of pressure in the throat. Myxedema may develop, in which the extremities and face swell due to water retention. Hair becomes brittle and falls out. Patients with hypothyroidism gain weight quickly and a lot. Constipation and nausea may be present. The heartbeat is slowed. In the early stages of Hashimoto’s or Ord thyroiditis, symptoms of hyperthyroidism may appear. Graves’ disease triggers hyperthyroidism. It is manifested by sweating, restlessness, cardiac arrhythmias and tremors. Affected individuals suffer from sleep disturbances and sweating. They have [[cravings9]attacks and rapid weight loss. The skin feels warm and moist. Sufferers complain of tightness in the throat. In the long term, Graves’ disease can result in the development of osteoporosis. The eyes may be affected. The disease can cause endocrine orbitopathy, in which the eyeballs protrude.
Diagnosis and course
The clinical picture provides the first clues to the diagnosis. Physical examination includes assessment of the size and condition of the thyroid gland. An electrocardiogram is obtained to detect cardiac arrhythmias. The blood test provides information about the nature of the thyroid disease. First, the thyroid hormones T3 (triiodothyronine), T4 (L-thyroxine) and the thyroid-stimulating hormone TSH are used to determine the metabolic state. Antibodies against thyroperoxidase (TPO-AK) and thyroglobulin (Tg-AK) are typical for Hashimoto’s and Ord’s disease. The presence of Graves’ disease is proven by TSH receptor antibodies (TRAK). Ultrasonography of the thyroid gland can provide an orientational assessment of the tissue. Doppler ultrasonography provides information about the blood flow to the organ. Scintigraphy uses nuclear medicine to examine the activity of the thyroid gland.The findings of these examinations complete the diagnosis of thyroid disease. If the findings are equivocal or the presence of malignant disease is suspected, a fine-needle biopsy may be necessary.
Complications
There are several types of autoimmune thyreopathy that may be associated with related complications. First, autoimmune disease can resemble hypothyroidism, as in Hashimoto’s disease. Without treatment, this can lead to heart failure at an early stage. This can sometimes even mean heart failure, which can lead to the death of the patient. Furthermore, Hashimoto’s thyroiditis can result in elevated cholesterol levels. This can lead to calcification of the vessels over many years (atherosclerosis) and to a reduced supply of blood to the organs in certain places. The worst consequences that can result from atherosclerosis are a heart attack or even a stroke. In addition, Hashimoto’s disease leads to a decrease in libido and can also lead to depression. Depression can be accompanied by increased addiction to alcohol and other drugs, and in the worst cases can lead to suicidal thoughts. Hyperthyroidism, as in Graves’ disease, also has various consequences. Here, too, there can be weakness of the heart, which can lead to immediate cardiac death. In the long term, hyperthyroidism leads to an increased risk of osteoporosis. As a rare and serious complication, a thyrotoxic crisis can occur. This involves a metabolic derailment characterized by fever, sweating, anxiety, and even coma.
When should you see a doctor?
Suspicion of autoimmune thyreopathy should always be discussed with the primary care physician. Medical clarification is necessary at the latest when characteristic symptoms appear. For example, depressive moods, cardiac arrhythmias and inner restlessness indicate a serious disease of the immune system. If water retention in the limbs or face, a feeling of pressure in the throat or changes in the voice are added to these complaints, the assumption of an autoimmune thyreopathy is obvious. A specialist in immunology must diagnose the respective disease and initiate treatment immediately. In case of sleep disturbances and psychological complaints, therapeutic advice should be sought concomitantly. It may also be useful to consult a nutritionist. In this way and through a rapid initial diagnosis, the autoimmune disease can be treated well. However, if the disease remains untreated, further physical complaints may develop. At the latest, if autoimmune thyreopathy manifests itself through external symptoms such as protruding eyeballs, moist and warm skin, and rapid weight loss, a doctor must be consulted immediately.
Treatment and therapy
There is no known causative treatment or cure for Hashimoto’s and Ord thyroiditis. Therapy involves compensating for hypothyroidism by supplying thyroid hormones in the form of tablets. Either only T4 or a combination of T3 and T4 can be given. The correct dosage is different for each patient and must be found by careful adjustment and close monitoring. Regular blood and ultrasound examinations ensure the long-term success of the therapy. In Graves’ disease, the initial focus is on reducing the symptoms of hyperthyroidism. This is done with thyrostatic drugs. These drugs slow down the hormone production of the thyroid gland. The drugs are administered with regular laboratory checks until the thyroid hormone levels have normalized. After a therapy period of twelve to 18 months, remission occurs in 40 percent of cases. After discontinuation of the thyrostatic drugs, hyperthyroidism does not recur. However, hypothyroidism may now develop. The final therapy for Graves’ disease is surgery or radioiodine therapy. Surgery removes all or part of the thyroid gland. In radioiodine therapy, radioactive iodine is administered, which irradiates and inactivates the diseased tissue in the thyroid gland.
Outlook and prognosis
There is no prospect of a cure for autoimmune thyroid disease. With the medical and therapeutic options available, significant relief of symptoms can be achieved.Nevertheless, a relapse occurs immediately after discontinuation of the medication and thus the irregularities immediately reappear. The severity of the disease is not relevant in the question of prognosis. In all possible degrees of severity, drug treatment is chosen so that the production of hormones can be better regulated. The dosage is variable, as is the frequency with which the drugs are taken. However, as soon as they are stopped, a relapse takes place immediately. The drugs improve the patient’s well-being to a considerable extent. He feels healthier, is fitter and has more zest for life. The emotional and also psychological problems decrease, so that there is an overall improvement in health. Coping with everyday life is possible with the remedy almost without complaints. Regular blood and control examinations must be noticed. In these, the dose is adjusted so that the acquired feeling of well-being can be maintained as stably as possible. If the treatment is discontinued or independently reduced even after a period of several years, the probability of relapse is slightly less than half of the patients.
Prevention
Because genetic components contribute to the development of autoimmune thyreopathies, prevention of the diseases is impossible in the strict sense. Avoidance of infection and strict indication for examinations with contrast agents can reduce potential triggers.
Follow-up
Follow-up cannot aim to prevent recurrence of autoimmune thyroid disease. The disease is not considered curable. It accompanies affected individuals throughout their lives. Rather, the purpose of scheduled follow-up examinations is to improve patients’ daily lives and prevent possible complications. Doctors use blood tests and ultrasound scans for this purpose, which must be performed regularly. Physicians can adjust the therapy to acute changes. The medical approach is to balance the hyperthyroidism or hypothyroidism. To do this, patients must take hormone tablets regularly. The typical complaints can be alleviated in this way. Patients feel fitter and more efficient. Psychological problems disappear. If the medication is discontinued, the typical complaints recur. Taking your own precautions is anything but insignificant. A healthy diet and regular exercise stimulate the metabolism and increase vitality. These general everyday tips are also effective in the case of a diagnosis of autoimmune thyreopathy. It is also scientifically proven that the trace element selenium supports thyroid function. Suitable dietary supplements are available in pharmacies and drugstores. Those affected experience a close-meshed network of examinations. In professional and private everyday life, there are nevertheless hardly any restrictions.
What you can do yourself
Autoimmune thyreopathy also has very differentiated effects on the individual affected and the associated everyday life due to various degrees of severity and side effects. With effects on sleep duration and drive, it becomes difficult to manage everyday work. In some cases, exhaustion states occur that cause an inability to work. If possible, patients should discuss with their superiors and colleagues how the state of illness and work performance can be easily reconciled. If the work is part-time, patients should not shy away from being open with superiors and try to distribute the working hours as best as possible so that there are enough recovery phases. If it is possible, more work can be done even in times when there are few side effects of the illness, so that compensatory time off is taken during periods of exacerbation. As self-help, regular endurance sports and walks are recommended to stimulate the metabolism and the body can react better to the respective effects. As a dietary supplement, the intake of the trace element selenium is particularly recommended. Selenium is known to support thyroid activity without further stimulating the autoimmune process. It is essential to take the thyroid medication prescribed by the doctor on a permanent basis. In addition, the intake of iodine should be reduced, as this only further stimulates the autoimmune process.
