Autoimmune thyroid disease

Autoimmune thyroid disorders are chronic inflammatory thyroid diseases. They can appear as an over- or underactive thyroid.

What is autoimmune thyroid disease?

Autoimmune thyroidopathies are diseases of the thyroid gland that lead to chronic inflammation of the organ. The autoimmune thyroiditis includes Hashimoto's thyroiditis, Ord thyroiditis and Graves' disease. According to the effects of the disease on the body, autoimmune thyroidopathies are divided into three types.

Type 1 describes a euthyroid metabolic condition. The concentration of thyroid hormones in the body is the same as in healthy people. There is a further subdivision into type 1A with goiter (goiter) and type 1B without goiter. Type 2 stands for a hypothyroid metabolic condition, i.e. a lack of thyroid hormones. Type 2 is divided into type 2A with goiter and type 2B without goiter.

Graves' disease is referred to as type 3 autoimmune thyroid disease. It is subdivided into type 3A with hyperthyroidism (an excess of thyroid hormones), type 3B with euthyroid metabolism and type 3C with hypothyroidism. Hashimoto's thyroiditis corresponds to types 1A or 2A. Ord thyroiditis differs from Hashimoto's disease in that there is no goiter and corresponds to types 1B and 2B.

causes

Autoimmune thyroid disorders are caused by a malfunction of the immune system. Hashimoto's or Ord thyroiditis is caused by incorrectly 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 dysfunction of the adrenal cortex and polycystic ovary syndrome. A genetic predisposition plays a role in the development of the disease.

Excessive iodine intake through administration of contrast media can trigger Hashimoto's disease. In Graves' disease, autoantibodies are formed that stimulate the production of thyroid hormones. An overactive thyroid develops. Graves' disease occurs due to a combination of genetic factors and external influences. With the appropriate predisposition, stress or infections can trigger the disease.

Symptoms, ailments & signs

In Hashimoto's and Ord diseases, symptoms of an underactive thyroid appear. The patients have a low body temperature and are sensitive to cold. You are tired, unmotivated and lackluster. Depressive moods can occur.

Affected people describe a change in voice and a feeling of pressure in the throat. Myxedema can develop, in which the extremities and face swell due to water retention. The hair becomes brittle and falls out. Patients with an underactive thyroid gain weight quickly and a lot.

Constipation and nausea may be present. The heartbeat is slowed. Symptoms of an overactive thyroid can occur in the early stages of Hashimoto's or Ord thyroiditis. Graves' disease causes an overactive thyroid. It manifests itself through sweating, restlessness, cardiac arrhythmias and tremors.

Those affected suffer from insomnia and sweating. They have [[cravings9] attacks and rapid weight loss. The skin feels warm and moist. Sufferers complain of a tightness in the throat. In the long term, Graves' disease can result in osteoporosis. The eyes can be affected. The condition can cause endocrine orbitopathy, in which the eyeballs protrude.

Diagnosis & course

The clinical picture provides the first clues to the diagnosis. The physical exam will include assessing the size and nature of the thyroid gland. An electrocardiogram is made to record cardiac arrhythmias.

The blood test provides information about the type of thyroid disease. First, the thyroid hormones T3 (triiodothyronine), T4 (L-thyroxine) and the thyroid-stimulating hormone TSH are used to determine the metabolic status. Antibodies against thyroid peroxidase (TPO-AK) and thyroglobulin (Tg-AK) are typical for Hashimoto's and Ord diseases.

The presence of Graves' disease is proven by TSH receptor antibodies (TRAK). With the ultrasound examination of the thyroid gland, the tissue can be assessed for orientation. Doppler sonography provides information about the blood flow to the organ. In scintigraphy, the activity of the thyroid gland is examined using nuclear medicine.

The findings of these examinations complete the diagnosis of thyroid diseases. A fine needle biopsy may be necessary if the results are doubtful or if a malignant disease is suspected.

Complications

There are several types of autoimmune thyroid disease that can be associated with complications. On the one hand, the autoimmune disease of an underactive thyroid can be similar to that of Hashimoto's disease. Without treatment, this can lead to heart failure (heart failure) at an early stage.

Sometimes this can even mean heart failure, which can lead to patient death. Hashimoto's thyroiditis can also lead to increased cholesterol levels. For many years this can lead to calcification of the vessels (atherosclerosis) and, in certain places, to an insufficient supply of the organs with blood.

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 associated with an increased addiction to alcohol and other drugs and in the worst cases can lead to thoughts of suicide.

An overactive thyroid, as in Graves' disease, also has various consequences. Here too, the heart can become weak, which can lead to immediate cardiac death. In the long run, the hyperfunction leads to an increased risk of osteoporosis. A thyrotoxic crisis can occur as a rare and serious complication. This leads to a metabolic imbalance, which is characterized by fever, sweating, fear and even coma.

When should you go to the doctor?

Any suspicion of autoimmune thyroid disease should be discussed with the family doctor. Medical clarification is necessary at the latest when characteristic symptoms occur. Depressive moods, cardiac arrhythmias and inner restlessness indicate a serious illness 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 suspicion of autoimmune thyroidopathy is likely. A specialist in immunology must diagnose the disease in question and initiate treatment immediately. In the case of sleep disorders and psychological complaints, therapeutic advice should be sought. It can also be useful to consult a nutritionist.

As a result of this and a quick initial diagnosis, the autoimmune disease can be treated well. However, if the disease is left untreated, other physical complaints can arise. At the latest when the autoimmune thyroid disease manifests itself through external symptoms such as protruding eyeballs, moist and warm skin and rapid weight loss, a doctor must be consulted immediately.

Doctors & therapists in your area

Treatment & Therapy

A causal treatment or cure for Hashimoto's and Ord thyroiditis is unknown. The therapy takes place via a compensation of the hypothyroidism by the supply of 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 through careful adjustment and close monitoring. Regular blood and ultrasound examinations ensure long-term therapeutic success. In Graves' disease, the focus is initially on reducing the symptoms of hyperthyroidism.

This is done using thyreostatics. These drugs slow the thyroid gland's production of hormones. The drug is administered under regular laboratory controls until the thyroid hormone levels have normalized. After a therapy period of twelve to 18 months, there is a remission in 40 percent of the cases.

After stopping the anti-thyroid drug, there is no renewed hyperthyroidism. However, a subfunction can now arise. The final therapy for Graves' disease takes place surgically or with radioiodine therapy. The operation removes all or part of the thyroid gland. In radio-iodine therapy, radioactive iodine is administered, which irradiates and inactivates the diseased tissue in the thyroid gland.

Outlook & forecast

There is no prospect of a cure for autoimmune thyroid disease. With the medical and therapeutic options available, the symptoms can be significantly alleviated. Nevertheless, a relapse occurs immediately after the medication is discontinued, and the irregularities immediately return.

The severity of the disease is not relevant to the question of the prognosis. Drug treatment is chosen in all possible degrees so that the production of hormones can be better regulated. The dosage is variable and so is the frequency of taking the preparations. However, as soon as they are discontinued, relapse occurs 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 psychological problems decrease, so that an overall improvement in health takes place.

Coping with everyday life is almost symptom-free with the medicine. Regular blood and check-ups must be carried out. In these, the dose is adjusted so that the feeling of well-being achieved can be maintained as stable as possible. If treatment is discontinued or reduced independently even after a period of several years, the probability of a relapse is slightly less than half of the patients.

prevention

Since genetic components contribute to the development of autoimmune thyroid disorders, prevention of the disease in the strict sense of the word is impossible. Avoiding infections and strict indications for examinations with contrast media can reduce possible triggers.

Aftercare

Follow-up care cannot aim to prevent autoimmune thyroid disease from recurring. The disease is considered incurable. It accompanies those affected throughout their lives. Rather, the purpose of scheduled follow-up examinations is to improve the everyday life of the patient and prevent possible complications. Doctors use blood and ultrasound tests, which must be done regularly.

Doctors can adapt therapy to acute changes. The medical approach is to compensate for the overactive thyroid or underactive thyroid. To do this, patients have to take hormone tablets regularly. The typical complaints can be alleviated. Patients feel fitter and more productive.

Mental problems disappear. If the medication is discontinued, the typical symptoms recur. Your own provision is anything but insignificant. A healthy diet and regular exercise stimulate the metabolism and increase the joy of life. These general everyday tips also apply to the diagnosis of autoimmune thyroid disease.

It is also scientifically justified that the trace element selenium supports the thyroid function. Suitable food supplements are available in pharmacies and drugstores. Those affected experience a close-knit network of examinations. Nevertheless, there are hardly any restrictions in everyday professional and private life.

You can do that yourself

Autoimmune thyroid disease has different degrees of severity and side effects, and also has very different effects on the individual affected and the everyday life associated with it.

If it has an impact on sleep duration and driving force, it becomes difficult to manage everyday work. Sometimes it comes to states of exhaustion that cause an inability to work. If possible, patients should discuss with their superiors and colleagues how the condition of the disease and work performance can be reconciled.

In the case of part-time work, patients should not be afraid to be open to their superiors and try to distribute the working hours as best as possible so that there are enough recovery phases. If possible, more work can be carried out even in times of a few side effects of the illness, so that leisure time is compensated for in times of relapse.

On the one hand, regular endurance sports and walks are a means of self-help; this stimulates your own metabolism and the body can react better to the respective effects. The consumption of the trace element selenium is particularly recommended as a dietary supplement.

Selenium is known to support thyroid activity without further stimulating the autoimmune process. It is essential to constantly take thyroid medication, which is prescribed by the doctor. In addition, the intake of iodine should be reduced, as this only further gets the autoimmune process going.