Autoimmune thyroid disorders are chronic inflammatory diseases of the thyroid gland. They can appear as an overactive or underactive thyroid.
What is autoimmune thyroid disease?
Abbreviated as AITD by AbbreviationFinder, autoimmune thyroidopathies are diseases of the thyroid gland that lead to chronic inflammation of the organ. Autoimmune thyroiditis includes Hashimoto’s thyroiditis, Ord thyroiditis and Graves’ disease. According to the way the disease affects the body, autoimmune thyroid disorders are divided into three types.
Type 1 describes a euthyroid metabolic state. 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. The subdivision is made 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 thyroidopathies 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
Symptoms of an underactive thyroid appear in Hashimoto’s and Ord’s disease. 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. It can be a myxedema arise through in the extremities and face water retention swell. The hair becomes brittle and falls out. Patients with hypothyroidism gain weight quickly and a lot.
Constipation and nausea may be present. The heartbeat is slowing down. Symptoms of an overactive thyroid can occur in the early stages of Hashimoto’s or Ord thyroiditis. Graves’ disease triggers an overactive thyroid. It occurs through sweating, restlessness, cardiac arrhythmias and tremors.
Those affected suffer from insomnia and sweating. They have 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 lead to the development of 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 of all, 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 of Hashimoto’s and Ord diseases.
The presence of Graves’ disease is proven by TSH receptor antibodies (TRAK). The tissue can be assessed by means of the ultrasound examination of the thyroid gland. 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 thyroidopathy 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 increased addiction to alcohol and other drugs and, in the worst cases, can lead to thoughts of suicide.
An overactive thyroid, such 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 overfunction 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?
The suspicion of an autoimmune thyroid disease should always 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, and through a quick initial diagnosis, the autoimmune disease can be treated well. However, if the disease remains untreated, further physical complaints can arise. At the latest, when the autoimmune thyroid disease manifests itself through external symptoms such as protruding eyeballs, damp and warm skin and rapid weight loss, a doctor must be consulted immediately.
Treatment & Therapy
There is no known causal treatment or cure for Hashimoto’s and Ord thyroiditis. 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 via thyreostatics. These drugs slow down 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 will be no renewed hyperthyroidism. However, a subfunction can now arise. The final therapy for Graves’ disease is surgical or with radioiodine therapy. The surgery 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, a significant alleviation of the symptoms can be achieved. 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 taken. 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 after a period of several years, the likelihood 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 strictest sense 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 patient’s everyday life 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 hyperthyroidism or hypothyroidism. To do this, patients have to take hormone tablets regularly. The typical complaints can be alleviated in this way. Patients feel fitter and more productive.
Mental problems disappear. If the medication is discontinued, the typical symptoms reappear. 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, due to its various degrees of severity and side effects, also very differentiated effects on the individual affected and the everyday life associated with it.
With effects on the duration of sleep and the driving force, it becomes difficult to manage the day-to-day 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 shy away from being 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 can be compensated for during periods of pushback.
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 intake 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 initiates the autoimmune process.
