• Monday May 25,2020

Autoimmunthyreopathie

Autoimmune thyroid disorders are chronic inflammatory thyroid disorders. They can occur as over or under thyroid function.

What is autoimmune thyroid disease?

The autoimmune thyroid disorders are caused by a malfunction of the immune system. They lead to over- or under-function of the thyroid gland.
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Autoimmune thyroid disorders are diseases of the thyroid gland that lead to chronic inflammation of the organ. Autoimmune thyroid disorders include Hashimoto's thyroiditis, Ord's thyroiditis and Graves' disease. After the impact of the disease on the body, the autoimmune thyroid diseases are divided into three types.

Type 1 refers to an euthyroid metabolism. The concentration of thyroid hormones in the body is similar to the situation in the healthy. There is a further subdivision in type 1A with goiter (goiter) and type 1B without goiter. Type 2 stands for a hypothyroid metabolism, ie a lack of thyroid hormones. Type 2 is divided into type 2A with goiter and type 2B without goiter.

Type 3 autoimmune thyroid is called Graves' disease. The subdivision is in type 3A with hyperthyroidism (an excess of thyroid hormones), type 3B with euthyroid metabolism and type 3C with hypothyroidism. Hashimoto's thyroiditis is type 1A or 2A. Ord.-thyroiditis differs from Hashimoto's disease by the absence of goiter and corresponds to types 1B and 2B.

causes

The autoimmune thyroid disorders are caused by a malfunction of the immune system. Hashimoto or Ord thyroiditis is caused by misplaced T lymphocytes. Antibodies against the thyroid tissue are formed. The disease can occur after viral infections.

These include the Pfeiffer's glandular fever or shingles. It also occurs in dysfunctional adrenals and polycystic ovary syndrome. A genetic bias plays a role in the development of the disease.

Excessive iodine supplementation can trigger Hashimoto's disease. In Graves' disease, autoantibodies are formed that stimulate the production of thyroid hormones. There is a hyperthyroidism. Graves' disease occurs through a combination of genetic factors and external influences. If properly predisposed stress or infections can trigger the disease.

Symptoms, complaints & signs

Symptoms of hypothyroidism occur in Hashimoto's and Ord's disease. The patients have a low body temperature and are sensitive to cold. They are tired, unmotivated and impotent. Depressed moods can occur.

Affected describe a change in voice and pressure in the throat. It can cause myxedema, in which extremities and face swell due to water retention. The hair becomes brittle and fall out. Patients with hyperthyroidism are gaining weight fast and fast.

Constipation and nausea may be present. The heartbeat is slowed down. Symptoms of hyperthyroidism may occur in the early stages of Hashimoto's or Ord's thyroiditis. Graves' disease triggers hyperthyroidism. It is characterized by sweating, restlessness, cardiac arrhythmias and tremors.

Those affected suffer from sleep disturbances and sweating. They have [[cravings] attacks and rapid weight loss. The skin feels warm and moist. Afflicted complain of tightness in the throat. In the long term, Graves' disease can lead to the development of osteoporosis. The eyes can be affected. The disease can cause an endocrine orbitopathy that causes the eyeballs to emerge.

Diagnosis & History

The clinical picture gives initial indications of the diagnosis. During the physical examination, among other things, the size and condition of the thyroid is assessed. To record cardiac arrhythmia, an electrocardiogram is made.

The blood test gives information about the type of thyroid disease. First, the metabolic status is determined by the thyroid hormones T3 (triiodothyronine), T4 (L-thyroxine) and the thyroid stimulating hormone TSH. Typical for the Hashimoto and the Ord disease are antibodies against thyroid peroxidase (TPO-AK) and thyroglobulin (Tg-AK).

The presence of Graves' disease is demonstrated by TSH receptor antibody (TRAK). Ultrasound examination of the thyroid gland allows the tissue to be assessed in an orienting manner. Doppler sonography provides information about the blood flow in the organ. In scintigraphy, the activity of the thyroid gland is examined by nuclear medicine.

The findings of these examinations complete the diagnosis of thyroid disease. In case of doubtful findings or the suspicion of the presence of a malignant disease, a fine needle biopsy may be necessary.

complications

There are several types of autoimmune thyroid disease that may be associated with complications. On the one hand, autoimmune disease may be the same as hypothyroidism as in Hashimoto's disease. Without treatment, this can lead early to a heart failure (heart failure).

This can sometimes even mean heart failure, which can lead to the death of the patient. Furthermore, Hashimoto's thyroiditis can lead to increased cholesterol levels. This can lead to calcification of the vessels for many years (atherosclerosis) and at certain points to a shortage of organs with blood.

The worst consequences of atherosclerosis are a heart attack or even a stroke. In addition, the Hashimoto disease leads to a reduction in libido and can also lead to depression. Depression can be associated with increased addictions to alcohol and other drugs, and can lead to suicidal thoughts in the worst cases.

Also, an overactive thyroid as in Graves' disease has various consequences. Here, too, there can be a weakness of the heart, which can lead to immediate cardiac death. In the long term, hyperfunction leads to an increased risk of osteoporosis. A rare and serious complication can be a thyrotoxic crisis. This leads to a metabolic derailment that is characterized by fever, sweating, anxiety and even coma.

When should you go to the doctor?

The suspicion of autoimmune thyroid disease should always be discussed with the family doctor. Medical clarification is necessary at the latest when characteristic symptoms occur. Thus depressive moods, cardiac arrhythmias and inner restlessness point to a serious illness of the immune system.

If these symptoms are accompanied by water retention in the limbs or face, a feeling of pressure in the throat or changes in the voice, the hypothesis of autoimmune thyroid disease is obvious. A specialist in immunology must diagnose the respective disease and initiate treatment immediately. For sleep disorders and mental health problems, therapeutic advice should be sought. It may also be useful to consult a nutritionist.

This and a quick initial diagnosis can treat the autoimmune disease well. If the disease remains untreated, however, further physical complaints may be added. At the latest, if the autoimmune thyroid is expressed by external symptoms such as bulging eyeballs, a moist and warm skin and a rapid weight loss, a doctor must be consulted immediately.

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Treatment & Therapy

A causal treatment or cure of Hashimoto and Ord-Thyreoidtis is not known. The therapy is carried out by balancing the hypothyroidism by the supply of thyroid hormones in the form of tablets. It can be given either only T4 or a combination of T3 and T4.

The right dosage is different for each patient and must be found by careful adaptation and close monitoring. Regular blood and ultrasound examinations ensure long-term therapeutic success. In Basedow's disease, first of all the reduction of the symptoms of hyperthyroidism is in the foreground.

This is done via antithyroid drugs. These drugs slow down thyroid hormone production. The medication is administered under regular laboratory controls until the levels of thyroid hormone have normalized. After a treatment period of twelve to 18 months, it comes in 40 percent of cases to a remission.

After stopping the antithyroid drugs no renewed hyperthyroidism occurs. Now, however, a subfunction may arise. The final therapy of Graves' disease is surgical or radioiodine therapy. The surgery removes all or part of the thyroid gland. Radioiodine therapy uses radioactive iodine to irradiate and inactivate the diseased tissue in the thyroid gland.

Outlook & Forecast

There is no prospect of a cure for autoimmune thyroid disease. With the existing medical and therapeutic options, a significant relief of the symptoms can be achieved. Nevertheless, a relapse takes place immediately after stopping the medication and thus the irregularities are immediately restored.

The severity of the disease is not relevant to the question of the prognosis. In all possible degrees a drug treatment is chosen so that the production of hormones can be better regulated. The dosage is variable and also the frequency of taking the preparations. However, as soon as they are discontinued, a relapse will take place immediately.

The medications improve the well-being of the patient to a considerable extent. He feels healthier, is fitter and has more joie de vivre. The emotional as well as mental problems sink, so that on the whole an improvement of the health takes place.

Coping with everyday life is possible with the remedy almost free of symptoms. Regular blood and check-ups must be performed. In these, the dose is adjusted so that the obtained well-being can be kept as stable as possible. If the treatment is discontinued after a period of several years or reduced on its own, the likelihood of relapse is slightly less than half of the patients.

prevention

Since genetic components contribute to the development of autoimmune thyroid diseases, prevention of the diseases in the strict sense is impossible. By avoiding infections and the strict indication for investigations with contrast agents, possible triggers can be reduced.

aftercare

The aftercare may not pursue the goal of preventing a recurrence of autoimmune thyroid disease. The disease is considered incurable. She accompanies those affected for a lifetime. Instead, regular follow-up examinations aim to improve the daily lives of patients and prevent possible complications. Doctors use the blood and ultrasound, which must be done regularly.

Physicians can adapt the therapy to acute changes. The medical approach is to compensate for hyperthyroidism or hypothyroidism. Patients must regularly take hormone pills. The typical complaints can be alleviated. Patients feel fitter and more efficient.

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

In addition, it is scientifically justified that the trace element selenium supports thyroid function. Suitable supplements are available in the drugstore and drugstore. Affected persons experience a close-meshed network of examinations. Nevertheless, there are hardly any restrictions in professional and private life.

You can do that yourself

Autoimmune thyroidopathy also has very differentiated effects on the individual affected person and the associated everyday life due to different degrees of severity and side effects.

With effects on the sleep duration and the driving force it becomes difficult to be able to accomplish the everyday work. Partly it comes to exhaustion, causing a disability. Whenever possible, patients should discuss with their supervisors and colleagues how disease conditions and work performance can be well-coordinated.

In the case of part-time work, patients should not be shy of openness to supervisors and try to spread the working hours as best they can so that enough rest periods are created. If it is possible, more work can be done in times of few side effects of the illness, so that during periods of respite the recreation takes place.

As a self-help offer on the one hand regular endurance sports and walks, so the own metabolism is stimulated and the body can better respond to the respective effects. As a dietary supplement, especially the intake of the trace element selenium is recommended.

Selenium is known to support thyroid activity without further boosting the autoimmune process. Indispensable is the permanent intake of thyroid medications, which are prescribed by the doctor. In addition, the intake of iodine should be reduced, since this will only further the autoimmune process.


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