Autoimmune thyroiditis (AIT) is the most common organ-specific thyroid disease [1]. The pathology develops under the influence of complex genetic, environmental, and epigenetic factors [1]. The underlying process involves the destruction of thyroid cells by lymphocytes and the production of specific antibodies, such as antibodies to thyroid peroxidase and thyroglobulin [1]. Over time, this can lead to subclinical or overt hypothyroidism [1].
Main Causes and Mechanisms of Development
The development of autoimmune thyroid damage is associated with immune system dysfunction, where the body begins to perceive its own tissues as foreign. As a result of a chronic inflammatory process, gradual damage to the follicular epithelium occurs [8]. Pathogenesis includes the activation of complex chemokine-receptor networks and the infiltration of the organ by immune cells [1, 8]. Although traditional therapy is aimed primarily at replenishing hormone deficiencies, new therapeutic strategies capable of influencing immune mechanisms are actively being studied [1, 8].
Characteristic Symptoms of Autoimmune Thyroiditis
The clinical picture of AIT is extremely diverse. In the early stages or during fluctuations in thyroid function, both signs of hormone deficiency and rare systemic manifestations may be observed. In addition to classic fatigue, weight gain, and feeling cold, the disease sometimes mimics other pathologies:
- Recurrent non-specific gastrointestinal symptoms or chronic fatigue under stress [2].
- Allergy-like reactions, including angioedema without urticaria or chronic idiopathic urticaria [3, 4].
- Rare neurological disorders, headaches, and cognitive impairment [5].
- Spontaneous hypoglycemia associated with rare autoimmune syndromes [6].
Autoimmune Thyroiditis and Reproductive Health
AIT is of particular importance for women of reproductive age, as this disease is often associated with fertility problems and reduces the effectiveness of assisted reproductive technologies (ART) [7]. Subclinical hypothyroidism frequently accompanies autoimmune thyroid diseases [7]. The issues of TSH thresholds for initiating hormone replacement therapy in women planning pregnancy remain a subject of discussion, but timely diagnosis and correction play a key role in improving reproductive outcomes [7].
Diagnosis and Treatment of Pathology
Diagnosis includes determining the levels of thyroid hormones, TSH, and antibody titers to thyroid tissue. Since manifestations can be non-specific (for example, latent adrenal insufficiency or encephalopathy), a comprehensive examination is required with the exclusion of other causes [2, 5]. The baseline treatment for the development of hypothyroidism remains lifelong or maintenance therapy with levothyroxine, which in some cases makes it successfully possible to relieve even atypical manifestations of the disease, such as severe skin edema [3].
Sources
- 1. Autoimmunity, New Potential Biomarkers and the Thyroid Gland-The Perspective of Hashimoto's Thyroiditis and Its Treatment. PubMed
- 2. Comorbid Latent Adrenal Insufficiency with Autoimmune Thyroid Disease. PubMed
- 3. Pediatric angioedema without urticaria: A rare presentation of autoimmune thyroid disease with complete remission on levothyroxine therapy. PubMed
- 4. Urticaria and thyroid autoimmunity. PubMed
- 5. Encephalopathy Associated with Autoimmune Thyroid Disease: A Potentially Reversible Condition. PubMed
- 6. Insulin Autoimmune Syndrome Associated With Hashimoto Thyroiditis and Nodular Thyroid Disease. PubMed
- 7. Autoimmune thyroid disease in infertility and assisted reproductive technology: A review. PubMed
- 8. Artemisinin-Related Therapeutic Strategies for Autoimmune Thyroiditis. PubMed
Disclaimer: The information presented in the article is for informational purposes only and does not replace an in-person consultation with an endocrinologist.