Hashimoto’s disease, also known as chronic lymphocytic thyroiditis, is a group of endocrine disorders that slow down the metabolic function of the whole body due to necrosis of a part or all of the thyroid follicles caused by low immunity of the thyroid gland and lymphocytes taking advantage of the situation.
Hashimoto’s disease should be alerted to the presence of the following symptoms.
(1) When a diffuse swelling of the thyroid gland is present, it indicates that the disease has been in progress for an average of 2 to 4 years.
(2) Common symptoms are generalized weakness, many patients do not have throat discomfort, and 10% to 20% of patients have localized pressure or vague pain in the thyroid area with occasional light pressure pain.
(3) The thyroid gland is mostly bilaterally symmetrical and diffusely enlarged, with the isthmus and conus lobe often enlarged at the same time, or unilaterally enlarged. The thyroid gland tends to increase in size gradually as the disease progresses, but rarely compresses the neck and causes difficulty in breathing and swallowing. On palpation, the thyroid gland is firm, with a smooth or fine sandy surface, or nodules of varying size, usually without adhesions to surrounding tissues, and can move up and down during swallowing movements.
(4) The cervical lymph nodes are usually not enlarged, but in a few cases they may also be accompanied by enlarged cervical lymph nodes, but they are soft in texture.
Diagnosis of Hashimoto’s disease.
The diagnosis of Hashimoto’s disease is relatively easy and is based mainly on higher than normal values of antithyroid microsomal antibodies (TMAb), antithyroglobulin antibodies (TGAb) and fine needle aspiration of the thyroid gland (FNAC), and ultrasound of the thyroid gland showing chronic enlargement of the thyroid rice bilaterally
Risk of Hashimoto’s disease in women of childbearing age.
The risk of Hashimoto’s disease in women of childbearing age Hashimoto’s disease is mostly seen in young women and causes women of childbearing age to be less likely to conceive, while clinically, multiple biochemical pregnancies in women of childbearing age are eventually found to be caused by the disease.
Thyroid cancer.
Thyroid cancer is generally divided into four pathological types: papillary carcinoma, follicular carcinoma, medullary carcinoma and undifferentiated carcinoma. Different pathological types have different clinical manifestations. The first choice of treatment for thyroid cancer should be surgery. However, the extent of thyroidectomy for differentiated thyroid cancer has long been the focus of surgical debate because of the high recurrence rate (median 35%) after surgery. The treatment options are subtotal thyroidectomy and total thyroidectomy. The main postoperative complications include temporary hypoparathyroidism and permanent hoarseness and neck hematoma.
Hashimoto’s and thyroid cancer.
The incidence of Hashimoto’s disease combined with thyroid cancer, especially papillary thyroid cancer, has been on the rise in recent years. Hashimoto’s disease may be one of the high-risk factors for the development of thyroid cancer. There is no treatment for autoimmune thyroiditis that addresses the cause of the disease. Restriction of iodine intake may help to slow the progression of autoimmune destruction of the thyroid gland. Patients with pre-existing hypothyroidism or significant subclinical hypothyroidism must be treated with thyroid hormone replacement therapy.
Principles of treatment for Hashimoto’s disease.
1.Medication
(1) If the thyroid function is normal, no special treatment is needed, but follow-up is required, and ultrasound and thyroid function are reviewed half-yearly. Chinese herbal treatment is more effective in improving the patient’s discomfort.
(2) Patients with hypothyroidism should undergo thyroid hormone replacement therapy, choosing thyroid tablets or levothyroxine until the maintenance dose is reached. Indicators for reaching maintenance dose are improvement of clinical symptoms and normal TT3, FT3, TT4, FT4 and TSH.
(3) Early Hashimoto’s disease will present with mild hyperthyroid symptoms, most of which do not require treatment. It goes through four periods: hyperthyroidism, normal thyroid function, hypothyroidism and normal thyroid function. Transient hyperthyroidism can be treated symptomatically with beta-blockers.
(4) Hormone therapy. This disease is generally not treated with hormones. For some patients with painful chronic thyroiditis, when the thyroid gland is painful and swollen, prednisone can be added. Gradually reduce the dosage after improvement, and use the drug for 1 to 2 months.
(5) Selenium is an essential trace element in the body and is an antioxidant. It has important physiological functions such as anti-aging, anti-tumor, cardiovascular protection and antagonism to heavy metal toxicity. Selenium can improve the immune function of human body. Selenium intervention therapy can reduce or inhibit the immune damage of autoimmune thyroiditis. In addition life should develop good habits, reasonable diet, regular work and rest, appropriate relief of mental stress.
2.Surgical treatment
There are only two indications for surgery: (1) local compression symptoms affecting breathing; (2) concurrent thyroid cancer.
In other cases, don’t choose surgery easily. After surgery, most patients have low thyroid function and need to take medication for life.