For many years, endocrine diseases have been characteristic of mature and elderly people. Over the past 10 years, the situation has changed dramatically, and pathology of the endocrine system has become common among children and adolescents.
That is why young people of military age have questions about whether they are recruited into the ranks of the armed forces with similar diseases? Conscripts’ doubts are explained by the fact that functional disorders of the thyroid gland negatively affect work internal organs and systems.
Signs of endocrine disorders
Before drawing conclusions about the suitability of such patients for the army, it is necessary to understand in detail the clinical picture of the pathology of the endocrine gland. The clinical picture is aggravated by the fact that the symptoms of diseases can be disguised as general fatigue. This is fraught with incorrect diagnosis and late recognition of endocrine disorders. Of course, during the examination, specialists discover the causes of the ailment, but at the same time, the young man himself must be more attentive to his health and notice changes in his general condition.
In the human body, the thyroid gland is responsible for the production of hormones that regulate calcium and phosphorus metabolism. In addition, the endocrine organ regulates tissue growth, general metabolism and has an indirect effect on the cardiac and nervous system.
Causes
The main reasons that can disrupt the function of the thyroid gland include:
- negative environmental impact;
- gross dietary violations;
- iodine deficiency;
- genetic predisposition;
- vascular pathology.
At the first manifestations of endocrine disorders, brain structures are affected as they are the most sensitive to hormonal effects from the thyroid gland.
In the case of a family history of endocrine diseases, other causative factors only increase the risk of developing the disease. In addition, emotional stress and systematic use of medications aggravate the situation, side effects which is negative impact on the endocrine system.
You should know that functional failures can be expressed in both excessive and insufficient production of hormones. Over time, the glandular organ loses its ability to maintain normal hormonal levels. Therefore, the disease naturally becomes chronic.
Do they take it with goiter?
Depending on the course of the disease, significant weight gain, emotional disturbances, behavioral changes, increased bone fragility, and heart rhythm disturbances may occur.
All thyroid diseases are divided into the following main groups:
The first group includes pathological conditions with reduced function of the glandular organ, namely:
- endemic goiter;
- diffuse toxic goiter;
- thyroiditis.
The cause of such diseases is considered to be insufficient intake of iodine from food, inflammatory or autoimmune processes in the gland.
The second group is represented by diseases characterized by hyperfunction of the thyroid gland. The causes of such conditions are tumor processes, excessive stimulation of hormonal secretion, or defects in the production of hormones.
Symptoms of endocrine disorders vary. Already on early stages development of the disease is noted increased sweating, slight tremor of the upper extremities, rapid heartbeat, moderate increase in the size of the gland and increased neuropsychic excitability.
In the later stages of development of the pathological condition, an increase in body weight, heart rhythm disturbances, increased fragility of bone structures and exophthalmos are detected. In this case, the glandular organ significantly increases in size and changes the contours of the neck, which can be seen with the naked eye.
In patients with similar endocrine pathology, disorders of other internal organs and systems are observed: myoplegia, diabetes mellitus and cardiomyopathies leading to heart failure. Men often develop impotence. Women have problems menstrual cycle and miscarriage.
Determination of suitability category
If a young man is diagnosed with thyroiditis of autoimmune origin, then the issue of his suitability for the army is decided on an individual basis. Most often, young people with similar diagnoses are enlisted in the reserve.
Of course, everything depends on the severity of functional disorders of the endocrine organ. We are talking about acute, subacute and chronic forms of the disease. For the conscription context it is of particular significance chronic form pathology. Therefore, suitability for the army is determined by the severity functional disorders thyroid gland.
When determining the functional deficiency of the gland, hormonal drugs are prescribed as replacement therapy. A young man with such a pathology is not suitable for military service and is added to the reserve. If the gland functions normally and the body does not need hormonal drugs, That young man recognized as suitable for the army.
Postponement
If a conscript develops an acute form of thyroiditis of an infectious or autoimmune nature, then he. Unfortunately, some patients are in no hurry to visit a doctor and begin treatment, which is considered unacceptable. In addition, the infectious version of thyroiditis can cause total damage to the gland, septic condition and death.
Upon examination, the draft commission gives the conscript a 12-month grace period to receive adequate treatment. If you intend to receive an exemption from military service in accordance with Article 13 of the List of Diseases, it is not recommended to provoke complications. If effective therapy does not produce a positive result, then the next meeting of the draft commission may end with the conscript being assigned a “B” or “D” category.
Enrollment in the reserve
Prospects of a different kind await a guy with a documented subacute or chronic form of thyroiditis. These forms of the disease are the most dangerous and are characterized by frequent relapses. The outcome of the disease directly depends on the severity of functional disorders. That is why, in the List of Diseases, such pathological conditions serve as a reason for enrollment in the reserve. If a young man with a similar diagnosis ends up in the army, then the medical unit is unlikely to have the necessary medications to stop the exacerbation. Therefore, the medical commission does not look for compromise solutions, but makes the only correct verdict.
If autoimmune thyroiditis
Autoimmune thyroiditis is practically untreatable. With the help of therapeutic measures it is only possible to change the severity of clinical manifestations. The patient will have to take it throughout his life medications to stimulate the thyroid gland. Taking into account the fact that the disease progresses slowly, the young man is assigned a category for health reasons. So with this category, with thyroiditis of an autoimmune nature, a citizen cannot be recruited to serve in the army even in extreme cases. Most often, the conscript is removed from military registration and appoint.
In other situations, specialists classify functional disorders of the thyroid gland as endocrine disorders, and the conscript is examined in accordance with Article 12 of the List of Diseases and assigned category “B”. If minor disorders of the thyroid gland are detected, a delay for treatment is provided. It is a mandatory requirement for all patients to provide the military registration and enlistment office with documents confirming the appropriate diagnosis and the fact of the therapy performed. In the absence of appeals to specialists, it is much more difficult to obtain a non-conscription category.
If the first signs of endocrine pathology appear, you must consult a doctor to undergo the necessary examination. This will make it possible to recognize the disease at an early stage of development and prepare medical documentation for the military commissariat.
Help for conscripts
In controversial situations, it is necessary to exercise the right to additional examination or deferment for effective treatment. Then you have to go through. Based on the data obtained, there may be talk of release from military service and enlistment in the reserves.
If earlier diseases Although older people were susceptible to thyroid disease, now the pathology is increasingly observed among young people. Therefore it becomes topical issue: “What awaits conscripts diagnosed with subacute or chronic autoimmune thyroiditis: army or deferment”?
Deferment from the army for thyroiditis
Thyroiditis is inflammation of the thyroid gland. Most often, this disease is exempt from conscription, but military registration and enlistment offices are in no hurry to establish a non-conscription category: first, the conscript must receive a deferment from the army.
The period for which the deferment is granted does not exceed one year. More often this period is limited to 6 months. At this time, the young man continues to be observed by an endocrinologist and either takes medications or undergoes surgical treatment. After the end of the deferment, the conscript must again undergo a medical examination and additional examination.
Expert opinion
Conscripts who want to get a military ID due to their health either do not know whether it is possible not to serve with their illness, or do not understand how to be exempt from conscription due to their diagnosis. Real stories conscripts who received a military ID, read in the "" section
Ekaterina Mikheeva, head of the legal department of the Assistance Service for Conscripts
Chronic autoimmune thyroiditis: is it accepted for military service?
People diagnosed with “autoimmune thyroiditis” are not accepted into the army only if additional examination confirms that the conscript has an increased level of the hormone TSH (more than 4 mIU/l) and an increased concentration of AT-TPO antibodies. If the level of hormones decreases, the conscript may be sent to serve.
I already mentioned above that conscripts with thyroiditis are first given a deferment and only after its completion are released from conscription. During the deferment, young people undergo treatment and take medications prescribed by the endocrinologist, so by the time they next report to the military registration and enlistment office, their hormone levels can return to normal. If hormonal background normalizes, then the doctor will not confirm the diagnosis during a second additional examination, so the conscript may be sent to the army.
If, based on the results of treatment (or in case of refusal of it), the level of TSH and AT-TPO remains unchanged and the endocrinologist re-confirms the non-conscription diagnosis, then the conscript will be released from the army.
The fitness category for thyroiditis is set in accordance with. According to point “c”, the subacute form of the disease with the appearance of relapses corresponds to the non-recruiting category “B”. In case of significant disruption of the endocrine gland, the conscript will be released from service with fitness category “D”.
Advice from the Recruit Help Service:
Please note that only the military registration and enlistment office decides whether a person with thyroid disease is accepted into the army. To exercise the right to exemption, you must present to the doctor medical documents confirming the diagnosis and request for medical help. It is extremely difficult to obtain category “B” without a medical history.
With respect to you, Anna Nikolaeva, lawyer of the Assistance Service for Conscripts.
Diseases associated with disruption of the endocrine system have traditionally been considered rare, and were typical for older people. Today, everything has changed dramatically, including the age threshold. Therefore, more and more often, young men of conscription age are forming some doubts about whether they are allowed to serve in the army with a similar diagnosis, because problems with the thyroid gland directly negatively affect their overall well-being?
Signs of endocrine system disorders
Before we begin to consider the patient’s direct relationship to military service, it is necessary to become more familiar with the clinical picture of thyroid disease. The picture is complicated by the fact that the symptoms of the disease can be perceived as a sign of general malaise, and this can lead to an incorrect diagnosis. Naturally, professional doctors will get to the bottom of the truth, but the young man, first of all, must understand the nature of his health problems.
The thyroid gland is considered the most mysterious component of our body. Not everyone knows that it produces hormones that affect the growth of all tissues, carry out metabolism, and control the supply of calcium to the body.
Thyroid dysfunction may be caused by:
- bad ecology;
- poor nutrition;
- lack of iodine.
At the first signs of the disease, the brain, in particular the pituitary gland, is affected; it is directly dependent on the condition of the thyroid gland.
A person may be genetically predisposed to such diseases, but these factors only increase the likelihood of disorders. In addition, this should include emotional stress, as well as side effect some medications. It is important to understand that a malfunction can be manifested by both an excess and a lack of hormones produced. Gradually, over time, the gland becomes unable to regulate the normal background, and the disease becomes chronic.
An accelerated metabolic process caused by increased levels of thyroid hormones causes general weakness, increased heart rate, irritability, blues. A lack of these hormones leads to weight gain, dry skin, swelling, and increased blood pressure.
Quite often, any dysfunction of the thyroid gland can be visually assessed by changes in its size. It increases or decreases, depending on the nature of the disease. An enlarged thyroid gland is called a goiter, which directly indicates a lack of iodine in the body. It is characterized by a feeling of tightness in the neck, due to which the patient experiences some discomfort when swallowing or throwing back the head.
The increased attention of doctors to the condition of the thyroid gland is explained by the fact that often enlarged lymph nodes become a sign of the development of cancer. Common autoimmune diseases are toxic goiter and autoimmune thyroiditis. They cause an increase in leukocytes in the blood, which has a destructive effect on tissue, and also cause disruptions in the regulatory functioning of the thyroid gland.
Autoimmune thyroiditis is characterized by changes in voice, memory impairment, changes in facial features, and shortness of breath. But at the initial stage of development of the disease, symptoms do not appear in any way, so a person gets to an endocrinologist already in neglected state. Doctors recommend getting an annual thyroid exam as a proactive measure.
How to determine the suitability category
If a young man is diagnosed with autoimmune thyroiditis, then it is too early to talk about the appropriate category of fitness, since the question is whether they will be accepted into the army with such a disease? – will be decided on a personal basis. Let us immediately note that the statistics provide results that make it clear that most guys are released from the army. But everything depends on the accompanying functional changes that have occurred in the thyroid gland. The disease itself can occur in acute, subacute or chronic form.
In general, the acute form of thyroiditis develops against the background infectious disease. It is believed that in the most severe cases, ulcers form, localized over the entire surface of the gland. Milder forms are represented by damage to individual areas. External symptoms that make it possible to recognize the disease manifest themselves as impaired swallowing ability, a feeling of constriction, which leads to difficulty breathing. Speech becomes unintelligible, and its timbre noticeably decreases. Gradually, the picture is filled with pain in the neck, increased temperature and increased heart rate.
Since acute thyroiditis will not exempt you from military service, and after treatment the young man will be drafted into the army, some guys tend to deliberately delay seeing a doctor, hoping to complicate the clinical picture. Such a game with health can end in death. Only with timely treatment can the disease be completely defeated, but if you ignore medical intervention for a while, the resulting abscesses can burst and blood poisoning can occur. The infection reaches the brain. Of course, death is not guaranteed, but it is still possible.
During the examination, the draft commission makes a decision according to which the young man is given a one-year deferment for effective treatment. As we have already noted, the time provided must be used effectively. If you intend to receive exemption from the army under Article 13 of the Schedule of Illnesses, then you should not deliberately provoke complications. The fact is that if there is no positive result of treatment at the re-meeting, the commission will most likely decide to assign category “B” or “D”.
A completely different perspective is provided to a conscript diagnosed with the disease “subacute thyroiditis” or “chronic thyroiditis”. In the presented stages, the disease is considered the most dangerous, and the experts of the military commission are well aware of this. For consolation, we note that a favorable outcome is quite possible, but relapses cannot be ruled out. Therefore, in the Schedule, these cases assume exemption from the army. If a young man had to be recruited into service with such a uniform, then the medical unit will not have the necessary means to stop the aggravation, therefore, on the issue of conscription, the commission does not seek a compromise, but unconditionally makes an appropriate decision.
Autoimmune thyroiditis is almost impossible to cure. You can only influence the nature of its manifestation. Thus, the patient is forced to take certain medications throughout his life that stimulate the functions of the thyroid gland.
Considering that this disease is gradually progressing, there is no doubt that the examination will occur. Note that if in the case of chronic or subacute thyroiditis category “B” is assigned, then autoimmune thyroiditis will not allow the citizen to be involved even in extreme cases. This leads to the guy being removed from the military register and assigned category “D”.
In other cases of disruption of the thyroid gland, experts are guided by the rule that without disturbances in the functioning of the endocrine system, the conscript is examined under Article 12 of the Schedule and will receive category “B”, and the presence of at least minor functional disturbances will be a reason for granting, at a minimum, a deferment.
And finally, the last requirement, which is considered universal, is that the young man is obliged to provide the military registration and enlistment office with all the necessary documents proving not only the diagnosis, but also the treatment. If you have not sought help from a doctor, the algorithm for obtaining a non-conscription category will become much more complicated. It will be necessary to seek the right to conduct additional examination, then use the deferment for treatment. After this, you will have to undergo another examination, and only then can we talk about exemption from military service.
What is hypothyroidism, what types of it exist, and in the presence of what accompanying symptoms can a conscript be diagnosed with this, and is a young man subject to receiving a military ID when diagnosed with this disease?
Hypothyroidism is a syndrome that is caused by a long-term decrease in the level of the hormones triiodothyronine (T3) and thyroxine (T4) in the human blood. A decrease in the level of these hormones affects the functioning of the entire body and leads to metabolic disorders.
Disorders of the thyroid gland may be caused by unbalanced diet, lack of iodine in the body or poor environmental situation.
In the subclinical stage of hypothyroidism, the disease is asymptomatic, without a pronounced clinical picture, while the patient can active image life. However, during the latent stage of the disease, the anomaly often causes disruptions in metabolic processes and can cause the development of various complications.
Can someone with hypothyroidism be drafted into the army?
In accordance with Article 13 of the Schedule of Diseases Russian Federation, regardless of the stage or form of the disease, as well as the pronounced effectiveness of treatment, the recruitment of a young man with hormonal imbalance is unacceptable.
Category “c” is assigned if a person liable for military service is diagnosed with manifest hypothyroidism (including drug-compensated), in which there is a reduced level of T4 hormones and an increase in the level of TSH in the blood. Also, with subclinical hypothyroidism, there is an increase in the production of pituitary hormone with completely normal level thyroxine.
A person may have a predisposition to the disease at the genetic level, and unfavorable concomitant factors may aggravate the likelihood of developing the disease. Psycho-emotional stress and side effects of certain types of medications can also be included here.
Hypothyroidism indicates a functional insufficiency of the thyroid gland due to the destruction of its constituent glandular cells, the disease is an autoimmune type of disease and is chronic.
Under military conditions, a young man diagnosed with hypothyroidism will not be able to take medications in a timely manner, and he will also constantly need to monitor hormone levels to adjust the dose of medications taken in order to avoid worsening the disease and the onset of negative consequences.
When is public debt released?
What are the health requirements for young men subject to conscription? When determining the fitness category of a conscript, members of the military medical commission are guided by the Schedule of Diseases of the Russian Federation - a document defining the list of diseases in which those liable for military service may be declared unfit for military service.
It is important to understand that dysfunction of the gland can be manifested by both an excess and a lack of hormones produced. Over time, the thyroid gland stops working normally and the disease becomes chronic, in which the conscript will need constant monitoring by an endocrinologist.
If the disease is confirmed, then after a meeting of the medical commission, the young man is subject to receiving a military ID. A conscript will be able to be drafted into the army only if the endocrinologist cancels the diagnosis.
If the disease is diagnosed as autoimmune thyroiditis, the young man is removed from the military register and assigned category “D”.
When is a deferment granted?
Upon completion of the examination of the conscript, the doctor responsible for this procedure is obliged to fill out an examination report to provide a report to the members of the expert military commission.
Hypothalamic syndrome serves as the basis for the release of a young man from conscription, as it indicates the presence of deviations in the functioning of the endocrine system.
According to the Schedule of Diseases, item “c” includes:
- Mild reversible forms of diffuse toxic goiter (in this case, mild neurosis-like symptoms are noted, there is also a decrease in tolerance to active physical activity, a pulse rate of up to 100 beats per minute is determined, and a slight enlargement of the thyroid gland of degrees I - II is observed).
Examination of those liable for military service during initial military registration and conscription for military service is carried out only after undergoing a full medical examination and treatment in a hospital setting.
Confirmation of the disease by medical examination. commissions
If the conscript does not agree with the decision of the commission, you can appeal the examination report to a higher commission or court, and obtain a re-examination report from medical institution to attach documents to the case of a person liable for military service with the submission of an appropriate application.
To confirm the presence of an existing disease, a conscript must undergo a number of additional examinations in accordance with a referral received from the military commissariat, and to confirm the diagnosis it will be necessary not only to convince the therapist and other members of the medical commission of the presence existing problems with health, and provide copies of medical documents.
Additional examination may include an ultrasound examination of the thyroid gland, and, if necessary, a puncture biopsy of its tissue. Laboratory values will also be required. biochemical analysis blood to determine hormone levels and detect the presence of antibodies to peroxidase.
Problems with the thyroid gland have a negative impact on overall health, so conscripts who have had problems with the thyroid gland in the past are recommended to undergo regular annual examinations as a preventive measure.
According to statistics, in the vast majority of cases Those liable for military service with a similar diagnosis are exempt from military service.
When examining a conscript, the expert commission makes a decision according to which the young man is given a one-year deferment from service for treatment.
The exact cause of the development of this disease is not fully known. Autoimmune thyroiditis, like any autoimmune disease, is based on genetic pathology, namely on the part of HLA (human leukocyte antigens). This genetic predisposition determines a higher risk of developing this disease with impaired immune response of T-lymphocytes, which interact with initiating and inducing factors (exposures external environment, infections (bacterial and viral), anthropogenic pollutants, etc.).
There is a family history of autoimmune thyroiditis in 25–30% of cases. Asymptomatic carriage of antibodies (Abs) to thyroid peroxidase and thyroglobulin is recorded in 56% of siblings and, according to at least, from one of the parents.
In other words, the role of a provoking element is any damage to the thyroid gland, which leads to the entry of thyroid antigens (Ag) into the blood. As a result, in a genetically predisposed person, the immune system perceives these Ags as foreign and begins to attack the thyroid gland (by forming antibodies to various components of the thyroid gland). This leads to replacement connective tissue damaged glandular parenchyma. As a result, insufficient function of the gland itself is formed (hypothyroidism).
The occurrence of the disease is associated with the survival of “forbidden” clones of T-lymphocytes and the synthesis of antibodies to thyroid receptors.
There may be a combination of AIT with other autoimmune pathology, such as:
- diffuse toxic goiter (DTZ);
- myasthenia gravis;
- infiltrative (autoimmune) ophthalmopathy;
- Shagren's syndrome;
- alopecia;
- vitiligo;
- lymphoid cell hypophysitis;
- collagenoses.
Clinical manifestations
AIT has no specific symptoms, and individual manifestations are multifaceted. In most cases, this disease is characterized by asymptomatic/subclinical variants.
There are hypertrophic (nodular, goiter) and atrophic forms of autoimmune thyroiditis. Hypertrophic AIT occurs in 65–80% of cases and is manifested by a progressive increase in size and a slow increase in insufficient thyroid function. The main complaints of patients are associated with an increase in the size of the gland itself. In other cases, atrophic AIT is recorded in patients and is characterized by a decrease in the size of the thyroid gland up to atrophy. Often this form occurs under the guise of nodular goiter with the slow development of hypothyroidism.
Quite often in older age groups there is a combination of AIT and nodular pathology of the thyroid gland itself - both benign (cyst, adenoma, nodular colloid goiter, cystadenoma) and malignant (lymphoma, follicular, papillary, atypical forms of cancer, etc.).
Quite common complaints among women include discomfort, a “hoop feeling,” a feeling of “pressure” in the area of the front surface of the neck, which intensifies during night sleep. There is no connection between the size of the thyroid gland and the severity of symptoms of the disease.
Depending on the functional state of the thyroid gland, patient complaints may reflect symptoms of hyperthyroidism/thyrotoxicosis or subclinical/manifest clinical hypothyroidism.
Hypothyroidism develops gradually; most patients at the time of contacting an endocrinologist are in a state of euthyroidism (thyroid function is not impaired) or subclinical hypothyroidism. In 10% of patients, a short phase of hyperthyroidism (hasitoxicosis) is observed at the onset of the disease, which is associated with the destruction of follicular epithelial cells (destructive thyrotoxicosis). Subsequently, hypothyroidism develops as a result of replacement of the thyroid parenchyma with connective tissue.
Diagnostics
When diagnosing autoimmune thyroiditis, the following data are taken into account:
- family history (presence of AIT or other autoimmune pathologies in relatives);
- objective examination (symptoms of hypothyroidism, dense consistency of the thyroid gland when palpated);
- laboratory tests (hypothyroidism, antibodies to TPO);
- instrumental studies (ultrasound, scintigraphy).
When diagnosing the disease, it is important to evaluate the combination with other autoimmune pathologies.
Diagnostic criteria for AIT have been proposed. The disease is diagnosed only when a combination of 3 signs is detected:
- detection of diagnostic levels of antithyroid Abs (the most informative determination of the levels of Abs to TPO);
- the presence of a specific ultrasound picture (hypoechogenicity of the thyroid tissue);
- confirmation of the presence of primary hypothyroidism by the level of thyroid-stimulating hormone (TSH).
The presence of 2 of the 3 listed signs allows you to verify a probabilistic diagnosis in the absence of hypothyroidism. The combination of any of the listed symptoms with hypothyroidism allows us to make a diagnosis of autoimmune thyroiditis.
A functional decrease in the thyroid gland in children and adolescents with AIT is not a mandatory symptom of the disease and cannot serve as its main diagnostic criterion. Although it should be regarded as a result of AIT in the presence of acquired primary hypothyroidism at this age.
Signs of AIT on ultrasound are the detection of an increase in the size of the isthmus and both lobes, a diffuse or variegated decrease in the echogenicity of the thyroid tissue. The sensitivity of this technique reaches about 85%.
Fine-needle aspiration biopsy of the thyroid gland is used not to verify the diagnosis of AIT, but to exclude the combination of AIT with nodular pathology of the thyroid gland.
Carrying out thyroid scintigraphy is not advisable. The presence of hypothyroidism and destructive thyrotoxicosis is characterized by the absence of uptake of the radiopharmacological drug by the thyroid gland - the “silent gland”.
Carriage of antibodies to TPO with preserved thyroid function predetermines a significant increase in the risk of developing hypothyroidism.
Treatment and prognosis
It is impossible to cure autoimmune thyroiditis. Specific treatment that can effectively influence the autoimmune component of the disease and prevent the development of hypothyroidism has not been developed. Immunosuppressive therapy is not indicated because the harm outweighs the benefit of this treatment.
Surgical treatment involving complete removal or subtotal resection of the thyroid gland is performed only in the presence of compression syndrome (squeezing respiratory tract). If hypothyroidism has developed, thyroid hormone replacement therapy is started.
The prognosis in the presence of this disease and compliance with lifelong replacement therapy is relatively favorable. You should know that autoimmune thyroiditis itself does not threaten human life.
A timely diagnosis of AIT is necessary due to the development of hypothyroidism and the associated risks of reproductive health disorders (failure to carry a pregnancy to term, decreased fertility) and the risks of maternal hypothyroidism for the development of nervous system fetus and the child's future intelligence.
It is possible to become pregnant after AIT, but to do this, thyroid hormones must be monitored and maintained at normal levels.
Causes and treatment of chronic thyroiditis of the thyroid gland
What is chronic thyroiditis? This is the name of a number of diseases associated with chronic inflammation of the thyroid gland. Among them are:
- autoimmune thyroiditis (AIT), also called lymphocytic or Hashimoto's thyroiditis;
- De Quervain's thyroiditis, or granulomatous;
- rare forms, which include fibrous thyroiditis.
Note. If not diagnosed in a timely manner, these diseases lead to a permanent or temporary decrease in the production of hormones necessary for the normal functioning of the body, and therefore affect the quality of human life.
The disease was first described in 1912, when the surgeon Hashimoto observed an enlarged gland due to the infiltration of its tissue by lymphocytes, cells of the immune system. This is where other names for her autoimmune pathology came from.
Causes and mechanism of development
The main factor in the development of the disease is a “breakdown” in immune system, which leads to aggression of lymphocytes against thyroid cells.
Note. Often chronic AIT is combined with other autoimmune diseases, for example, type I diabetes mellitus, rheumatoid arthritis and others.
Damage to gland cells, thyrocytes, gradually leads to hypothyroidism, that is, to a significant decrease in hormone synthesis and the development of corresponding clinical symptoms.
- Phase 1 is called euthyroid because there are no clinical and laboratory signs of AIT. However, lymphocytes are already infiltrating the gland tissue. This stage can last for years or even decades.
- Phase 2 represents subclinical hypothyroidism, that is, changes in hormone levels begin to appear. Characteristic is an increase in TSH, which is needed to stimulate the production of T4, due to which the T4 hormone remains at normal levels. The duration can also be on the order of tens of years.
- Phase 3 is characterized by clinically obvious hypothyroidism. Since the number of affected non-working cells increases, there is no one left to answer the TSH request. In a blood test, this will be manifested by an increase in TSH and a decrease in T4.
Symptoms
In the first and second phases, the disease often does not manifest itself in any way, because the body uses compensation mechanisms. However, as the pathology progresses and overt hypothyroidism develops, clinical manifestations also arise. These include:
- appearance:
- general swelling of the face;
- puffiness;
- weakly expressed facial expressions;
- aloof look;
- hair loss;
- slow speech with a swollen tongue;
- dry skin;
- nervous system:
- depression and depression;
- deterioration of memory, attention and intelligence;
- metabolic disorder:
- development of obesity;
- sometimes hypothermia and chilliness are determined;
- significant increase in cholesterol levels;
- circulatory system:
- decreased heart rate;
- pericardial effusion;
- digestive system:
- constipation;
- anemia;
- menstrual cycle disorders in women;
- abortion.
The manifestations of AIT are very diverse and affect the entire body, but most of them undergo reverse development during replacement therapy, that is, when taking hormonal drugs.
AIT and pregnancy
If a woman has been diagnosed with AIT before pregnancy, then there is a possibility of developing thyroid hormone deficiency. This is due to the fact that during this important period, an adequately functioning mother’s gland is necessary for the proper development of the baby.
Advice. Chronic thyroiditis and pregnancy are quite common, so timely consultation with an endocrinologist and the prescription of hormone replacement therapy will lead to normalization of the condition.
Identification of the disease
Diagnosis of AIT in the phase of latent and overt hypothyroidism is not difficult:
- determination of the level of antibodies to thyroid peroxidase (AT-TPO);
- determination of TSH and T4, which were mentioned earlier;
- carrying out ultrasound examination.
The main difficulty is to timely prescribe these studies to a patient with atypical manifestations.
Treatment
There is no specific treatment for AIT, and if hypothyroidism develops, replacement therapy with Levothyroxine is recommended, the specifics of its administration will be explained by an endocrinologist.
De Quervain's thyroiditis
A characteristic feature of this pathology, in addition to inflammation, is severe pain in the thyroid gland and destruction of the tissue of the latter.
Causes of the disease and its development
Due to the fact that the disease often occurs after diseases of the upper respiratory tract, such as influenza, measles, the cause of de Quervain's disease is considered to be a virus.
The structure of the thyroid gland consists of many follicles - vesicles with a viscous liquid - the wall of which is formed by a thyrocyte. The virus destroys these cells and the contents of the follicles enter the blood, resulting in the development of thyrotoxicosis.
Note. After treatment, there is a temporary decrease in hormone levels - hypothyroidism - and restoration of thyroid function.
Manifestations of the disease
There are several typical symptoms of de Quervain's disease:
- sudden pain in the projection of the thyroid gland, aggravated by swallowing and neck movement;
- signs of intoxication:
- temperature increase;
- pain in muscles, joints;
- general malaise;
- signs of thyrotoxicosis:
- weight loss;
- tachycardia;
- excitability, irritability;
- increased sweating;
Sometimes De Quervain's thyroiditis may present only with neck pain and mild to moderate thyrotoxicosis.
Detection and treatment of the disease
An important diagnostic criterion for the onset of the disease, before signs of increased hormones, is a significant increase in the erythrocyte sedimentation rate, ESR, up to 50-60 mm/hour.
Ultrasound examination and the Crail test are of great importance in diagnosis. The latter is considered positive when the pain decreases significantly or disappears completely after taking prednisolone. The test is sensitive almost only to de Quervain's thyroiditis.
In mild cases, treatment may not be required, only the prescription of non-steroidal anti-inflammatory drugs. In case of severe pain, prednisolone is recommended for 2-3 months. After elimination of symptoms, after some time, a relapse of the disease may occur, which is treated in the same way.
If temporary hypothyroidism develops after treatment, hormone replacement therapy is prescribed until the thyroid gland is completely restored.
Treatment of de Quervain's disease folk remedies is used only as an auxiliary.
Advice. To diagnose and prescribe adequate treatment for de Quervain's disease, timely consultation with a doctor plays a huge role.
Chronic fibrous thyroiditis
The disease is rare, so the exact causes of its occurrence are unclear. Some suggest that this is the outcome of an autoimmune process, some suggest that viruses are to blame.
Symptoms of fibrous chronic thyroiditis
First of all, patients complain of difficulty swallowing, sometimes breathing, constant coughing and choking. When a person sees an endocrinologist, examination reveals an enlarged and very dense thyroid gland, which does not move due to fixation to surrounding tissues.
Diagnostic and therapeutic measures
Pathology is identified through examination by a specialist, ultrasound examination and biopsy, which is performed due to suspected cancer.
Surgical treatment consists of a complete thyroidectomy, after which hormone replacement therapy is prescribed under laboratory control.
Due to the fact that during the operation the parathyroid glands are also removed, the patient is strongly recommended to take calcium.
Summing up
The main criterion for effective treatment is early detection chronic thyroiditis of the thyroid gland. This is necessary in order not to bring the disease to a more severe course. Therefore, you should not stay at home, especially if close relatives have been diagnosed with thyroid pathology. Timely treatment of chronic thyroiditis is very effective.
Autoimmune thyroiditis and pregnancy – is this combination dangerous?
Autoimmune thyroiditis during pregnancy - dangerous condition, which can pose a threat to the life of mother and baby. This disease is associated with thyroid dysfunction, when active production of autoantibodies occurs.
If you do not pay attention to your health in time, this can result in gestosis, placental insufficiency and even premature birth. That is, autoimmune thyroiditis and pregnancy, when combined, can have quite severe consequences.
Reasons for the development of the disease
According to statistics, this problem occurs among young girls and middle-aged women who live in big cities. High levels of gas pollution, an overly active lifestyle, lack of control over your diet - all this has a detrimental effect on the female body.
To all this it is worth adding that women have a “brighter” hormonal background, which is much more active than men’s. Therefore, problems with the endocrine system occur more often in the weaker half of humanity. And what can we say about pregnancy!
In medicine, the following causes of thyroiditis are distinguished:
- infectious and viral diseases, both acquired and chronic;
- increased iodine concentration;
- genetic predisposition;
- intoxication;
- not taking medications correctly;
- a history of miscarriages;
- exposure to ultraviolet radiation for a long time;
- weakened immunity or disruptions in its functioning;
- bad ecology;
- auto-aggressive lymphocytes in the body of the bone marrow.
You can learn more about the reasons from the video in this article. Indeed, sometimes thyroiditis in pregnant women is provoked by diseases such as autoimmune hypocortisolism and oophoritis, severe anemia, chronic hepatitis, diabetes, rheumatoid arthritis, Sjogren's disease. Therefore, having familiarized yourself with this, you can know how to proceed further.
Symptoms of the disease
Pregnancy and thyroiditis are also dangerous because in the initial stages of its development, the disease may not manifest itself in any way. If a woman knows that someone in her family has already had this problem, then even at the stage of planning a child, it is worth undergoing an examination.
Autoimmune thyroiditis during pregnancy can manifest itself with the following symptoms:
| First stage | Second stage |
| the skin becomes dry and begins to peel | constantly breaks into a sweat |
| a pregnant woman gets tired quickly, even if she does not do anything active | arrhythmia, tachycardia, cardiac arrhythmia are noted |
| hair starts to fall out | problems with memory and concentration occur |
| I want to sleep all the time | hypertension |
| severe swelling occurs, especially in the legs | shortness of breath appears |
| experiencing sudden mood swings | problems with defecation |
| discomfort and pain begin to appear in the front of the neck (see Causes of pain in the thyroid gland), which intensify when swallowing | there is trembling in the fingers |
| seals often appear, and the thyroid gland itself may become significantly enlarged |
As can be seen from all of the above, the signs of this disease can easily be confused with other ailments or even simply attributed to banal fatigue. That is why a pregnant woman should always take all the tests prescribed to her in order to identify the problem in time and begin to solve it.
Carrying a child with autoimmune thyroiditis in a mother can be quite dangerous and lead to adverse consequences. The thing is that during such a period, the female body requires more thyroid hormones, and the diseased gland is not able to produce them normally.
Thus, the fetus does not receive all the substances it needs, which increases the risk of developing hypothyroxinemia. There are other dangers here, ranging from developmental disorders to fetal death.
Even if the pregnancy went well with AIT, after childbirth the woman may develop diseases of cardio-vascular system, postpartum thyroiditis, other pathological changes in endocrine system and in the body as a whole. And the baby has deviations in physical and mental development.
Chronic autoimmune thyroiditis
This form of the disease is also called Hashimoto's disease. It usually occurs in a family line, and the trigger can be any other autoimmune disease. Another interesting point is that the chronic form, like the acquired form, may not manifest itself for a long time.
Chronic AIT can be determined by deformation of the thyroid glands. If this is the beginning of development, then changes can only be seen on an ultrasound, but over time it will become noticeable even with the naked eye.
Upon palpation, you can feel lumpiness and tightness at the location of the thyroid gland. The patient herself has a feeling of the presence of a foreign body in the throat, which causes difficulties with breathing and swallowing.
If a woman knows that she has autoimmune thyroiditis and planning a pregnancy is very important for her, then she should undergo all the necessary tests in order to have a complete understanding of her condition. You will also need a qualified specialist who will monitor her and the baby throughout the entire period. Otherwise, there is no point in hoping for a favorable outcome.
Diagnosis and treatment
It has already been said above that pregnancy and AIT pose a danger to both parties. Therefore, it is in the interests of the expectant mother herself to monitor her health and undergo all the necessary tests on time.
To identify autoimmune thyroiditis, a pregnant woman is forced to undergo a complete blood test (detects the level of TSH and autoantibodies), ultrasound, and laboratory diagnostics. At an appointment with a specialist, the thyroid gland is palpated, since in many pathologies this organ changes in size.
If the doctor suspects a malignant tumor (in the case when the woman has already advanced her disease), he will give a referral for histological examination. Here tissue will be taken from the thyroid gland to identify cancer cells. Depending on what the examination shows, the doctor prescribes a course of treatment.
As for the therapy itself, there is nothing you can do with your own hands. You will need the help of a qualified specialist. The point is that it is important not to harm either the mother or the baby. Therefore, hormone therapy or surgery are often contraindicated during this period (unless there are special reasons).
Levothyroxine sodium is used here, which is a replacement treatment. The rules for taking it in each specific case are individual, therefore, even if the instructions indicate a certain dosage, you should first consult a doctor! Also, the pregnant woman will need to take TSH tests every month throughout the entire treatment (see On what day of the cycle should I take TSH). In addition, the patient will have to take iodides for the entire period.
As an addition, therapy may include relaxation therapy, diet and exercise therapy. Whatever the situation, an endocrinologist should monitor the treatment process. He will prescribe examinations and adjust medications as necessary. Every woman should understand that the cost in such a situation may be her life and the life of her child.
The thyroid gland is an organ that can be “silent” for a long time and not notify its owner about the onset or development of an existing disease. But when a woman adequately assesses the situation and cares about her health and the future of her children, she promptly seeks medical help. After all, in the future this will significantly help reduce the risk of developing any complications!