Diagnosis of autoimmune chronic thyroiditis
Last reviewed: 23.04.2024
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Until recently, the detection of antibodies to thyroglobulin (or microsomal antigen), especially with a large titer, served as a diagnostic criterion for autoimmune thyroiditis. It is now established that similar changes are observed in diffuse toxic goiter and some forms of cancer. Therefore, these studies help to make a differential diagnosis with vnnetireoidnymi violations and play the role of auxiliary, rather than absolute. Examination of the thyroid function with 131 1 usually gives a reduced number of absorption and accumulation. However, there may be variants with normal or even increased accumulation (due to an increase in the gland mass) against the background of clinical symptoms of hypothyroidism.
The scintigram of hypertrophic autoimmune goiter is characterized by an increase in the size of the gland, uneven absorption of the isotope (areas with increased absorption alternate with "cold zones"), which can give a picture of a multinodal goiter, although palpation is not determined. This "variegated" scannogram helps differentiate the hyperthyroid phase of thyroiditis from diffuse toxic goiter, where a uniformly increased isotope distribution is noted on the scan.
However, nowadays scanning is rarely used, since ultrasound examination in comparison with the presence of antibodies and the data of puncture biopsy allows in almost 100% of cases to verify the diagnosis.
The pattern of structural changes characteristic for ultrasound is no different from the changes in diffuse toxic goiter, so a specialist can not make a diagnosis in accordance with ultrasound. He should only note the changes characteristic of the autoimmune disease of the gland.
The diagnosis is determined by the clinician to compare all the patient's examination data.
Puncture biopsy, as a rule, allows on the basis of histological features to clarify the diagnosis of autoimmune thyroiditis. However, in some cases it is necessary to diagnose with consideration of all clinical and laboratory methods.
Radioimmune ways of revealing thyroid and thyroid-stimulating hormones in the blood, as well as carrying out a test with thyreoliberin, can reveal thyroid dysfunction at the earliest stages. Of the indicators obtained with hypothyroidism, the most valuable are the levels of TTG and T 4. Initially, a high level of TSH in a sample with an intravenous injection of 200 μg of thyreoliberin increased by 30 minutes, by more than 25 μED / L. With diffuse toxic goiter, the initially normal and elevated TSH level does not increase after stimulation with thyroidibericin.
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