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Diagnosis of autoimmune chronic thyroiditis
Last reviewed: 04.07.2025
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Until recently, detection of antibodies to thyroglobulin (or microsomal antigen), especially at high titers, served as a diagnostic criterion for autoimmune thyroiditis. It has now been established that similar changes are observed in diffuse toxic goiter and some forms of cancer. Therefore, these studies help to conduct a differential diagnosis with extrathyroidal disorders and play an auxiliary, rather than absolute, role. A thyroid function test with 131 1 usually gives reduced absorption and accumulation figures. However, there may be variants with normal or even increased accumulation (due to an increase in the mass of the gland) against the background of clinical symptoms of hypothyroidism.
The scanogram 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 "multinodular goiter", although the nodes are not determined by palpation. Such a "variegated" scanogram helps to differentiate the hyperthyroid phase of thyroiditis from diffuse toxic goiter, where the scanogram shows a uniformly increased distribution of the isotope.
However, scanning is rarely used at present, since ultrasound examination, in comparison with the presence of antibodies and puncture biopsy data, allows for verification of the diagnosis in almost 100% of cases.
The characteristic ultrasound picture of structural changes is no different from the changes in diffuse toxic goiter, so the specialist cannot make a diagnosis based on ultrasound data. He should only note the changes characteristic of an autoimmune disease of the gland.
The diagnosis is determined by a clinician by comparing all the patient's examination data.
A puncture biopsy usually allows for a more precise diagnosis of autoimmune thyroiditis based on histological features. However, in some cases, it is necessary to diagnose taking into account all clinical and laboratory methods.
Radioimmune methods for detecting thyroid and thyroid-stimulating hormones in the blood, as well as conducting a test with thyrotropin-releasing hormone (thyrotropin-releasing hormone) make it possible to detect thyroid dysfunction at the earliest stages. Of the obtained indicators for hypothyroidism, the most valuable are the levels of TSH and T4 . The initially high level of TSH during a test with intravenous administration of 200 mcg of thyrotropin-releasing hormone increases by more than 25 mcU/l in the 30th minute. In diffuse toxic goiter, the initially normal and elevated level of TSH does not increase after stimulation with thyrotropin-releasing hormone (thyrotropin-releasing hormone).
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