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Autoimmune thyroiditis in a child
Last reviewed: 23.04.2024
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Chronic non-specific form of thyroiditis includes two subspecies: autoimmune and fibrotic. So, autoimmune thyroiditis in a child occurs quite often, and in principle affects only children and adolescents. Fibrous type of disease does not occur in children at all. Definition of the disease is performed using an autoimmune mechanism, but the main immunological defect is not known. Histologically, lymphocytic infiltration, as well as hyperplasia of thyroid tissue, is detected.
ICD-10 code
This disease was introduced into the international classification of diseases. So, according to her autoimmune thyroiditis is one of the diseases of the endocrine system, its code in microbial 10 - E00-E90.
E00-E90 Diseases of the endocrine system, eating disorders and metabolic disorders. E00-E07 Diseases of the thyroid gland. E00 Syndrome of congenital iodine deficiency. These include diseases that have arisen against the background of iodine deficiency. E01 Diseases of the thyroid gland associated with iodine deficiency, and similar conditions. This subgroup includes both diseases based on iodine deficiency, and goiter endemic. E02 Subclinical hypothyroidism due to iodine deficiency. The subgroup includes hypothyroidism and iodine deficiency disorders. E03 Other forms of hypothyroidism, including hypothyroidism. E04 Other forms of non-toxic goiter. E05 Thyrotoxicosis [hyperthyroidism]. In this subgroup included goiter nodal toxic and diffuse. E06 Thyroiditis. The subgroup includes thyroiditis, subacute thyroiditis, and also its chronic autoimmune form. E07 Other thyroid disorders.
E06 Thyroiditis. E06.0 Acute thyroiditis. E06.1 Subacute thyroiditis. E06.2 Chronic thyroiditis with transient thyrotoxicosis, including hyperthyroidism. E06.3 Autoimmune thyroiditis. E06.4 Medical thyroiditis. E06.5 Thyroiditis. E06.9 Thyroiditis, unspecified
The causes of autoimmune thyroiditis in a child
This disease can not occur through the fault of the patient himself. After multiple studies, it was found that the main cause of autoimmune thyroiditis in a child is the presence of hereditary predisposition. This disease can be affected by severe stress. The frequency of the development of the disease directly depends on the age of the patient and his sex. So, in boys, the disease occurs much less often than in girls. Viral or bacterial diseases can trigger a negative process. Even a bad ecological situation in the region where a person lives can make a contribution. The immune system is not always able to cope with such influence.
If a person has a genetic predisposition or has suffered stress, then the immune mechanisms start to fail. This allows foreign bodies to penetrate the body and adversely affect it. In addition, the immune system begins to harm itself, producing special antibodies. Their action is directed against the body itself, which leads to an effect on the thyroid gland. There is a destruction of the "positive" cells.
Pathogenesis
Lead to the development of the disease can the effect of trigger factor directly on the tissue of the thyroid gland. This can happen only in the case of a genetic predisposition. A clear violation of thyrocytes leads to the migration of antigen-presenting cells into the thyroid tissue. For the pathogenesis of this disease is characterized by a violation of immune tolerance. The basis of this process is the deficiency of T-regulating cells.
Most likely, genetic deterministic low expression of the CTLA-4 receptor on the membranes of the Treg leads to a decrease in their activity. This process leads to a deficiency of antigen-specific Treg. In the following, activation of B cells is observed. This process leads to the synthesis of autoantibodies of the IgG class. In the final phase of the development of the disease, there is an increased infiltration of the gland tissues, autoreactive T-cells. Ultimately, there is a pronounced decrease in the functionality of the thyroid gland.
When histological examination of the thyroid gland tissues, they can detect diffuse or focal infiltration in them. It occurs due to lymphocytes and plasma cells. Depending on the severity of the process, the detection of fibroids of the thyroid stroma is possible.
Symptoms of an autoimmune thyroiditis in a child
Autoimmune thyroiditis is a chronic disease. It is characterized by the development of the inflammatory process in the tissues of the thyroid gland. The disease affects the follicular cells, leading to the destruction of the follicle. The main symptoms of autoimmune thyroiditis in a child are: the appearance of goiter, the production of antibodies and impaired production of peripheral hormones.
The process of goiter develops gradually. Children begin to feel pain in the thyroid gland. Often there is difficulty in swallowing and breathing, pain syndrome is poorly expressed. The child has no complaints, his hormonal background is in perfect order.
The main symptom of thyroiditis is the presence of dry mouth, especially in the morning. At the same time, the baby does not feel thirsty. Children suffering from this disease, somewhat behind in their development from their peers. Over time, goiter may disappear, in some cases it persists for a long time. Quite often it leads to the development of hypothyroidism. Sometimes the recovery occurs suddenly.
First signs
During the first few years, the disease may not manifest itself. To reveal its presence is possible due to examination of the thyroid gland. At the initial stage, the first signs are mild. A child may be pained by moderate pain. Over time, there are difficulties with swallowing and breathing. This is due to the growth of goiter and a decrease in the thyroid gland.
The child can move slowly, his face becomes puffy and pale. Sometimes the shade of the skin changes to yellowish. Eyelids become swollen, the face rough. Due to the pallor of the skin, an unhealthy blush, covering the cheekbones and nose, becomes noticeable. Hair is flimsy and rare, sometimes they can fall out of the fires, leading to the appearance of bald patches.
During the development of the disease, the facial expressions of the child do not change. In adolescents, hair can fall out in the armpits and in the pubic part. The person is talking slowly, it is difficult for him to find the right words. Remembering an event becomes a real problem, because all reactions are inhibited. The child lags behind in development from his peers.
Effects
The disease can lead to serious abnormalities on the part of the body. Babies suffer greatly from thyroiditis, there is a pronounced inhibition in development. As a result of the disease, the production of thyroid hormones, namely hypothyroidism, may decrease. This is the first consequence that can occur against a background of thyroiditis.
Not timely treatment leads to an increase in goiter, which significantly worsens the condition of the child. Perhaps the formation of nodes of their parts of the thyroid tissue. On the density they considerably differ from norm. They can be detected by ultrasound examination.
If the thyroid gland does not work properly, the body simply can not cope with its basic functions. This will lead to penetration into it of harmful substances, bacteria and infections. Due to weakened immunity, the body can not cope with such influence. Moreover, he will begin to "work" against himself, destroying antibodies and worsening the situation.
Complications
Thyroiditis can lead to the development of serious problems. Its main complication is progressive hypothyroidism. It manifests itself in the form of a small goiter, but it is characterized by a normal level of TSH.
Some patients complain of symptoms of mild hypothyroidism. At the same time there is an increased level of lipids and other factors contributing to the development of coronary heart disease. In extremely rare cases, thyroid gland lymphoma may develop. Until now, the causes of this condition are not known. It is possible that the process originates from anomalous expansion. For lymphoma is characterized by rapid growth, even despite the quality of therapy. The development of cancer against the background of thyroiditis is impossible, but these processes can occur simultaneously.
Timely treatment will allow the child to recover, despite the fact that this is a complex process. After a violation of the functionality of the thyroid gland can lead to a decrease in the overall performance of a person and the slowness of his actions.
Diagnosis of an autoimmune thyroiditis in a child
The diagnosis is made against the background of the history of the disease and the clinical picture. In the analysis of blood, a sharp jump in the level of lymphocytes is observed, while the white blood cells are reduced. At the stage of hyperthyroidism, there is an increase in the main hormones of the thyroid gland in the blood. Once the functionality of the thyroid gland starts to decrease, the level of the hormone will also drop. But at the same time there is an increase in thyrotropin. In the diagnosis of autoimmune thyroiditis, a special role is played by examining the child.
The performed immunogram records significant changes. With ultrasound examination there is a change in the size of the thyroid gland, as well as its unevenness. At a biopsy in a studied tissue the large quantity of lymphocytes, and also other cells which both testify to presence of disease reveal.
In the presence of the main symptoms of the disease, there is a risk of malignant formation, but this is extremely rare. Most often, autoimmune thyroiditis is characterized by a benign course. Very rarely develop thyroid lymphomas.
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Analyzes
Thanks to laboratory studies, it is possible to determine the presence of antibodies in the body, which are associated with components of the thyroid gland. A general blood test can reveal the level of lymphocytes and leukocytes. With an increase in the level of lymphocytes, the level of leukocytes is usually several times lower.
In addition to blood tests, the so-called immunogram is performed. It allows to detect the presence of antibodies to thyreperoxidase and thyroglobulin. The final action is the determination of T3 and T4, as well as the level of TSH in serum. If the T4 level is normal, but the TSH is elevated, then the person has subclinical hypothyroidism. If the level of TSH is elevated, but at the same time the concentration of T4 is reduced, then it is a question of clinical hypothyroidism.
Despite the detailed data, some tests are not enough to make a diagnosis. For a complete picture it is necessary to perform instrumental diagnostics.
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Instrumental diagnostics
To make an accurate diagnosis, you need to use additional research. So, instrumental diagnostics includes ultrasound of the thyroid gland, fine needle biopsy sonography.
- Ultrasound of the thyroid gland. This study shows how much iron has been reduced or enlarged. Moreover, it allows you to notice changes in the structure. The results of ultrasound are in addition to the clinical picture and other laboratory studies.
- Fine needle biopsy of the thyroid gland. This method allows you to identify the number of lymphocytes and other cells that are characteristic for the presence of autoimmune thyroiditis. This method is used at risk of malignant nodal degeneration of the thyroid gland.
- Sonography. This procedure is similar to ultrasound examination. Moreover, it performs the same functions, determining the size of the thyroid gland. Together with laboratory analyzes, instrumental research allows you to make an accurate diagnosis.
Differential diagnostics
As a compulsory research differential diagnosis is carried out. To it carry the general analysis of a blood, allowing to define level of lymphocytes, in relation to leukocytes. If the first are significantly elevated, the probability of having thyroiditis is high.
To obtain the completeness of the picture, an immunogram should be performed. This study is a determination of the presence of antibodies that are characteristic of thyroiditis. Among them are: thyroglobulin, thyroid peroxidase and colloidal antigen.
In addition, the level of TSH is determined. If it exceeds the norm, but the T4 index is normal, most likely a person has subclinical hypothyrosis. If the level of TSH is exceeded, but even T4 does not lag behind it, there is evidence of clinical hypothyroidism.
Often, a biopsy of the affected area is performed. For this, tissue is taken and special research is carried out with the help of special reagents. It is aimed at detecting the level of lymphocytes.
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Treatment of autoimmune thyroiditis in a child
To date, there is no specific therapy for the disease. Therefore, most often resort to the help of symptomatic means. If hypothyroidism is detected, then the treatment of autoimmune thyroiditis in a child consists in the use of thyroid hormones.
The use of glococorticoids is resorted only if the autoimmune phase of the disease is combined with a subacute. Often this condition is observed in the autumn-winter period. If the functionality of the thyroid gland is significantly increased, tirostatics are used. Among them are: Tiamazol and Mercazolil. In order to reduce the production of antibodies, anti-inflammatory drugs are used. Most commonly used: Indomethacin, Metindol and Voltaren.
As an auxiliary therapy can be used drugs for the correction of the immune system, as well as vitamins and adaptogenes. If the functionality of the thyroid gland is reduced, thyroid hormones are used. It is possible to maintain a person's condition only through medical treatment.
Medications
To restore the functionality of the thyroid gland resort to the help of Thiamazole and Mercazolil. These drugs can bring the thyroid function back to normal. To combat the production of antibodies, more precisely, their overestimated amounts use anti-inflammatory drugs. Most often the doctor recommends using: Indomethacin, Metindol and Voltaren.
- Thiamazole. The agent is applied to 0,02-0,04 grams per day for one and a half months. After the thyroid functions are normal, they switch to maintenance therapy. It is sufficient to apply up to 10 mg of the agent for 2 months. Use the drug is not recommended for people with increased sensitivity. It can lead to the development of allergic skin rash, dyspepsia and neuritis.
- Mercazolyl. Tablets are taken internally, 5 mg three times a day. The dose depends on the patient's condition, as well as the severity of his illness. Take the product preferably after eating, squeezed with enough liquid. Use it is not necessary for nodular forms of goiter, as well as severe leukopenia. It is able to cause swelling, itching, skin, rash, nausea and headache.
- Indomethacin. The drug is used during meals, 25 mg 3 times a day. This is the initial dosage, it can be adjusted according to the doctor's indications. The maximum dosage does not exceed 150 mg per day. The drug should not be used for bronchial asthma, as well as for people whose work is associated with increased concentration of attention. May cause headache, nausea, dizziness and loss of appetite.
- Metindol. The usual dosage is 1-2 tablets per day. For children, it can be adjusted. Use the tool is not necessary in the presence of congenital heart disease, intolerance of the components of the drug, as well as inflammatory bowel diseases. May lead to the development of diarrhea, nausea, skin rash and hives.
- Voltaren. The dose is selected individually. Usually use one tablet 2-3 times a day. For children, the dose is calculated by a doctor. Use the tool is not necessary in case of blood circulation, children under 6 years of age, and also with intolerance. May lead to the development of hypertension, stomach pain, nausea, hearing and visual impairment.
Alternative treatment
To ease the condition, you need to buy a couple of packages of pine buds. The main ingredients should be filled with vodka, before that the kidneys are thoroughly crushed. The received product should be sent to insist in a warm place for 3 weeks. After the preset time has elapsed, it is wrung out. Use this method of alternative treatment for rubbing the neck in the thyroid gland. Repeat the procedure 3-4 times a day.
One of the most pleasant and tasty methods of treatment includes the use of sokoterapii. You just need to use a mixture of beet and carrot juice. You must prepare the preparation yourself. For this, carrots need to be taken 3 times more than beets. For better digestion, add a tablespoon of flax oil. If carrots and beets are not to your liking, you can make juice from cabbage and lemon. Therapy with juices is carried out neatly, it lasts from one month to a year.
To prepare another effective agent, you need to acquire certain ingredients. So, you should take 100 grams of sea kale, 50 grams of walnut, plantain, pine buds, field horsetail and tincture of fucus. Of all this, a mixture is prepared. Take only 2 tablespoons and pour them with boiling water. Then boil on low heat for 15 minutes. For efficiency, add 50 grams of honey and crushed lemon. Then you need to boil for another 15 minutes. The resulting broth is cooled, filtered and taken on a tablespoon 3 times a day.
Herbal Treatment
With an enlarged thyroid gland resort to the use of tincture celandine. It is enough to apply it on an empty stomach daily in the morning and in the afternoon. One teaspoon of the drug is enough. To prepare this tincture you need to get 700 grams of alcohol. Purity is simply poured with alcohol and insisted. The positive effect of herbal treatment is observed in a short time. But in this business the main thing is a systematic application.
It is necessary to take 100 grams of sea kale, 50 grams of plantain, as many pine buds. All these ingredients should be mixed together and take only 2 tablespoons of the collection. They should be poured with steep boiling water and boil for 15 minutes with the lid closed on low heat. If desired, you can add 50 grams of honey and boil a little more. The agent is applied on a tablespoon up to 3 times a day. It is advisable to drink the broth for a month.
Before using alternative medicine, you need to consult a doctor. After all, we are talking about child health.
Homeopathy
Homeopathic remedies have always been an alternative to traditional medicine. At least because in their composition are exclusively natural components. But because of the lack of clinical studies, it is impossible to talk about the complete safety of homeopathy.
Homeopathic remedies are aimed at regulating immunity, psyche, nervous and endocrine system. The minimum amount of the drug is able to reach the cause of the disease and suppress it. Means are selected in accordance with the patient's drug type. Most drugs need to be taken along with other medication. This will achieve the maximum positive result.
It is unequivocal to say whether a tool can help or not. To do this, you should visit a homeopathic doctor, consult with him. After all, every disease requires its own individual approach, even when treated with homeopathic remedies. Learn about the possible preparations, as well as their use can be a specialist. It's not recommended to take funds yourself.
Operative treatment
To a surgical intervention at presence of an autoimmune thyroiditis do not resort. The problem is eliminated by a purely medicamentous way. To do this, the child is assigned a number of special drugs that require constant admission. Their action is aimed at normalizing the thyroid gland. It is advisable to resort to surgical treatment in the event that the goiter reaches too large a size and prevents the child from living normally. Too enlarged the thyroid gland may not only be painful, but also hinder breathing and swallowing. In this case, a decision can be made about the surgical intervention.
The operation can lead to the development of hypothyroidism. Because of the risk of aggravating the situation, surgical removal is rarely resorted to. But if the goiter is too large and it squeezes the neck organs, they immediately resort to surgery.
More information of the treatment
Prevention
It is impossible to foresee the development of the disease. It can arise both against the background of weakened immunity, and the experienced stress. Naturally, it is necessary to enhance the protective functions of the body with the help of proper nutrition, sports and vitamin intake. But to avoid stress is almost impossible, they can catch a person at any time. In the case of children, everything is somewhat simpler. It is enough to monitor the baby's condition, strengthen his body and move more, this is the main prevention of thyroiditis. But, unfortunately, such actions do not guarantee the possibility of the development of the disease.
If a child develops an autoimmune thyroiditis, the patient should be monitored. After all, without proper treatment, the situation can worsen, leading to the development of hypothyroidism. It is necessary to monitor the functionality of the thyroid gland at all times. When complaining about difficulty in swallowing and breathing, the child should immediately go to the hospital.
Forecast
If you start a timely treatment, then everything will end well. In general, the forecast has a favorable current. People who have this disease need to take Levothyroxine for life. This will avoid the resumption of the process and improve the patient's condition.
Once every six months, it is necessary to carry out dynamic monitoring of hormonal parameters. This will allow you to monitor the condition of the thyroid gland and changes in it. If in the case of ultrasound revealed nodal neoplasms, it is necessary to visit a doctor-endocrinologist.
Normal state of health and ability to work in case of illness can last for 15 years. Even, despite the fact that there will be periods of exacerbation. When all recommendations are implemented, the forecast will be extremely positive. To delay with treatment is not necessary, it will avoid serious consequences.