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Volume 2
Journal of Clinical Diagnosis and Treatment
Annual Nephrology & Chronic Diseases 2019
May 20-21, 2019
Page 13
Nephrology
Chronic Diseases
May 20-21, 2019 London, UK
19
th
Annual Conference on
3
rd
International Conference on
&
Francesco Lippi
University of Pisa, Italy
Francesco Lippi, J Clinical Diagnosis and Treatment, Volume 2
Autoimmune thyroid diseases
T
he autoimmune chronic thyroiditis or Hashimoto' thyroiditis is an inflammatory autoimmune
disease of the thyroid, characterized by a lymphocytic chronic infiltration. This pathology is
frequently silent, often hands to a gradual but progressive and irreversible hypo-function of the
thyroid. It is the most frequent cause of hypothyroidism in the guilty ones of the world to enough
contribution of iodine, while it is relatively being rare in the zones to lack iodine. The greatest
incidence is the women it is calculated around 3,5 cases for 1000 inhabitants a year. At the base of
the pathology there is an inflammatory autoimmune process that brings to the destruction of the
thyroid follicles, caused both from a cells-mediate mechanism and from organ specific antibodies.
Once activated the lymphocytic T helper it produces different cytokines that perpetuates and the
inflammatory process they make autoimmune chronic. Therefore, both the inflammatory process
and the lymphocytic infiltration leads to a reduction of the synthesis of the thyroid hormones. The
bio-humoral mechanism seems to have a secondary role. Sometimes in some occasions we can also be
found some antibodies anti TSH receptor blocking (TSHRblokingAb) responsible of the atrophy variant
(idiopathic myxedema) or even more rarely anti Receptor of the TSH antibodies (TRAB) responsible of
the condition of transient hyperthyroidism or at times permanent that rarely can be found in patients with
Hashimoto' thyroiditis (Hashitoxicosis) due to the release of the thyroid hormones from the destroyed
thyroid cells. Often the chronic thyroiditis can be are associated with other autoimmune diseases (poly-
glandular autoimmune syndrome). The diagnosis founds him on the data of laboratory that underline
elevated values of specific antibodies (overall AbTPO). Nevertheless in a low percentage of cases 5-
10%, we can find a condition of chronic thyroiditis in absence of specific antibodies. In such case the
diagnosis is sustained by the aid of the sonography. The typical picture in fact it is peculiar with a
markedly hypoechoic thyroid with poor intra-thyroidal vascularization. In many cases is not in demand
some treatment because the gullet is small the patient it is often asymptomatic with levels of TSH in
the range of the norm and in absence of antibodies. In that case it is not required any therapy a part the
use of selenium as anti-oxidant agent and Vitamin D. In patients with hypothyroidism (both subclinical
than clinical) the pharmacological treatment was mandatory as the administration of the substitutive
therapy with levo-thyroxine especially in children and in the women that are in pregnancy or to the
search of pregnancy. The purpose of the hormone-therapy is that to normalize the TSH values with a
first control to 45-60 days and once reached the therapeutic remuneration they are enough hormonal