Autoimmune thyroiditis in a child

Chronic non-specific thyroiditis includes two subtypes: autoimmune and fibrous. Thus, autoimmune thyroiditis in children is quite common, and in principle affects only children and adolescents. The fibrous type of the disease does not occur in children at all. The disease is determined by an autoimmune mechanism, but the main immunological defect is unknown. Histologically, lymphocytic infiltration is detected, as well as hyperplasia of the thyroid tissue.

ICD-10 code

This disease was included in the international classification of diseases. Thus, according to it, autoimmune thyroiditis is classified as a disease of the endocrine system, its code according to ICD 10 is E00-E90.

E00-E90 Diseases of the endocrine, nutritional and metabolic systems. E00-E07 Diseases of the thyroid gland. E00 Congenital iodine deficiency syndrome. This group includes diseases due to iodine deficiency. E01 Diseases of the thyroid gland associated with iodine deficiency and similar conditions. This subgroup includes both iodine deficiency diseases and endemic goiter. E02 Subclinical hypothyroidism due to iodine deficiency. The subgroup includes hypothyroidism and iodine deficiency diseases. E03 Other forms of hypothyroidism, including hypothyroidism. E04 Other forms of nontoxic goiter. E05 Thyrotoxicosis [hyperthyroidism]. This subgroup includes toxic nodular goiter and diffuse goiter. E06 Thyroiditis. The subgroup includes thyroiditis, subacute thyroiditis, and its chronic autoimmune form. E07 Other diseases of the thyroid gland.

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 Drug-induced thyroiditis. E06.5 Thyroiditis. E06.9 Thyroiditis, unspecified

Causes of autoimmune thyroiditis in a child

This disease cannot occur due to the fault of the patient himself. After multiple studies, it was found that the main reason for the development of autoimmune thyroiditis in a child is the presence of a hereditary predisposition. This disease can be affected by severe stress. The frequency of the disease directly depends on the patient's age and gender. Thus, the disease occurs much less often in boys than in girls. The negative process can be triggered by viral or bacterial diseases. Even a poor environmental situation in the region where a person lives can make its contribution. The immune system is not always able to cope with such an influence.

If a person has a genetic predisposition or has experienced stress, then the immune mechanisms begin to fail. This allows foreign bodies to penetrate the body and negatively affect it. In addition, the immune system begins to harm itself by producing special antibodies. Their action is directed against the body itself, which leads to an effect on the thyroid gland. The destruction of "positive" cells occurs.

Pathogenesis

The development of the disease can be caused by the effect of a trigger factor directly on the thyroid tissue. This can only happen in the case of a genetic predisposition. An obvious violation of thyrocytes leads to the migration of antigen-presenting cells into the thyroid tissue. The pathogenesis of this disease is characterized by a violation of immune tolerance. The basis of this process is the deficiency of T-regulatory cells.

Most likely, genetically determined low expression of the CTLA-4 receptor on Treg membranes leads to a decrease in their activity. This process leads to a deficiency of antigen-specific Treg. Subsequently, activation of B cells is observed. This process leads to the synthesis of IgG class autoantibodies. In the final phase of the disease, increased infiltration of gland tissues by autoreactive T cells is observed. Ultimately, a marked decrease in thyroid gland functionality is observed.

During histological examination of thyroid tissue, diffuse or focal infiltration can be detected. It occurs due to lymphocytes and plasma cells. Depending on the severity of the process, fibromas of the thyroid gland stroma can be detected.

Symptoms of autoimmune thyroiditis in a child

Autoimmune thyroiditis is a chronic disease. It is characterized by the development of an inflammatory process in the tissues of the thyroid gland. The disease affects follicular cells, leading to the destruction of the follicle. The main symptoms of autoimmune thyroiditis in a child are considered to be: the appearance of goiter, the production of antibodies and the disruption of the production of peripheral hormones.

The process of goiter development occurs gradually. Children begin to feel pain in the thyroid gland. Often there is difficulty swallowing and breathing, the pain syndrome is weakly expressed. The child has no complaints, his hormonal background is completely normal.

The main symptom of thyroiditis is dry mouth, especially in the morning. At the same time, the baby does not feel thirsty. Children suffering from this disease are somewhat behind their peers in development. Over time, the goiter may disappear, in some cases it remains for a long time. Quite often, it leads to the development of hypothyroidism. Sometimes recovery occurs suddenly.

First signs

During the first few years, the disease may not manifest itself. Its presence can be detected by examining the thyroid gland. At the initial stage, the first signs are weakly expressed. The child may be bothered by moderate pain. Over time, difficulties with swallowing and breathing appear. This is due to the growth of the goiter and the reduction of the thyroid gland.

The child may move slowly, his face becomes puffy and pale. Sometimes the skin tone changes to yellowish. The eyelids become swollen, the face becomes rough. Due to the paleness of the skin, an unhealthy blush becomes clearly visible, covering the cheekbones and nose. The hair is flimsy and sparse, sometimes it can fall out in patches, leading to the appearance of bald spots.

As the disease progresses, the child's facial expressions do not change. Teenagers may experience hair loss in the armpits and pubic area. The person speaks slowly and has difficulty finding the right words. Remembering an event becomes a real problem, because all reactions are inhibited. The child lags behind his peers in development.

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Consequences

The disease can lead to serious deviations from the body. Children suffer greatly from thyroiditis, there is a pronounced inhibition in development. As a result of the disease, the production of thyroid hormones can decrease, namely hypothyroidism. This is the first consequence that can occur against the background of thyroiditis.

Untimely treatment leads to an increase in goiter, which significantly worsens the child's condition. Nodes may form in areas of thyroid tissue. Their density differs significantly from the norm. They can be detected by ultrasound examination.

If the thyroid gland does not work properly, the body simply will not be able to cope with its basic functions. This will lead to the penetration of harmful substances, bacteria and infections. Due to weakened immunity, the body will not be able to cope with such influence. Moreover, it will begin to "work" against itself, destroying antibodies and worsening the situation.

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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 at the same time it is characterized by a normal level of TSH.

Some patients complain of mild hypothyroidism symptoms. In this case, there is an elevated lipid level and other factors that contribute to the development of coronary heart disease. In extremely rare cases, thyroid lymphoma may develop. The causes of this condition are still unknown. It is possible that the process originates from abnormal expansion. Lymphoma is characterized by rapid growth, even despite high-quality 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 all, a malfunction of the thyroid gland can lead to a decrease in a person's overall performance and a slowdown in his actions.

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Diagnosis of autoimmune thyroiditis in a child

The diagnosis is made based on the history of the disease and the clinical picture. A blood test shows a sharp jump in the level of lymphocytes, while leukocytes are reduced. At the stage of hyperthyroidism, an increase in the main hormones of the thyroid gland in the blood is observed. As soon as the functionality of the thyroid gland begins to decrease, the hormone level will also fall. But at the same time, an increase in thyrotropin is observed. In the diagnosis of autoimmune thyroiditis, a special role is played by examining the child.

The immunogram recorded significant changes. Ultrasound examination revealed changes in the size of the thyroid gland, as well as its unevenness. Biopsy revealed a large number of lymphocytes in the tissue being examined, as well as other cells, which indicate the presence of the disease.

In the presence of the main symptoms of the disease, there is a risk of malignancy, but this is extremely rare. Most often, autoimmune thyroiditis is characterized by a benign course. Thyroid lymphomas develop extremely rarely.

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Tests

Laboratory tests can determine the presence of antibodies in the body that are associated with thyroid components. A general blood test can determine the level of lymphocytes and leukocytes. When the level of lymphocytes increases, the level of leukocytes is usually reduced several times.

In addition to blood tests, a so-called immunogram is performed. It allows detecting the presence of antibodies to thyroid peroxidase and thyreglobulin. The final step is to determine T3 and T4, as well as the level of TSH in the blood serum. If the T4 level is normal, but TSH is elevated, then the person has subclinical hypothyroidism. If the TSH level is elevated, but the concentration of T4 is reduced, then we are talking about clinical hypothyroidism.

Despite the detailed data, tests alone are not enough to make a diagnosis. For a complete picture, instrumental diagnostics are required.

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Instrumental diagnostics

To establish an accurate diagnosis, it is necessary to use additional studies. Thus, instrumental diagnostics includes thyroid ultrasound, fine-needle biopsy, and sonography.

• Thyroid ultrasound. This examination shows how much the gland has been reduced or enlarged. Moreover, it allows you to notice changes in the structure. The ultrasound results are an addition to the clinical picture and other laboratory studies.
• Thyroid fine-needle biopsy. This method allows to detect the number of lymphocytes and other cells that are characteristic of the presence of autoimmune thyroiditis. This method is used when there is a risk of malignant nodular 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. In combination with laboratory tests, instrumental examination allows for an accurate diagnosis.

Differential diagnostics

Differential diagnostics are carried out as mandatory studies. This includes a general blood test, which allows determining the level of lymphocytes in relation to leukocytes. If the former are significantly elevated, then the probability of thyroiditis is high.

To get a complete picture, an immunogram should be performed. This study is a determination of the presence of antibodies that are characteristic of thyroiditis. These include: thyreglobulin, thyroid peroxidase, and colloidal antigen.

In addition, the TSH level is determined. If it exceeds the norm, but the T4 indicator is normal, most likely the person has subclinical hypothyroidism. If the TSH level is exceeded, but T4 does not lag behind it, this indicates the presence of clinical hypothyroidism.

Often a biopsy of the affected area is performed. For this, tissue is taken and a study is conducted using special reagents. It is aimed at identifying the level of lymphocytes.

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Treatment of autoimmune thyroiditis in a child

There is currently no specific therapy for the disease. Therefore, symptomatic treatment is most often used. If hypothyroidism is detected, then the treatment of autoimmune thyroiditis in a child consists of the use of thyroid hormones.

Glucocorticoids are used only if the autoimmune phase of the disease is combined with a subacute phase. This condition is often observed in the autumn-winter period. If the functionality of the thyroid gland is significantly increased, thyrostatics are used. These include: Thiamazole and Mercazolil. In order to reduce the production of antibodies, anti-inflammatory drugs are used. The most commonly used are: Indomethacin, Metindol and Voltaren.

As an adjuvant therapy, drugs for correcting the immune system, as well as vitamins and adaptogens can be used. If the functionality of the thyroid gland is reduced, thyroid hormones are used. The person's condition can only be maintained through drug treatment.

Medicines

To restore the functionality of the thyroid gland, they resort to the help of Thiamazole and Mercazolil. These drugs allow you to bring the thyroid function back to normal. To combat the production of antibodies, or rather their increased amount, anti-inflammatory drugs are used. Most often, the doctor recommends using: Indomethacin, Metindol and Voltaren.

• Thiamazole. The drug is used at 0.02-0.04 grams per day for one and a half months. After the thyroid gland functions are normalized, they switch to maintenance therapy. It is enough to use up to 10 mg of the drug for 2 months. It is not recommended for people with increased sensitivity. It can lead to the development of allergic skin rash, dyspeptic phenomena and neuritis.
• Mercazolil. Tablets are taken orally, 5 mg three times a day. The dose depends on the patient's condition, as well as the severity of his disease. It is advisable to take the drug after meals, with a sufficient amount of liquid. It should not be used in nodular forms of goiter, as well as severe leukopenia. It can 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 instructions. The maximum dosage does not exceed 150 mg per day. The drug should not be used in bronchial asthma, as well as in people whose work is associated with increased concentration. It can cause headache, nausea, dizziness and loss of appetite.
• Metindol. The usual dosage is 1-2 tablets per day. For children, it can be adjusted. Do not use the drug if you have congenital heart defects, intolerance to the components of the drug, or inflammatory bowel diseases. It can lead to the development of diarrhea, nausea, skin rash, and urticaria.
• Voltaren. The dose is selected individually. Usually one tablet is used 2-3 times a day. For children, the dose is calculated by a doctor. The drug should not be used in case of circulatory disorders, for children under 6 years of age, and in case of intolerance. It can lead to the development of hypertension, stomach pain, nausea, hearing and vision impairment.

Folk remedies

To alleviate the condition, you need to buy a couple of packages of pine buds. The main ingredients should be poured with vodka, before that the buds are thoroughly crushed. The resulting remedy should be sent to infuse in a warm place for 3 weeks. After the specified time has passed, it is squeezed out. This method of folk treatment is used for rubbing the neck in the thyroid gland area. Repeat the procedure 3-4 times a day.

One of the most pleasant and delicious methods of treatment involves the use of juice therapy. You just need to drink a mixture of beetroot and carrot juice. You need to prepare the remedy yourself. To do this, you need to take 3 times more carrots than beets. For better absorption, you should add a tablespoon of flaxseed oil. If you don’t like carrots and beets, you can make juice from cabbage and lemon. Juice therapy is carried out carefully, it lasts from one month to a year.

To prepare another effective remedy, you need to get certain ingredients. So, you should take 100 grams of seaweed, 50 grams of walnuts, plantain, pine buds, horsetail and fucus tincture. A mixture is prepared from all this. You only need to take 2 tablespoons and pour boiling water over them. Then boil over low heat for 15 minutes. For effectiveness, add 50 grams of honey and chopped lemon. Then you need to boil everything for another 15 minutes. The resulting broth is cooled, filtered and taken in a tablespoon 3 times a day.

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Herbal treatment

In case of an enlarged thyroid gland, celandine tincture is used. It is enough to use it on an empty stomach every morning and afternoon. One teaspoon of the product is enough. To prepare this tincture, you need to get 700 grams of alcohol. Celandine is simply poured with alcohol and infused. The positive effect of herbal treatment is observed in a short time. But the main thing in this case is systematic use.

You need to take 100 grams of seaweed, 50 grams of plantain, and the same amount of pine buds. Mix all these ingredients together and take only 2 tablespoons of the mixture. Pour boiling water over them and boil for 15 minutes with the lid closed over low heat. If desired, you can add 50 grams of honey and boil a little more. The remedy is used one tablespoon up to 3 times a day. It is advisable to drink the decoction for a month.

Before using folk medicine, you need to consult a doctor. After all, we are talking about children's health.

Homeopathy

Homeopathic remedies have always been an alternative to traditional medicine. At least because they contain only natural components. But due to 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 systems. A minimal amount of the drug is able to reach the cause of the disease and suppress it. The remedies are selected in accordance with the patient's drug type. Most drugs should be taken in a course together with another remedy. This will allow achieving the maximum positive result.

It is impossible to say for sure whether the remedy will help or not. To do this, you should visit a homeopathic doctor and consult with him. After all, each disease requires its own individual approach, even when treated with homeopathic remedies. You can find out about possible drugs, as well as their use, from a specialist. Taking the drugs on your own is highly discouraged.

Surgical treatment

Surgical intervention is not used in the presence of autoimmune thyroiditis. The problem is eliminated purely by medication. For this, the child is prescribed a number of special drugs that require constant use. Their action is aimed at normalizing the thyroid gland. It is advisable to resort to surgical treatment if the goiter has reached too large a size and interferes with the child's normal life. An overly enlarged thyroid gland can not only be painful, but also make breathing and swallowing difficult. In this case, a decision may be made regarding surgical intervention.

The operation may lead to the development of hypothyroidism. Due to the risk of aggravating the situation, surgical removal is resorted to extremely rarely. But if the goiter is too large and at the same time it compresses the organs of the neck, the operation is resorted to immediately.

Prevention

It is impossible to predict the development of the disease. It can occur both against the background of weakened immunity and experienced stress. Naturally, it is necessary to increase the body's defenses with the help of proper nutrition, sports and taking vitamins. But it is almost impossible to avoid stress, it 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 developing the disease.

If a child develops autoimmune thyroiditis, the patient should be monitored. After all, without proper treatment, the situation may worsen, leading to the development of hypothyroidism. It is necessary to constantly monitor the functionality of the thyroid gland. If the child complains of difficulty swallowing and breathing, you should immediately go to the hospital.

Forecast

If you start timely treatment, everything will end well. In general, the prognosis is favorable. People with this disease need to take Levothyroxine for life. This will prevent the process from recurring and improve the patient's condition.

Once every six months to a year, it is necessary to perform dynamic monitoring of hormonal indicators. This will allow you to monitor the condition of the thyroid gland and changes in it. If nodular neoplasms were detected during an ultrasound, you must visit an endocrinologist.

Normal health and working capacity with the disease can be maintained for 15 years. Even despite the fact that there will be periods of exacerbation. If all recommendations are followed, the prognosis will be extremely positive. You should not delay treatment, this will help avoid serious consequences.

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