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FURTHER IMPROVEMENT OF MEDICAL PREVENTIVE MEASURES
AIMED AT PREVENTING ENDEMIC GOITER AND AUTOIMMUNE
THYROIDITIS IN THE MILITARY.
Sharipova Gulnihol Idiyevna
https://orcid.org/0009-0009-0825-0534
Yormatova Madina Nurmurodovna
https://orcid.org/0009-0002-2959-7536
https://doi.org/10.5281/zenodo.15661142
Abstract.
Against the background of autoimmune thyroiditis, patients are
found to have antibodies to thyroid antigens. The thyroid gland is damaged and
gradually grows. Over time, autoimmune thyroiditis leads to hypothyroidism, in
which the div lacks thyroid hormones. Hypothyroidism is accompanied by
weight gain, dry skin, and increased fatigue.
Key words.
Diffuse toxic goiter, remission, autoimmune thyroiditis, UTT
test method, osteoporosis, hypertension, atherosclerosis.
Autoimmune thyroiditis is an autoimmune disease that affects the thyroid
gland. Autoimmune thyroiditis is ten times more common in women than in
men. Symptoms usually first appear between the ages of 30 and 50. The overall
incidence increases with age in both men and women[1,3].
Against the background of autoimmune thyroiditis, patients are found to
have antibodies to thyroid antigens. The thyroid gland is damaged and gradually
grows. Over time, autoimmune thyroiditis leads to hypothyroidism, in which the
div lacks thyroid hormones. Hypothyroidism is accompanied by weight gain,
dry skin, and increased fatigue[2,5].
The diagnosis is made on the basis of a medical examination and
comprehensive diagnostics. The main diagnostic criteria include the
determination of antibodies in a blood test, hormone levels, and ultrasound
results. Therapy for autoimmune thyroiditis involves correcting hormonal
imbalance. Hormone replacement therapy involves lifelong administration of
thyroxine. Surgical treatment is indicated if a large goiter is formed, which
disrupts the functions of adjacent organs and causes physical or aesthetic
discomfort[2,4].
Autoimmune thyroiditis progresses slowly. It may take several months or
years before the condition is diagnosed.
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Symptoms are caused by hypothyroidism. In the early stages,
hypothyroidism is accompanied by subtle signs that can develop into striking
clinical manifestations.
• Early symptoms may include:
• fatigue, increased tiredness;
• constipation;
• dry skin;
• weight gain;
• More pronounced symptoms that indicate worsening hypothyroidism and
an enlarged thyroid gland:
• intolerance to low ambient temperatures;
• hair loss;
• feeling of pressure in the neck;
• voice change, hoarseness;
• menstrual cycle failure;
• joint and muscle pain;
• insomnia;
• depression.
• Subacute infectious thyroiditis is accompanied by pain, while autoimmune
thyroiditis does not cause local discomfort.
• Autoimmune thyroiditis is an autoimmune pathology. In this condition, the
immune system produces antibodies that attack the cells of the thyroid gland.
The reasons for the erroneous reaction of the immune system remain unclear.
Normally, antibodies are synthesized in response to bacterial and viral
infections.
• Risk factors for autoimmune thyroiditis include:
• hereditary predisposition;
• previous infectious disease;
• chronic stress;
• radiation exposure;
• autoimmune diseases.
• Scientists also note that there is a link between vitamin D deficiency and
autoimmune thyroiditis.
• The endocrinologist conducts a survey and then performs an examination.
The symptoms of the disease are varied and depend on the degree of
hypothyroidism:
• puffiness of the face, swelling around the eyes;
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• cold, dry, flaky skin;
• swelling of the hands and feet;
• increased blood pressure;
• decreased heart rate;
• slow movements;
• impaired coordination.
The doctor measures blood pressure (BP) and determines the heart rate
(HR). Hypothyroidism is characterized by hypotension and a decreased heart
rate.
• Patients with suspected autoimmune thyroiditis undergo tests:
• Thyroid-stimulating hormone (TSH). Produced in the brain. Activates the
production of thyroid hormones. Autoimmune thyroiditis is accompanied by
tissue destruction, decreased synthesis of the corresponding hormones in the
thyroid gland. The pituitary gland registers a decrease in the hormone content in
the blood and increases the production of stimulating thyroid-stimulating
hormone. Thus, TSH increases;
• Thyroxine (T4) and triiodothyronine (T3). The main hormones produced
in the thyroid gland. They participate in all metabolic physiological processes. A
decrease in the content of these hormones against the background of increased
TSH confirms the diagnosis;
• Thyroglobulin antibodies (AT-TG) and thyroid peroxidase antibodies.
Thyroglobulin is a substance from which thyroid hormones are synthesized in
the process of a chemical reaction, it is called a prohormone or precursor.
Thyroid peroxidase is an enzyme that participates in the synthesis of T3 and T4.
Against the background of autoimmune thyroiditis, the immune system
produces antibodies that attack the prohormone and enzyme, blocking the
production of hormones.
The following tests are not mandatory, but may be performed to evaluate
complications of hypothyroidism:
• Complete blood count: results show that almost half of patients have
anemia caused by hypothyroidism;
• Lipid profile: characteristic changes include elevated cholesterol and low-
density lipoproteins;
• Kidney function: uncompensated hypothyroidism impairs kidney
function, which leads to changes in the water-salt balance in the div.
Instrumental diagnostics:
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• ultrasound examination: allows you to determine the size, structure of the
thyroid gland, and also evaluate the gland for nodular formations;
• biopsy: fine-needle aspiration is performed to exclude an oncological
process.
The main treatment for autoimmune thyroiditis is hormone replacement
therapy. Levothyroxine is a synthetic hormone that acts like thyroxine in the
thyroid gland. The dose is selected individually and depends on age, weight,
symptoms, diagnosis, and concomitant disorders. Thyroxine is usually taken
throughout life. A blood test for TSH is taken after 6-10 weeks and, if necessary,
the dosage is adjusted[3].
After determining the optimal dosage, a blood test for TSH is taken once a
year. Thyroxine is usually taken in the morning before breakfast. Thyroxine
preparations are not indicated for autoimmune thyroiditis if the test results
show that the hormones are within normal limits. In this case, the attending
physician recommends regularly monitoring the TSH level[4].
Indications for surgical treatment include:
• large goiter, which causes obstructive syndrome: difficulty swallowing,
breathing, voice change;
• malignant neoplasm according to histology results;
• large goiter, which creates an undesirable aesthetic defect.
Complications of thyroiditis
• Thyroid hormones are required for the normal functioning of the entire
div. Uncompensated hypothyroidism, which developed due to autoimmune
thyroiditis, leads to the following complications:
• • Nodular goiter. Against the background of autoimmune thyroiditis,
hormone synthesis decreases. The thyroid gland begins to increase in size, as it
receives signals from the brain. However, this condition is not effective, since the
growth of the gland does not lead to an increase in hormone synthesis. Nodes
appear in the gland, which can reach large sizes and put pressure on adjacent
anatomical structures;
• Heart disease. Decreased thyroid function leads to impaired lipid
metabolism,
increased
cholesterol
and
low-density
lipoproteins.
Hypothyroidism leads to irregular heartbeat, which, combined with lipid
metabolism disorders, increases the risk of developing heart diseases such as
coronary heart disease;
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• Mental disorders. Autoimmune thyroiditis with hypothyroidism increases
the risk of mental disorders, which are not very pronounced at the beginning,
but can worsen over time if left untreated;
• Reproductive disorders. Thyroid hormones are closely related to sex
hormones. Due to insufficient thyroid hormones, there may be difficulties with
ovulation and pregnancy, menstrual irregularities with irregular, scanty or,
conversely, heavy periods. Men with hypothyroidism are diagnosed with erectile
dysfunction, reduced sperm count; • Pregnancy complications. Pregnant women
with hypothyroidism have an increased risk of premature birth and miscarriage.
If a pregnant patient has not received replacement therapy, there is a risk of
giving birth to a child with reduced intellectual abilities, with an autism
spectrum disorder, and speech delay;
• Myxedema. This is a serious complication of advanced hypothyroidism,
which is accompanied by swelling of the skin and subcutaneous tissue in the face
and neck, lethargy, drowsiness, and loss of consciousness. The extreme
manifestation is myxedematous coma, which requires urgent medical care[2].
To date, there is no primary prevention to prevent the development of
autoimmune thyroiditis. The good news is that with timely hormonal treatment,
thyroiditis and hypothyroidism respond well to treatment.
Recommendations, the observance of which ensures a favorable prognosis
for autoimmune thyroiditis:
• undergoing medical examinations and annual preventive examinations;
• if hypothyroidism is detected, regular monitoring by the attending
physician, taking medications strictly in accordance with the doctor's
prescriptions.
It is also recommended to pay attention to cases of thyroid disease and
autoimmune pathology in the family.
References:
1. Klinicheskie rekomendatsii Rossiyskoy Assotsiatsii Endokrinologov po
diagnostike i lecheniyu autoimmunenogo thyroidita u vzroslyx. Sost. Dedov I.I.,
Melnichenko G.A., Gerasimov G.A., Fadeev V.V., Petunina N.A., Alexandrova G.F.,
Troshina E.A., Kuznetsov N.S., Vanushko V.E., 2013
2. Lechenie endokrinnyx zabolevaniy: Rukovodstvo/Balabolkin M.I., Klebanova
E.M., Kreminskaya V.M. - Moscow: OOO "Meditsinskoe informatsionnoe
agentstvo", 2008
3. Olifirova O.S. Hashimoto's autoimmune thyroiditis in surgical practice //
Dalnevostochnyy meditsinsky journal, 3/2021. - pp. 13-15.
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4. Rozhko V.A. Sovremennoe sostoyanie problemy autoimmune thyroiditis //
Problemy zdorovya i ekologii, 2019. – p. 4-13.
5. Sadykhov F.G. Chirurgicheskoe lechenie bolnyx autoimmunenym
thyreoiditom // Vestnik Natsionalnogo mediko-khirurgicheskogo Tsentra im.
N.I. Pirogova 2023, vol. 18, No. 1. - p. 51-57.
