Hashimotov tireoiditis

Hašimoto tireoiditis je autoimuno oboljenje s nastankom strume te s povišenim titrom antitijela protiv tiroidne peroksidaze i tiroglobulina u krvi. Prvi put ga je opisao 1912. godine Hakaru Hašimoto.^[1]

Epidemiologija

Pacijenti su u 90-95% slučajeva žene, obično između 45 i 65 godina starosti, i češće obolijevaju bijelci u odnosu na crnce i Japance.^[2] Nema razlike između žena i muškaraca u učestalosti ovog oboljenja kod djece s Downovim sindromom.^[3]

Klinički znaci

Odrasli pokazuju bezbolnu, postepenu insuficijenciju štitne žlijezde zbog autoimune destrukcije žljezdanog tkiva i u početku mogu imati prolazni hipertioroidizam (povišena produkcija hormona štitne žlijezde). Djeca pokazuju promjenljivi hipotireoidizam (smanjena produkcija hormona štitne žlijezde) i mogu pokazati remisiju do eutiroidizma (normalna produkcija hormona štitne žlijezde).^[4] Hašimoto tiroiditis je asociran s dobro diferenciranim karcinomom štitnjače^[5] i može se razviti u limfom štitnjače.^[6] Kod pacijenata kojima se štitnjača odstrani zbog Hašimoto tiroiditisa, karcinom štitnjače je već prisutan u tkivu štitnjače, čak i ukoliko preoperativno nije postojala sumnja na njega.^[7]

Laboratorijski nalazi

Antitijela:

Anti-TSHR: Karakteristična za Hašimoto i Grave-tiroiditis, s naznakom da se ova antitijela u obje bolesti vežu za TSH-receptore, ali u Hašimoto-tiroiditisu ih blokiraju, a u Grave-tiroiditisu ih stimuliraju;^[8]
Anti-tiroglobulin: manje senzitivna, ali jednako specifična kao anti-tiroidperoksidaza;^[9]
Anti-tiroidperoksidaza (prethodno nazivana "antimikrozomalna antitijela"), senzitivna ali ne i specifična, jer 20% zdravih žena ima ova antitijela u krvi.

Terapija

Obično nije potrebna nikakva terapija. Ukoliko se pojavi hipotiroiditis, potrebno je nadomjestiti nedostatak hormona, a ukoliko štitnjača previše naraste, vrši se subtotalno hirurško odstranjenje štitnjače.^[10]

Reference

^ Hashimoto’s Thyroiditis
^ Racial and Age-related Differences in Incidence and Severity of Focal Autoimmune Thyroiditis
^ "http://www.karger.com/Article/Abstract/157874". www.karger.com. Pristupljeno 29. 4. 2016. Vanjski link u parametru |title= (pomoć)
^ Assessment of thyroid function during the long course of Hashimoto's thyroiditis in children and adolescents
^ Larson, Shawn D.; Jackson, Lindsey N.; Riall, Taylor S.; Uchida, Tatsuo; Thomas, Robert P.; Qiu, Suimin; Evers, B Mark (1. 5. 2007). "INCREASED INCIDENCE OF WELL-DIFFERENTIATED THYROID CANCER ASSOCIATED WITH HASHIMOTO'S THYROIDITIS AND THE ROLE OF THE PI3K/AKT PATHWAY". Journal of the American College of Surgeons. 204 (5): 764–775. doi:10.1016/j.jamcollsurg.2006.12.037. ISSN 1072-7515. PMC 2430882. PMID 17481480.
^ Moshynska, O. V.; Saxena, A. (1. 4. 2008). "Clonal relationship between Hashimoto thyroiditis and thyroid lymphoma". Journal of Clinical Pathology. 61 (4): 438–444. doi:10.1136/jcp.2007.051243. ISSN 1472-4146. PMID 18006670.
^ Shih, Ming-Lang; Lee, James A.; Hsieh, Chung-Bao; Yu, Jyh-Cherng; Liu, Hsaio-Dung; Kebebew, Electron; Clark, Orlo H.; Duh, Quan-Yang (1. 7. 2008). "Thyroidectomy for Hashimoto's thyroiditis: complications and associated cancers". Thyroid: Official Journal of the American Thyroid Association. 18 (7): 729–734. doi:10.1089/thy.2007.0384. ISSN 1050-7256. PMID 18631001.
^ Akamizu, T.; Mori, T.; Nakao, K. (1. 10. 1997). "Pathogenesis of Graves' disease: molecular analysis of anti-thyrotropin receptor antibodies". Endocrine Journal. 44 (5): 633–646. ISSN 0918-8959. PMID 9466318.
^ Tozzoli, Renato; Villalta, Danilo; Kodermaz, Graziano; Bagnasco, Marcello; Tonutti, Elio; Bizzaro, Nicola (1. 1. 2006). "Autoantibody profiling of patients with autoimmune thyroid disease using a new multiplexed immunoassay method". Clinical Chemistry and Laboratory Medicine. 44 (7): 837–842. doi:10.1515/CCLM.2006.137. ISSN 1434-6621. PMID 16776630.
^ "Hashimoto's disease Treatments and drugs - Mayo Clinic". www.mayoclinic.org. Pristupljeno 29. 4. 2016.

[1] Hashimoto’s Thyroiditis

[2] Racial and Age-related Differences in Incidence and Severity of Focal Autoimmune Thyroiditis

[3] "http://www.karger.com/Article/Abstract/157874". www.karger.com. Pristupljeno 29. 4. 2016. Vanjski link u parametru |title= (pomoć)

[4] Assessment of thyroid function during the long course of Hashimoto's thyroiditis in children and adolescents

[5] Larson, Shawn D.; Jackson, Lindsey N.; Riall, Taylor S.; Uchida, Tatsuo; Thomas, Robert P.; Qiu, Suimin; Evers, B Mark (1. 5. 2007). "INCREASED INCIDENCE OF WELL-DIFFERENTIATED THYROID CANCER ASSOCIATED WITH HASHIMOTO'S THYROIDITIS AND THE ROLE OF THE PI3K/AKT PATHWAY". Journal of the American College of Surgeons. 204 (5): 764–775. doi:10.1016/j.jamcollsurg.2006.12.037. ISSN 1072-7515. PMC 2430882. PMID 17481480.

[6] Moshynska, O. V.; Saxena, A. (1. 4. 2008). "Clonal relationship between Hashimoto thyroiditis and thyroid lymphoma". Journal of Clinical Pathology. 61 (4): 438–444. doi:10.1136/jcp.2007.051243. ISSN 1472-4146. PMID 18006670.

[7] Shih, Ming-Lang; Lee, James A.; Hsieh, Chung-Bao; Yu, Jyh-Cherng; Liu, Hsaio-Dung; Kebebew, Electron; Clark, Orlo H.; Duh, Quan-Yang (1. 7. 2008). "Thyroidectomy for Hashimoto's thyroiditis: complications and associated cancers". Thyroid: Official Journal of the American Thyroid Association. 18 (7): 729–734. doi:10.1089/thy.2007.0384. ISSN 1050-7256. PMID 18631001.

[8] Akamizu, T.; Mori, T.; Nakao, K. (1. 10. 1997). "Pathogenesis of Graves' disease: molecular analysis of anti-thyrotropin receptor antibodies". Endocrine Journal. 44 (5): 633–646. ISSN 0918-8959. PMID 9466318.

[9] Tozzoli, Renato; Villalta, Danilo; Kodermaz, Graziano; Bagnasco, Marcello; Tonutti, Elio; Bizzaro, Nicola (1. 1. 2006). "Autoantibody profiling of patients with autoimmune thyroid disease using a new multiplexed immunoassay method". Clinical Chemistry and Laboratory Medicine. 44 (7): 837–842. doi:10.1515/CCLM.2006.137. ISSN 1434-6621. PMID 16776630.

[10] "Hashimoto's disease Treatments and drugs - Mayo Clinic". www.mayoclinic.org. Pristupljeno 29. 4. 2016.

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