Dealing of rheumatologists with a disease purely endocrine, due to two main reasons: 1)
The frequent presence of symptoms of the musculoskeletal system, no obvious disruption of thyroid hormones and 2) The presence of antinuclear antibodies in the blood of patients, which requires direct intervention by the rheumatologist to perform a differential diagnosis with other connective tissue diseases.
The disease called chronic lymphocytic thyroiditis and is very common in the general population (3.5 / 1000). particularly affects women (1 in 10 men) and the usual age of infection is 45-65 years. It is the most common cause of hypothyroidism in the US. He received its name from the Japanese physician Dr. Hakaru Hashimoto who worked sto Berlin in 1912.
It is an autoimmune disease. Although the cause is not known it is probable that the effect of some exogenous agent (virus or other), on a hereditary sensitive substrate and coupled with the appropriate age and gender, causes the production of antibodies against the thyroid cells. This will lead to a universal inflammation of the gland (thyroiditis), infiltration of abundant lymphocytes and plasma cells and the progressive destruction of the end result of inhibition of function (hypothyroidism).
The disease usually occurs as a stand alone entity, and only 10-15% can be combined with other. The presence of hereditary immune support shown by the presence of common histocompatibility antigens (HLA-DR3 and HLA-B8) and the appearance of antithyroid antibodies in relatives who suffer or suffer from autoimmune thyroiditis.
Symptoms of the disease are as chronic hypothyroidism namely: sensitivity to cold and heat, depression, fatigue, bradycardia, high cholesterol, obesity, reactive hypoglycemia, constipation, headaches, cramps, goiter, memory loss, alopecia and manic state.
Many believe that the complaints of the musculoskeletal system due to chronic hypothyroidism and is that too often rheumatic events occur in people who are in a euthyroid state. It could therefore be concluded that one of the complaints are two sources, one holing symptoms associated with the disorders of thyroid hormones (hypothyroidism) and other symptoms due to a chronic autoimmune and diffuse inflammation of the musculoskeletal system.
In the first case the year fall of the levels of thyroid hormones in the body, resulting in increased mucopolysaccharides concentration in the musculoskeletal system. therapies carpal, myopathies with increasing kretinikis kinase without muscle weakness and osteonecrosis hip or other bone.
In the second case, the articular manifestations of autoimmune thyroiditis of Hashimoto vary in severity, ranging from simple arthralgias and myalgias, which closely resemble those of fibromyalgia, until the appearance of symmetric type polyarthritis, moderate, usually limb hands and in rare cases asymmetric oligoarthritis of large joints. Attribute arthritis is that despite the chronicity does not lead to corrosive damage. These events can occur in euthyroid individuals.
The diagnosis of thyroiditis Hashimoto’s easy. Apart from the basic blood tests done to check thyroid gland, namely TSH, T3 and T4, we will while rarely found and antibodies the TSH receptor. At a rate that is around 15% of cases, no antibodies found in the blood. In these cases the thyroid biopsy will provide diagnosis.
One of the most striking findings that often leads the patient to a rheumatologist is the presence of positive antipyrine antibodies in titers ranging whose course the exclusion of their association with a connective tissue disease such as systemic lupus erythematosus is an emergency procedure. The frequency of ANA in Hashimoto’s thyroiditis is up to 15%.
Treatment of hypothyroidism of Hashimoto’s thyroiditis is relatively simple. Thyroxine is administered at different doses depending on age and disease severity. Achieving euthyroid state requires quite a long time. Should thyroxine not administered with cholestyramine, iron preparations, soulfakrati, calcium preparations and antacids, as absorption is not affected.
Conversely difficult the treatment of musculoskeletal disease events. Unfortunately, the administration of thyroid hormone does not solve the problem. The symptoms are maintained even though the patient is euthyroid. In many cases we are forced to face thyroiditis treatments such other autoimmune diseases namely the granting of nonsteroidal anti-inflammatory drugs, cortisone, antimalarials, even Methotrexatis5. In some studies, the administration of formulations of selenium reduced the concentration of antibodies up to 50%.
Except in rare cases, the prognosis is very good. Several times there with thyroxine therapy requires only one per 6 months laboratory test thyroid.