In the practice of an endocrinologist, there are 2 horror stories: hormones and chronic autoimmune thyroiditis (HAIT). And if the hormones are different, among them there may be those who should be feared, then the danger of KHAIT is clearly overestimated.
What is HAIT? This is the production of antibodies by the body against its thyroid gland. Antibodies attack an innocent organ for a long time and very often can destroy it completely. Scary.
The first nightmare faced by patients is an increase in antibodies to thyroid peroxidase (TPO). Moreover, the normal values of antibodies are very low (usually up to 6 units ), against this background, even 30 units seem to be a nightmare. Meanwhile, an isolated increase in antibodies to TPO (i.e., if the levels of hormones TSH, free T4 and free T3 are within the normal range) is not yet a reason for treatment.
According to statistics, after detecting an increase in antibodies, the likelihood of developing real chronic autoimmune thyroiditis in the next 20 years of life is 30%.
The situation with antibodies to thyroglobulin (TG) is even more interesting: they have no relation to KHAIT by themselves, they can rise up “for the company.” An isolated increase in antibodies to thyroglobulin (when antibodies to TPO are not increased) is diagnostically significant only with a completely removed thyroid gland. In other situations, this is an accidental find, let’s say “a personal matter of the organism itself, not related to the endocrinologist.”
The second “nightmare” of KHAIT : changes in ultrasound. They are usually very colorfully described by doctors, awakening different associations in patients. In fact, doctors are simply describing a typical situation that happens to the thyroid gland when it is in trouble.
It is impossible to diagnose KHAIT by ultrasound alone .
What is the threat to a person of changes in the thyroid gland with HAIT ? Nothing. This condition will not develop into cancer, it is not necessary to operate on it, it will not spread to other organs.
When do antibodies to TPO really matter?
- When there are more than 500 (several years) or 1000 (detected for the first time) with a normal level of TSH, T4 and T3 free. In this case, a person needs to check the function of the thyroid gland annually (the above 4 indicators are better in winter, since the likelihood of thyroid failure in winter is higher). 20 years is a long time, 30% is not enough, but it is better to play it safe.
- If the above situation is noted during pregnancy or during a planned pregnancy, then the woman will be observed much more closely. Pregnancy is a burden for the thyroid gland, who knows how it will cope with it.
- If, with a high level of antibodies, there is a violation of the level of TSH, and T4 and T3 are free – normal. This is called subclinical hypothyroidism. It is highly likely that the antibodies did reach the thyroid gland. In such a situation, hormone replacement therapy can be prescribed. And you can not appoint. And you can assign and then cancel. Here it is up to the doctor to decide in each specific case, for this he was trained for so many years.
- If the impaired TSH is combined with the impaired free T4 + high antibodies. This is already a real HAIT. In this situation, treatment is necessary.
And now we smoothly come to the third nightmare of KHAIT : lifelong hormone replacement therapy (HRT). Sounds awful, but it actually means just one pill in the morning. In principle, there are no restrictions and contraindications.
- You can get pregnant and give birth on HRT, the drug does not pass through the placenta, and the child synthesizes hormones for himself from the 8th – 10th week on his own.
- The sun, sea, sauna, massage will not fundamentally change the state, so there is no point in avoiding them, depriving yourself of pleasure.
- Alcohol, parties – no question, live as before.
- Skipping one tablet – yes, at least 3, the drug accumulates and the body will last for some time without much loss. Skipping longer is already fraught.
The fourth nightmare of HAIT is weight gain on HRT. It will not be. You are simply replacing a natural hormone with an artificial one. Fortunately, it was produced very well, so the body does not feel the difference and lives on.
It should be noted that CAIT was first described by the Japanese Hashimoto (so the disease sometimes called thyroiditis Hashimoto ) in 1912, HRT patients receive is not less than 30 years. During this time, extensive material has been accumulated on the preparations, confirming that they do not affect either life expectancy or its quality.
The only proven adverse effect is worsening of osteoporosis. In this regard, X-ray densitometry is recommended for persons who have been taking 100 or more mcg of the drug for more than 10 years to assess the amount of calcium in the bones.
It is imperative to be monitored with KHAIT , but the frequency of examinations must be determined by the doctor individually. It depends on several reasons: age, initial TSH level, and the prescribed dose of the drug. Let’s say right away that the annual ultrasound scan will definitely not be included in this list.