Itoh Mitsuyasu
Department of Endocrinology and Metabolism, Fujita Health University, School of Medicine.
Nihon Rinsho. 2012 Nov;70(11):1938-44.
Hashimoto's thyroiditis emerges in patients who have genetic preponderance such as SNPs of CTLA-4 and risk factors such as excess intake of iodine, pregnancy or postpartum period, and smoking. Such risk factors also affect the entire clinical course. One of the major outcomes in Hashimoto's thyroiditis appears to be increased in cardio-vascular risks through subclinical hypothyroidism and concomitant metabolic syndrome, but in most cases, treatment with L-T4 has little effects on cardio-vascular benefit or quality of life. The pregnant women also have risks for obstetric complications and postpartum thyroid dysfunction. The women who have anti-TPO antibodies, type 1 diabetes, or previous history of post-partum thyroid dysfunction are recommended to be measured their TSH. It is noteworthy that Hashimoto's thyroiditis is sometimes complicated with encephalopathy, papillary carcinoma, or IgG4-related thyroiditis. IgG4-related thyroiditis is partly similar but partly discerned from a variant of Hashimoto's thyroiditis. The pathogenetic roles of this variant on autoimmune-based thyroiditis remain unclear.
桥本甲状腺炎出现在具有遗传易感性(如细胞毒性T淋巴细胞相关抗原4的单核苷酸多态性)以及危险因素(如碘摄入过量、妊娠或产后时期、吸烟)的患者中。这些危险因素也会影响整个临床病程。桥本甲状腺炎的主要后果之一似乎是通过亚临床甲状腺功能减退和伴随的代谢综合征增加心血管风险,但在大多数情况下,左甲状腺素治疗对心血管益处或生活质量几乎没有影响。孕妇也有产科并发症和产后甲状腺功能障碍的风险。建议对有抗甲状腺过氧化物酶抗体、1型糖尿病或既往产后甲状腺功能障碍病史的女性检测促甲状腺激素。值得注意的是,桥本甲状腺炎有时会并发脑病、乳头状癌或IgG4相关性甲状腺炎。IgG4相关性甲状腺炎部分与桥本甲状腺炎的一种变体相似,但部分又有所不同。这种变体在自身免疫性甲状腺炎中的致病作用仍不清楚。