桥本甲状腺炎的研究进展

doi:10.16138/j.1673-6087.2024.04.01

摘要/Abstract

摘要：

桥本甲状腺炎(Hashimoto thyroiditis，HT)是很常见的器官性自身免疫性甲状腺疾病，发病率逐年上升，在临床中不仅会导致甲状腺功能减退，还发现其与多种免疫性疾病、内分泌疾病、风湿性疾病及甲状腺癌之间存在诸多联系。虽然确切的病因尚未完全阐明，治疗的主流仍是基于管理与替代治疗甲状腺功能减退，但随着研究的进一步深入，更多的临床变异类型被逐步发现，越来越多的因素被发现与HT的发病相关，治疗方法也有新发现。本文就HT的临床表现、病理特征和诊断、发病机制、与其他疾病的关系及治疗等方面的研究进展作一综述。

关键词: 桥本甲状腺炎, 自身免疫, 甲状腺功能减退, 甲状腺自身免疫性疾病

Abstract:

Hashimoto thyroiditis (HT) is a very common organic autoimmune thyroid disease, and its incidence is increasing year by year. It not only causes hypothyroidism in clinical practice, but also has many connections with a variety of immune diseases, endocrine diseases, rheumatic diseases and thyroid cancer. Although the exact etiology of HT has not been fully clarified, the mainstream treatment is still based on management and alternative treatment of hypothyroidism. However, as the research further deepens, more clinical variants have been gradually discovered, more and more factors have been found to be related to the onset of HT, and new discoveries have been made in treatment methods. This article reviews the research progress on clinical manifestations, pathological features, diagnosis, pathogenesis, relationship with other diseases and treatment of HT.

Key words: Hashimoto thyroiditis, Autoimmunity, Hypothyroidism, Autoimmune thyroid disorders

中图分类号:

R581.4

田利民, 冯婧. 桥本甲状腺炎的研究进展[J]. 内科理论与实践, 2024, 19(04): 217-223.

TIAN Limin, FENG Jing. Research progress of Hashimoto thyroiditis[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(04): 217-223.

参考文献 59

[1]	Cayres LCF, de Salis LVV, Rodrigues GSP, et al. Detection of alterations in the gut microbiota and intestinal permeability in patients with hashimoto thyroiditis[J]. Front Immunol, 2021,12:579140.
[2]	Hashimoto H. Zur kenntnis der lymphömatosen veränderung der schilddrüse (struma lymphomatosa)[J]. Arch Klin Chir, 1912, (97):219-248.
[3]	Caturegli P, De Remigis A, Chuang K, et al. Hashimoto’s thyroiditis: celebrating the centennial through the lens of the Johns Hopkins Hospital surgical pathology records[J]. Thyroid, 2013, 23(2):142-150. doi: 10.1089/thy.2012.0554 pmid: 23151083
[4]	Ragusa F, Fallahi P, Elia G, et al. Hashimotos’ thyroiditis: epidemiology, pathogenesis, clinic and therapy[J]. Best Pract Res Clin Endocrinol Metab, 2019, 33(6):101367.
[5]	Ralli M, Angeletti D, Fiore M, et al. Hashimoto’s thyroiditis: an update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation[J]. Autoimmun Rev, 2020, 19(10):102649.
[6]	Demirhan S, Polat O, Mert M. The relationship between tsh levels, thyroid autoantibodies and atherogenic index of plasma, ast to platelet ratio index score, and fibrosis 4 index in patients with hypothyroidism[J]. Acta Endocrinol (Buchar), 2023, 19(3):333-338.
[7]	Feldt-Rasmussen U. Hashimoto’s thyroiditis as a risk factor for thyroid cancer[J]. Curr Opin Endocrinol Diabetes Obes, 2020, 27(5):364-371. doi: 10.1097/MED.0000000000000570 pmid: 32773575
[8]	Chiarella G, Russo D, Monzani F, et al. Hashimoto thyroiditis and vestibular dysfunction[J]. Endocr Pract, 2017, 23(7):863-868. doi: 10.4158/EP161635.RA pmid: 28534686
[9]	Fallahi P, Ferrari SM, Antonelli A. In patients with subclinical hypothyroidism while in therapy with tablet l-t4, the liquid l-t4 formulation is more effective in restoring euthyroidism[J]. Endocr Pract, 2017, 23(2):170-174. doi: 10.4158/EP161545.OR pmid: 27849377
[10]	Amino N, Tada H, Hidaka Y. Postpartum autoimmune thyroid syndrome: a model of aggravation of autoimmune disease[J]. Thyroid, 1999, 9(7):705-713. doi: 10.1089/thy.1999.9.705 pmid: 10447018
[11]	Peng CC, Huai-En Chang R, Pennant M, et al. A literature review of painful hashimoto thyroiditis: 70 published cases in the past 70 years[J]. J Endocr Soc, 2019, 4(2):bvz008.
[12]	Ferracci F, Bertiato G, Moretto G. Hashimoto’s encephalopathy: epidemiologic data and pathogenetic considerations[J]. J Neurol Sci, 2004, 217(2):165-168. doi: 10.1016/j.jns.2003.09.007 pmid: 14706219
[13]	Brain L, Jellinek EH, Ball K. Hashimoto’s disease and encephalopathy[J]. Lancet, 1966, 2(7462):512-514. doi: 10.1016/s0140-6736(66)92876-5 pmid: 4161638
[14]	Laurent C, Capron J, Quillerou B, et al. Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT): characteristics, treatment and outcome in 251 cases from the literature[J]. Autoimmun Rev, 2016, 15(12):1129-1133. doi: S1568-9972(16)30203-8 pmid: 27639840
[15]	Waliszewska-Prosół M, Ejma M. Hashimoto encephalopathy-still more questions than answers[J]. Cells, 2022, 11(18):2873.
[16]	Riedel B. Die chronische, zur bildung eisenharter tumoren führende entzündung der schilddrüse[J]. Verh Dtsch Ges Chir, 1896, 25:101-105.
[17]	Hennessey JV. Clinical review: Riedel’s thyroiditis[J]. J Clin Endocrinol Metab, 2011, 96(10):3031-3041. doi: 10.1210/jc.2011-0617 pmid: 21832114
[18]	Kakudo K, Li Y, Taniguchi E, et al. IgG4-related disease of the thyroid glands[J]. Endocr J, 2012, 59(4):273-281. pmid: 22133985
[19]	Kust D, Matesa N. The impact of familial predisposition on the development of Hashimoto’s thyroiditis[J]. Acta Clin Belg, 2020, 75(2):104-108.
[20]	Weetman AP. An update on the pathogenesis of Hashimoto’s thyroiditis[J]. J Endocrinol Invest, 2021, 44(5):883-890. doi: 10.1007/s40618-020-01477-1 pmid: 33332019
[21]	Zhang QY, Liu W, Li L, et al. Genetic study in a large cohort supported different pathogenesis of Graves’ disease and Hashimoto’s hypothyroidism[J]. J Clin Endocrinol Metab, 2020, 105(7):dgaa170.
[22]	Vargas-Uricoechea H. Molecular mechanisms in autoimmune thyroid disease[J]. Cells, 2023, 12(6):918.
[23]	Huang CY, Chang TY, Chu CC, et al. The HLA-B gene and Hashimoto disease in Han Chinese children: a case-control and family-based study[J]. Tissue Antigens, 2012, 80(5):431-436. doi: 10.1111/tan.12003 pmid: 23020308
[24]	Ueda S, Oryoji D, Yamamoto K, et al. Identification of independent susceptible and protective HLA alleles in Japanese autoimmune thyroid disease and their epistasis[J]. J Clin Endocrinol Metab, 2014, 99(2):E379-E383.
[25]	Jia X, Wang B, Yao Q, et al. Variations in CD14 gene are associated with autoimmune thyroid siseases in the Chinese population[J]. Front Endocrinol (Lausanne), 2019,9:811.
[26]	Xu C, Wu F, Mao C, et al. Excess iodine promotes apoptosis of thyroid follicular epithelial cells by inducing autophagy suppression and is associated with Hashimoto thyroiditis disease[J]. J Autoimmun, 2016,75:50-57.
[27]	Toulis KA, Anastasilakis AD, Tzellos TG, et al. Selenium supplementation in the treatment of Hashimoto’s thyroiditis: a systematic review and a meta-analysis[J]. Thyroid, 2010, 20(10):1163-1173.
[28]	Ma J, Wu D, Li C, et al. Lower serum 25-hydroxyvitamin D level is associated with 3 types of autoimmune thyroid diseases[J]. Medicine (Baltimore), 2015, 94(39):e1639.
[29]	Wang K, Wei H, Zhang W, et al. Severely low serum magnesium is associated with increased risks of positive anti-thyroglobulin antibody and hypothyroidism: a cross-sectional study[J]. Sci Rep, 2018, 8(1):9904. doi: 10.1038/s41598-018-28362-5 pmid: 29967483
[30]	Zhao F, Feng J, Li J, et al. Alterations of the gut microbiota in Hashimoto’s thyroiditis patients[J]. Thyroid, 2018, 28(2):175-186.
[31]	Carlé A, Pedersen IB, Knudsen N, et al. Moderate alcohol consumption may protect against overt autoimmune hypothyroidism: a population-based case-control study[J]. Eur J Endocrinol, 2012, 167(4):483-490. doi: 10.1530/EJE-12-0356 pmid: 22802427
[32]	Lim DW, Choi MS, Kim SM. Bioinformatics and connectivity map analysis suggest viral infection as a critical causative factor of Hashimoto’s thyroiditis[J]. Int J Mol Sci, 2023, 24(2):1157.
[33]	Effraimidis G, Wiersinga WM. Mechanisms in endocrinology: autoimmune thyroid disease: old and new players[J]. Eur J Endocrinol, 2014, 170(6):R241-R252.
[34]	Wang B, Shao X, Song R, et al. The emerging role of epigenetics in autoimmune thyroid diseases[J]. Front Immunol, 2017,8:396.
[35]	Lu X, Liu Y, Xu L, et al. Role of jumonji domain-containing protein D3 and its inhibitor GSK-J4 in Hashimoto’s thyroiditis[J]. Open Med (Wars), 2023, 18(1):20230659.
[36]	Pitto L, Gorini F, Bianchi F, et al. New insights into mechanisms of endocrine-disrupting chemicals in thyroid diseases: the epigenetic way[J]. Int J Environ Res Public Health, 2020, 17(21):7787.
[37]	Chen YT, Chen YJ, Hwang CY, et al. Comorbidity profiles in association with vitiligo: a nationwide population-based study in Taiwan[J]. J Eur Acad Dermatol Venereol, 2015, 29(7):1362-1369. doi: 10.1111/jdv.12870 pmid: 25510261
[38]	Daneshpazhooh M, Mostofizadeh G M, Behjati J, et al. Anti-thyroid peroxidase antibody and vitiligo: a controlled study[J]. BMC Dermatol, 2006,6:3.
[39]	Pan XF, Gu JQ, Shan ZY. The prevalence of thyroid autoimmunity in patients with urticaria: a systematic review and meta-analysis[J]. Endocrine, 2015, 48(3):804-810.
[40]	Confino-Cohen R, Chodick G, Shalev V, et al. Chronic urticaria and autoimmunity: associations found in a large population study[J]. J Allergy Clin Immunol, 2012, 129(5):1307-1313. doi: 10.1016/j.jaci.2012.01.043 pmid: 22336078
[41]	Nuzzo V, Tauchmanova L, Colasanti P, et al. Idiopathic chronic urticaria and thyroid autoimmunity: experience of a single center[J]. Dermatoendocrinol, 2011, 3(4):255-258. doi: 10.4161/derm.3.4.17066 pmid: 22259654
[42]	Posselt RT, Coelho VN, Skare TL. Hashimoto thyroiditis, anti-thyroid antibodies and systemic lupus erythematosus[J]. Int J Rheum Dis, 2018, 21(1):186-193. doi: 10.1111/1756-185X.13089 pmid: 28544477
[43]	Ong SG, Choy CH. Autoimmune thyroid disease in a cohort of Malaysian SLE patients: frequency, clinical and immunological associations[J]. Lupus, 2016, 25(1):67-74. doi: 10.1177/0961203315593164 pmid: 26113361
[44]	Ferrari SM, Fallahi P, Ruffilli I, et al. The association of other autoimmune diseases in patients with Graves’ disease (with or without ophthalmopathy): review of the literature and report of a large series[J]. Autoimmun Rev, 2019, 18(3):287-292.
[45]	Lu MC, Chang SC, Huang KY, et al. Higher risk of thyroid disorders in young patients with type 1 diabetes: a 12-year nationwide, population-based, retrospective cohort study[J]. PLoS One, 2016, 11(3):e0152168.
[46]	Kahles H, Fain PR, Baker P, et al. Genetics of autoimmune thyroiditis in type 1 diabetes reveals a novel association with DPB1*0201: data from the type 1 diabetes genetics consortium[J]. Diabetes Care, 2015,38 Suppl 2:S21-S28.
[47]	Daramjav N, Takagi J, Iwayama H, et al. Autoimmune thyroiditis shifting from Hashimoto’s thyroiditis to Graves’ disease[J]. Medicina (Kaunas), 2023, 59(4):757.
[48]	Dailey ME, Lindsay S, Skahen R. Relation of thyroid neoplasms to Hashimoto disease of the thyroid gland[J]. AMA Arch Surg, 1955, 70(2):291-297. doi: 10.1001/archsurg.1955.01270080137023 pmid: 13227748
[49]	Jankovic B, Le KT, Hershman JM. Clinical review: Hashimoto’s thyroiditis and papillary thyroid carcinoma: is there a correlation?[J]. J Clin Endocrinol Metab, 2013, 98(2):474-482. doi: 10.1210/jc.2012-2978 pmid: 23293329
[50]	Chao G, Zhu Y, Fang L. Correlation between Hashimoto’s thyroiditis-related thyroid hormone levels and 25-hydroxyvitamin D[J]. Front Endocrinol (Lausanne), 2020,11:4.
[51]	Sulaieva O, Selezniov O, Shapochka D, et al. Hashimoto’s thyroiditis attenuates progression of papillary thyroid carcinoma: deciphering immunological links[J]. Heliyon, 2020, 6(1):e03077.
[52]	Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria[J]. Autoimmun Rev, 2014, 13(4-5):391-397. doi: 10.1016/j.autrev.2014.01.007 pmid: 24434360
[53]	Wichman J, Winther KH, Bonnema SJ, et al. Selenium supplementation significantly reduces thyroid autoantibody levels in patients with chronic autoimmune thyroiditis: a systematic review and meta-analysis[J]. Thyroid, 2016, 26(12):1681-1692. pmid: 27702392
[54]	Bruscolini A, Sacchetti M, La Cava M, et al. Quality of life and neuropsychiatric disorders in patients with Graves’ orbitopathy: current concepts[J]. Autoimmun Rev, 2018, 17(7):639-643. doi: S1568-9972(18)30102-2 pmid: 29729448
[55]	Roehlen N, Doering C, Hansmann ML, et al. Vitamin D, FOXO3a, and sirtuin1 in Hashimoto’s thyroiditis and differentiated thyroid cancer[J]. Front Endocrinol (Lausanne), 2018,9:527.
[56]	Vieira IH, Rodrigues D, Paiva I. Vitamin D and autoimmune thyroid disease-cause, consequence, or a vicious cycle?[J]. Nutrients, 2020, 12(9):2791.
[57]	Liontiris MI, Mazokopakis EE. A concise review of Hashimoto thyroiditis (HT) and the importance of iodine, selenium, vitamin D and gluten on the autoimmunity and dietary management of HT patients[J]. Hell J Nucl Med, 2017, 20(1):51-56. doi: 10.1967/s002449910507 pmid: 28315909
[58]	Topliss DJ. Clinical update in aspects of the management of autoimmune thyroid diseases[J]. Endocrinol Metab (Seoul), 2016, 31(4):493-499.
[59]	Guldvog I, Reitsma LC, Johnsen L, et al. Thyroidectomy versus medical management for euthyroid patients with Hashimoto disease and persisting symptoms: a randomized trial[J]. Ann Intern Med, 2019, 170(7):453-464. doi: 10.7326/M18-0284 pmid: 30856652