Autoimunitné zápaly štítnej žľazy

10.7.2012 , Jakub Šulta

Autoimunitné zápaly štítnej žľazy sú choroby, ktoré sa vyznačujú tým, že protilátky alebo bunky nášho imunitného systému útočia proti bunkám štítnej žľazy. Dve základné ochorenie z tejto skupiny sú Graves-Basedowova choroba a tzv. Hashimotova tyreoiditída. Oba tieto autoimunitné zápaly štítnej žľazy môžu mať naozaj nepríjemné a nebezpečné prejavy.

Autoimunitné zápaly štítnej žľazy

V dnešnej dobe rastie počet pacientov s ochorením štítnej žľazy. Najčastejšie sa objavujú u žien, ale nevyhýbajú sa ani mužom a deťom. Štítna žľaza je orgán špecializovaný na tvorbu hormónov trijódtyronínu (T3), tyroxínu (T4) a kalcitonínu. Prvé dva hormóny ovplyvňujú chod prakticky všetkých častí ľudského tela od hospodárenia s kyslíkom, cez tvorbu bielkovín po odbúravanie tukov. Akékoľvek ochorenie štítnej žľazy sa prejaví buď zvýšenou tvorbou hormónov (hypertyreóza), alebo zníženou tvorbou (hypotyreóza). Hypotyreóza aj hypertyreóza sú stavy, ktoré majú veľmi veľa nepríjemných príznakov, ktoré znižujú kvalitu života. Tieto choroby majú mnoho príčin, medzi ktorými majú svoje miesto autoimunitné zápaly.

Autoimunitný zápal

Každý človek má imunitný systém, ktorý nás chráni pred všetkým, čo poškodzuje rovnováhu v našom organizme. Bojuje napríklad proti vírusom, baktériám, dokonca aj rakovinovým bunkám. Hoci bez milosti zlikviduje všetko cudzie alebo poškodené, zdravé bunky vlastného tela necháva bez povšimnutia. Ak je funkcia imunitného systému narušená, môže sa stať, že niektoré vlastné bunky ľudského tela (alebo orgány) nespozná a začne ich ničiť. V dôsledku týchto zmien dochádza k vzniku zápalu v napadnutom tkanive, ktorým nemusí byť len štítna žľaza ale veľmi často to bývajú črevá alebo pečeň. Hoci nie je presný mechanizmus vzniku autoimunitných ochorení známy, predpokladá sa porucha v riadení imunitného systému či vplyv niektorých vírusov.

Graves - Basedowova choroba

Graves - Basedowova choroba je autoimunitný zápal štítnej žľazy, ktorý je najčastejšou príčinou hypertyreózy čiže zvýšenej tvorby hormónov. Podľa štatistiky sa podieľa až na 60-80% prípadov. Graves - Basedowova choroba je silne geneticky podmienená a ovplyvňuje až 2% celej ženskej populácie. Najčastejšie postihuje ženy v strednom veku, ktoré sú ohrozené päťkrát viac než muži.

Príznaky

Príznaky Graves - Basedowovej choroby zodpovedajú prejavom hypertyreózy. Hypertyreóza je charakteristická zrýchlením metabolizmu, chorý je unavený, hyperaktívny, nadmerne sa potí, má časté nutkanie na stolicu, hnačku a búšenie srdca. Z príznakov, ktoré môžeme ďalej pozorovať sa tento autoimunitný zápal štítnej žľazy prejavuje jej zväčšením tzv. strumou a pre bežnú hypertyreózu neobvyklým príznakom Basedowovej choroby oftalmopatiou, čo sú charakteristicky vypúlené oči, ktoré akoby vyliezajú chorému z očnice.

Vznik

Príčina vzniku tohto autoimunitného zápalu štítnej žľazy nie je objasnená, ale existuje niekoľko teórií, ktoré sú viac či menej pravdepodobné. Najčastejšie sa vedci prikláňajú k názoru, že príčinou sú baktérie alebo vírusy, ktorý naštartujú autoimunitu. Neskôr bunky imunitného systému začnú tvoriť protilátky proti bunkám štítnej žľazy, kde začne prebiehať zápal, čo orgán poškodzuje a spôsobuje špecifické príznaky.

Liečba

Keďže nepoznáme pravú príčinu autoimunitných zápalov, nemôže nasadiť presnú liečbu. Štítnu žľazu pri Graves - Basedowovej chorobe liečime pomocou tyreostatík, rádiojódu a chirurgického zákroku. Tyrostatiká sú lieky, ktoré znižujú tvorbu hormónov štítnej žľazy a normalizujú tak zvýšenú funkciu. Čiastočné alebo úplné zničenie štítnej žľazy môžeme vykonať rádiojódom. Poslednou možnosťou býva chirurgické odstránenie štítnej žľazy alebo jej časti. Žiadny typ liečby nie je preferovaný a pri výbere záleží na aktuálnom stave chorého, rozsahu ochorenia a štáte či kontinente. Zatiaľ čo v USA je najpopulárnejšia liečba rádiojódom, naopak v Európe častejšie volíme podanie tyreostatík a následné chirurgické odstránenie žľazy.

Hashimotov zápal štítnej žľazy

Hashimotov zápal štítnej žľazy (Hashimotova tyreoiditída) je najčastejšou príčinou zníženej funkcie štítnej žľazy tzv. hypotyreózy. Ide o chronický autoimunitný zápal, ktorý bol ako prvý uznaný za autoimunitné ochorenie.

Príznaky

Hashimotova tyreoiditída veľmi často vedie k hypotyreóze. Príznaky tejto choroby sú preto veľmi podobné zníženej funkcii štítnej žľazy. U chorých sa môže objaviť prírastok hmotnosti, depresia, citlivosť na teplo, chlad, únava, záchvaty paniky, vysoký cholesterol, zápcha, svalová slabosť a rad ďalších prejavov, ktoré sa líšia predovšetkým intenzitou podľa rozsahu ochorenia. Ďalej sa môže prechodne objaviť struma, ktorá je však prítomná obzvlášť v počiatočných štádiách ochorenia.

Vznik

Podobne ako Graves - Basedowova choroba je aj Hashimotova tyreoiditída autoimunitný zápal štítnej žľazy u ktorého nepoznáme presný mechanizmus vzniku. Opäť dochádza pravdepodobne k poruche v imunitnom systéme, ktorá môže byť podmienená geneticky alebo spustená bakteriálnym alebo vírusovým ochorením. Neskôr začnú bunky imunitného systému produkovať protilátky, ktoré poškodzujú bunky štítnej žľazy.

Liečba

Liečba tohto autoimunitného zápalu štítnej žľazy je zameraná hlavne na doplnenie chýbajúcich hormónov, ktoré štítna žľaza nedokáže sama vyrobiť. Hormóny sa berú v tabletách. Prognóza je zvyčajne priaznivá v prípade včasnej diagnózy a správnej liečby.

Liečba autoimunitných zápalov štítnej žľazy

Liečba závisí na druhu zápalu a jeho prejavoch na celkový stav organizmu. Choroby štítnej žľazy lieči endokrinológ. Veľmi dôležité sú pravidelné prehliadky u lekára, ktorý kontroluje hladiny hormónov v krvi a na základe toho určuje dávkovanie liekov. Pravidelné lekárske prehliadky sú veľmi dôležité aj z jedného veľmi závažného dôvodu. Pacienti, u ktorých bol zistený autoimunitný zápal štítnej žľazy, majú vyššie riziko vypuknutia ďalších autoimunitných chorôb. Môže sa pridať napríklad cukrovka 1. typu, celiakia, cirhóza pečene, ulcerózna kolitída, Crohnova choroba a ďalšie choroby. Preto je potrebné veľmi starostlivo strážiť svoj zdravotný stav a byť pod trvalým dohľadom nielen endokrinológa, ale aj imunológa.

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