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Der Internist

, Volume 58, Issue 1, pp 47–58 | Cite as

Autoimmune Schilddrüsenerkrankungen

  • S. AlleleinEmail author
  • J. Feldkamp
  • M. Schott
CME

Zusammenfassung

Autoimmune Schilddrüsenerkrankungen gelten in Deutschland als die häufigste Ursache von Schilddrüsenfunktionsstörungen. Unterschieden werden die Autoimmunthyreoiditis (AIT) und der Morbus Basedow. Die AIT ist die häufigste Autoimmunerkrankung des Menschen; initial kann es zu einer Freisetzungshyperthyreose und im Verlauf durch Infiltration der Schilddrüse mit zytotoxischen T‑Zellen zu einer Destruktion des Schilddrüsengewebes und zu einer Hypothyreose kommen. Die Substitution mit Levothyroxin ist bei der manifesten Hypothyreose bzw. bei ausgeprägter latenter Hypothyreose indiziert und soll das thyreoideastimulierende Hormon (TSH) normalisieren. Der Morbus Basedow ist gekennzeichnet durch stimulierende TSH-Rezeptor-Antikörper, die zur Überfunktion der Schilddrüse führen. Auch eine endokrine Orbitopathie kann auftreten. Eine ablative Behandlung mit Radiojodtherapie oder Thyreoidektomie ist bei fehlender Remission nach 1‑jähriger thyreostatischer Therapie indiziert.

Schlüsselwörter

Hashimoto-Thyreoiditis Morbus Basedow Hypothyreose Hyperthyreose Levothyroxin 

Autoimmune diseases of the thyroid gland

Abstract

Autoimmune diseases of the thyroid gland are considered to be the most frequent cause of thyroid gland disorders. Autoimmune thyroid diseases consist of two subgroups: autoimmune thyroiditis (AIT) and Graves’ disease. The AIT is the most common human autoimmune disease. Infiltration of the thyroid gland with cytotoxic T‑cells can lead to an initial thyrotoxicosis und during the course to hypothyroidism due to destruction of the thyroid gland. Substitution with Levothyroxine is indicated for manifest hypothyroidism and subclinical hypothyroidism with increased thyroid antibodies with the intention of normalizing the serum thyroid stimulating hormone (TSH). Graves’ disease is characterized by the appearance of stimulating TSH receptor antibodies leading to hyperthyroidism. Endocrine ophthalmopathy may also occur. Ablative therapy with radioiodine therapy or thyroidectomy is administered to patients with Graves’ disease without remission after at least 1 year of antithyroid drug therapy.

Keywords

Hashimoto disease Graves disease Hypothyroidism Hyperthyroidism Levothyroxine 

Notes

Danksagung

Wir bedanken uns bei Herrn PD Dr. Hubertus Hautzel, stellvertretender Direktor der Nuklearmedizinischen Klinik des Universitätsklinikums Düsseldorf (Standort Jülich), für die Bereitstellung der szintigraphischen Abbildungen.

Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Allelein, J. Feldkamp und M. Schott geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag Berlin 2016

Authors and Affiliations

  1. 1.Funktionsbereich Spezielle EndokrinologieUniversitätsklinikum DüsseldorfDüsseldorfDeutschland
  2. 2.Klinik für Allgemeine Innere Medizin, Endokrinologie, Diabetologie und InfektiologieKlinikum Bielefeld MitteBielefeldDeutschland

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