Журнал заболеваний щитовидной железы и терапии
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Etiopathogenetic Mechanisms in Hashimoto’s Autoimmune Thyroid Disease

Sergio Abanades

Hashimoto’s disease (HD) is an autoimmune thyroid disease often leading to hypothyroidism. The current therapy for these patients consists in traditional Hormone Replacement Therapy (HRT) to compensate inadequate thyroid function. However, clinical management of this and other autoimmune disorders usually dismisses the etiologic component, even when the gold-standard pharmacological treatment is not effective and/or the patient remains asymptomatic. Here, we propose to dig into the etiopathogenic factors as an attempt to unravel patient’s negative response to therapy and to improve therapeutic and preventive approaches as standard medical practice as well as to complement HRT. These factors may include genetic susceptibility, intestinal permeability defects, other pathologies like celiac disease, gluten intolerance and biopsychosocialstress, gender, sex hormones and micronutrients (vitamin D, iodine and selenium). Exposure to environmental toxic substances (heavy metals and others) and infectious agents (both viral and bacterial) may also trigger HD development. Finally, given the implication of multiple mechanisms of etiology and pathogenesis, a multidisciplinary strategy may be required to deliver integrated and successful patient care.