Autoimunska tireoidna bolest i poliglandularne autoimunske bolesti

Abstract

Autoimmune polyglandular syndrome (APS) involves dysfunction of two or more endocrine glands, which is based on the autoimmune mechanism. Many authors in addition to the two main APS syndrome, involves the third stand in which autoimmune thyroid disease (ATD) is associated with other autoimmune diseases. APS type 1 occurs less frequently, starting in early childhood and the key is mutation in autoimmune regulator gene. Three major components characterize this syndrome: hypoparathyroidism, autoimmune adrenal insufficiency and mucocutaneous candidiasis. APS type 2 is associated with the HLA antigen system and basically is a disorder of CD4+ and CD25+ regulatory T-cells. The main components of the syndrome are: Addison's disease, ATD and type 1 diabetes mellitus. An important feature of APS is that the expression of components occurs in different time intervals, with each other long periods. ATD is more common than other autoimmune endocrine diseases and include Graves' disease, chronic autoimmune thyroiditis and postpartum thyroiditis. ATD associated with HLA class II genes and polymorphism of cytotoxic T-lymphocytes antigen 4. In basic there is disorder of cellular and humoral immunity, with auto-antibodies targeting tissue specific antigen and and present infiltration of mononuclear cells, predominantly lymphocytes in the affected tissue. The most common antibodies are thyroid peroxidase, thyroglobulin and TSH receptor antibodies. ATD is often associated with other endocrine (diabetes mellitus type 1, Addison's disease, autoimmune pituitary disease, hypoparathyreoidism, premature ovarian failure) and non-endocrine autoimmune diseases. Given the frequency of ATD is a legitimate screening of ATD in other autoimmune diseases, and not vice versa. Testing involves the determination of TPO antibodies and TSH to separate those with high risk of developing ATD and forecasts for further screening.