Hashimoto’s thyroiditis — a therapeutic or surgical problem? (Literature review)

More than a hundred-year history of the study of Hashimoto’s thyroiditis testifies to the urgency of the disease and the theoretical and practical problems not solved yet. From a practical point of view, it is important to choose the therapeutic approach and treatment method. The complexity of the pathogenesis of this autoimmune process, which from a local, organ-specific subsequently acquires systemic features, creates certain difficulties for diagnosis and treatment. Accordingly, the clinical picture of the disease changes from local symptoms and hypothyroidism to multifaceted extrathyroid symptoms. They include arthralgia and muscle pain, mental and memory disorders, problems with women fertility, behavioral responses and quality of life. Therefore, therapeutic approach and methods of treatment should correspond to changes in the nature of the pathological process, its activity and clinical course of the disease. Today, it looks simplistic, focused only on drug treatment. There is no pathogenic treatment, and thyroid hormone replacement therapy only relieves the symptoms of hypothyroidism and does not affect the course of the autoimmune process. Hashimoto’s thyroiditis problem is associated with a steadily growing incidence and an increase in the number of patients with extrathyroid lesions and a severe clinical course. In recent years, publications are appearing in the literature that have raised questions about the feasibility of surgical treatment, and thyroidectomy is suggested a method of choice. In this review, we have attempted to analyze publications, which are based on the literature data about the issues raised over the past two decades. Almost all papers emphasize the need to eliminate the active focus of autoimmune aggression. In this regard, the choice of therapeutic approach and indications for surgical treatment remain unresolved.