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Guías: enfermedad de Hashimoto. Historia natural, sintomatología y diagnóstico - página 2

17.02.2023
Autores: Joanna Klubo-Gwieździńska (MD, PhD, MHSc), Leonard Wartofsky (MD, MPH)
Hashimoto thyroiditis: an evidence-based guide to etiology, diagnosis and treatment, Polish Archives of Internal Medicine, 2022, 132: 16222. doi: 10.20452/pamw.1622

Los trastornos de la coagulación, típicos para las personas con hipotiroidismo clínico, pueden manifestarse en mujeres en forma de menstruación abundante. Las demás manifestaciones del sistema reproductor en mujeres incluyen ciclos anovulatorios, causados por la alteración de la conversión de los precursores de estrógeno. El hipotiroidismo también causa alteraciones en el sistema urinario, como disminución de la filtración glomerular, y en especial la alteración en la excreción de agua libre, que como efecto puede conducir a la aparición de hiponatremia. En cuanto al sistema nervioso central, a menudo se observa el cansancio, la depresión, la pérdida de la memoria y la incapacidad para concentrarse. El estadio final del hipotiroidismo grave es el coma en el curso de mixedema.40 El término "encefalopatía de Hashimoto" describe una patología muy rara, que se caracteriza por la presencia de anticuerpos anti-TPO, niveles elevados de proteína en el líquido cefalorraquídeo, lesiones corticales inespecíficas en la resonancia magnética y una respuesta variable a la terapia con glucocorticoides.41

Diagnóstico

El diagnóstico de la enfermedad de Hashimoto se basa en la observación de manifestaciones clínicas de hipotiroidismo y la presencia de anticuerpos anti-TPO (sin embargo, se debe tener en cuenta la forma seronegativa de la enfermedad de Hashimoto, que se presenta en un 5-10 % de los casos). En el diagnóstico diferencial, especialmente en pacientes seronegativos, puede ser útil la ecografía de tiroides.37 La ecogenicidad disminuida de la glándula tiroides, la heterogeneidad del parénquima, el flujo vascular aumentado y la presencia de los pequeños quistes son las características ecográficas típicas de la enfermedad de Hashimoto (fig. 3).42

Los anticuerpos anti-TPO se observan en el suero en un 95 % de los enfermos, mientras que los anticuerpos anti-Tg en un 60-80 %.41,43 Los anticuerpos anti-TPO se consideran un factor de riesgo de progresión de la enfermedad de Hashimoto al hipotiroidismo clínico, tanto en población general, como en las personas que desarrollaron el hipotiroidismo tras la exposición a amiodarona, litio o interferón α. Los anticuerpos anti-TPO se asocian al riesgo de desarrollo de hipotiroidismo durante el embarazo, el riesgo elevado de aborto espontáneo y del fracaso de la fecundación in vitro.44

Fig. 3. Imagen ecográfica de la glándula tiroides en la enfermedad de Hashimoto

Volver al artículo principal: Guías: enfermedad de Hashimoto. Etiología, diagnóstico y tratamiento

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