Authors
Alimagomedova Z.K.1, Solomakha S.A.2, Lyalin V.A.2, Murodov O.R.3, Bobobekova N.Z.3
1 Dagestan State Medical University, Makhachkala
2 First Saint Petersburg State Medical University named after Academician I.P. Pavlov, Saint Petersburg
3 National Research Ogarev Mordovia State University, Saransk
Abstract
Rationale. Autoimmune thyroiditis (AIT) is an organ-specific autoimmune disorder characterized by lymphocytic infiltration of the thyroid tissue, impaired tolerance to thyroid antigens, and the production of organ-specific autoantibodies.
Objective. The aim of this study is to review current data regarding immunotherapeutic approaches to the treatment of AIT.
Methods. The analysis was conducted based on literature published between 2019 and 2025, selected from the PubMed, Scopus, Web of Science, and eLIBRARY databases. Included were publications focused on the pathogenesis of AIT and immunotherapeutic approaches that met the criteria of originality and scientific validity.
Results. Key immunopathogenetic mechanisms implicated in AIT development were examined, including activation of autoreactive CD4+ cells, deficiency and dysfunction of regulatory T cells, hyperactivity of B-lymphocytes, and dysregulation of pro-inflammatory cytokines. Contemporary immunotherapeutic approaches are presented, encompassing monoclonal antibodies (particularly anti-CD20), therapies utilizing regulatory T cells, administration of synthetic peptide vaccines, and targeting of Toll-like receptors.
Conclusion. Immunotherapy aimed at restoring antigen-specific immune tolerance represents a promising direction in the pathogenetic treatment of AIT. The most substantiated strategies involve selective modulation of critical immune components. Despite encouraging experimental findings, the integration of these approaches into clinical practice is currently limited by the absence of large-scale randomized trials and insufficient evidence base.
Keywords: autoimmune thyroiditis, immunotherapy, thyroid antibodies, regulatory T cells, peptide vaccines, CD20, Toll-like receptors, antigen-specific tolerance.
References
1. Xiao ZX, Miller JS, Zheng SG. An updated advance of autoantibodies in autoimmune diseases. Autoimmun Rev. 2021; 20(2): 102743. doi: 10.1016/ j.autrev.2020.102743.
2. Miller FW. The increasing prevalence of autoimmunity and autoimmune diseases: an urgent call to action for improved understanding, diagnosis, treatment, and prevention. Curr Opin Immunol. 2023; 80: 102266. doi: 10.1016/j.coi.2022.102266.
3. Ragusa F, Fallahi P, Elia G, et al. Hashimotos’ thyroiditis: Epidemiology, pathogenesis, clinic and therapy. Best Pract Res Clin Endocrinol Metab. 2019; 33(6): 101367. doi: 10.1016/j.beem.2019.101367.
4. Hu X, Chen Y, Shen Y, et al. Global prevalence and epidemiological trends of Hashimoto’s thyroiditis in adults: A systematic review and meta-analysis. Front Public Health. 2022; 10: 1020709. doi: 10.3389/fpubh.2022. 1020709.
5. Ferrari SM, Ragusa F, Elia G, et al. Precision Medicine in Autoimmune Thyroiditis and Hypothyroidism. Front Pharmacol. 2021; 12: 750380. doi: 10.3389/fphar.2021.750380.
6. Pisetsky DS. Pathogenesis of autoimmune disease. Nat Rev Nephrol. 2023; 19: 509-524. doi: 10.1038/s41581-023-00720-1.
7. Song Y, Li J, Wu Y. Evolving understanding of autoimmune mechanisms and new therapeutic strategies of autoimmune disorders. Sig Transduct Target Ther. 2024; 9: 263. doi: 10.1038/s41392-024-01952-8.
8. Kaur J, Jialal I. Hashimoto thyroiditis. StatPearls. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459262/. Accessed 24.04.2025.
9. Ferrari SM, Fallahi P, Elia G, et al. Novel therapies for thyroid autoimmune diseases: An update. Best Practice & Research Clinical Endocrinology & Metabolism. 2020; 34(1): 101366. doi: 10.1016/j.beem.2019.101366.
10. Stramazzo I, Mangino G, Capriello S, et al. CD20 + T lymphocytes in isolated Hashimoto’s thyroiditis and type 3 autoimmune polyendocrine syndrome: a pilot study. J Endocrinol Invest. 2024; 47(11): 2865-2871. doi: 10.1007/s40618-024-02370-x.
11. Demirci H, Aydoğan E, Ceydilek B. Transition of Thyroid Autoantibodies by Rituximab Treatment in Women with Rheumatoid Arthritis. Gazi Med J. 2024; 35(4): 449-451. doi: 10.12996/gmj.2024.4237.
12. Fisher MS, Sennikov SV. T-regulatory cells for the treatment of autoimmune diseases. Frontiers in Immunology. 2025; 16: 1511671. doi: 10.3389/fimmu.2025.1511671.
13. Guo J, Si G, Si F. Treg cells as a protective factor for Hashimoto`s thyroiditis: a mendelian randomization study. Frontiers in Endocrinology. 2024; 15: 1347695. doi: 10.3389/fendo.2024.1347695.
14. Li CW, Osman R, Menconi F, et al. Effective Inhibition of Thyroid Antigen Presentation Using Retro-Inverso Peptides in Experimental Autoimmune Thyroiditis: A Pathway Toward Immune Therapies of Thyroid Autoimmunity. Thyroid. 2023; 33(4): 492-500. doi: 10.1089/thy.2022.0511.
15. Kim HJ, Kim H, Lee JH, et al. Toll-like receptor 4 (TLR4): new insight immune and aging. Immun Ageing. 2023; 20: 67. doi: 10.1186/s12979-023-00383-3.
16. Klatka M, Polak A, Mertowska P, et al. The Role of Toll-like Receptor 2 (TLR2) in the Development and Progression of Hashimoto’s Disease (HD): A Case Study on Female Patients in Poland. International Journal of Molecular Sciences. 2023; 24(6): 5344. doi: 10.3390/ijms24065344.
