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Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis and Hashimoto's disease, is an autoimmune disease in which the thyroid gland is gradually destroyed. A slightly broader term is autoimmune thyroiditis, identical other than that it is also used to describe a similar condition without a goiter. Early on, symptoms may not be noticed. Over time, the thyroid may enlarge, forming a painless goiter. Some people eventually develop hypothyroidism with accompanying weight gain, fatigue, constipation, depression, hair loss, and general pains. After many years the thyroid typically shrinks in size. Potential complications include thyroid lymphoma. Furthermore, because it is common for untreated patients of Hashimoto's to develop hypothyroidism, further complications can include, but are not limited to, high cholesterol, heart disease, heart failure, high blood pressure, myxedema, and potential pregnancy problems. Hashimoto's thyroiditis is thought to be due to a combination of genetic and environmental factors. Risk factors include a family history of the condition and having another autoimmune disease. Diagnosis is confirmed with blood tests for TSH, T4, and antithyroid autoantibodies. Other conditions that can produce similar symptoms include Graves' disease and nontoxic nodular goiter. Hashimoto's thyroiditis is typically treated with levothyroxine. If hypothyroidism is not present, some may recommend no treatment, while others may treat to try to reduce the size of the goiter. Those affected should avoid eating large amounts of iodine; however, sufficient iodine is required especially during pregnancy. Surgery is rarely required to treat the goiter. Hashimoto's thyroiditis affects about 5% of Caucasians at some point in their lives. It is the most common cause of hypothyroidism in iodine-sufficient areas of the world. It typically begins between the ages of 30 and 50 and is much more common in women than men. Rates of the disease appear to be increasing. It was first described by the Japanese physician Hakaru Hashimoto in 1912. In 1957, it was recognized as an autoimmune disorder. Signs and symptoms Many symptoms are attributed to the development of Hashimoto's thyroiditis. The most common symptoms include: fatigue, weight gain, pale or puffy face, feeling cold, joint and muscle pain, constipation, dry and thinning hair, heavy menstrual flow or irregular periods, depression, panic disorder, a slowed heart rate, and problems getting pregnant and miscarriages. Some patients in the early stage of the disease may experience symptoms of hyperthyroidism due to the release of thyroid hormones from intermittent thyroid destruction. Hashimoto's disease is about seven times more common in women than in men. It can occur in teens and young women, but more commonly appears in middle age, particularly for men. People who develop Hashimoto's disease often have family members who have thyroid or other autoimmune diseases, and sometimes have other autoimmune diseases themselves. Early stages of autoimmune thyroiditis may have a normal physical exam with or without a goiter. A goiter is a diffuse, often symmetric, swelling of the thyroid gland visible in the anterior neck that may develop. The thyroid gland may become firm, large, and lobulated in Hashimoto's thyroiditis, but changes in the thyroid can also be nonpalpable. Enlargement of the thyroid is due to lymphocytic infiltration and fibrosis, rather than tissue hypertrophy. While their role in the initial destruction of the follicles is unclear, antibodies against thyroid peroxidase or thyroglobulin are relevant, as they serve as markers for detecting the disease and its severity. They are thought to be the secondary products of the T cell-mediated destruction of the gland. As lymphocytic infiltration progresses, patients may exhibit signs of hypothyroidism in multiple bodily systems, including, but not limited to, a larger goiter, weight gain, cold intolerance, fatigue, myxedema, constipation, menstrual disturbances, pale or dry skin, and dry, brittle hair, depression, ataxia, and muscle weakness. Patients with goiters who have had autoimmune thyroiditis for many years might see their goiter shrink in the later stages of the disease due to destruction of the thyroid. While rare, more serious complications of the hypothyroidism resulting from autoimmune thyroiditis are pericardial effusion, pleural effusion, both of which require further medical attention, and myxedema coma, which is an endocrine emergency. Epidemiology Autoimmune thyroiditis is the most common cause of hypothyroidism in settings of sufficient iodine. It is estimated to affect 2% of the world's population. It may affect up to 5% of the United States' population. Anyone may develop this disease, but autoimmune thyroiditis affects women more often than men by about 10 times. The difference in prevalence amongst genders is due to the effects of sex hormones. Incidence peaks in the fifth decade of life, but patients are usually diagnosed between age 30–50. Genetics Thyroid autoimmunity can be familial. Many patients report a family history of autoimmune thyroiditis or Graves disease. Twin studies have revealed a concordance of Hashimoto's disease in monozygotic twins. High iodine consumption Autoimmune thyroiditis has a higher prevalence in societies that have a higher intake of iodine in their diet, such as the United States and Japan. It is the most common cause of hypothyroidism in areas of sufficient iodine. Also, the rate of lymphocytic infiltration increased in areas where the iodine intake was once low, but increased due to iodine supplementation. Age It has been shown that "the prevalence of positive tests for thyroid antibodies increases with age, with a frequency as high as 33 percent in women 70 years old or older." Incidence peaks in the fifth decade of life and the prevalence increases with age. Relationship to other autoimmune conditions Graves disease may occur before or after the development of autoimmune thyroiditis. Patients may also have coexisting autoimmune conditions of other organs. These may include Addison disease, type 1 diabetes, Sjogren's syndrome, Celiac disease, and rheumatoid arthritis. Autoimmune thyroiditis has also been seen in patients with autoimmune polyendocrine syndromes type 1 and 2. Risk factors The strong genetic component is borne out in studies on monozygotic twins, with a concordance of 38–55%, with an even higher concordance of circulating thyroid antibodies not in relation to clinical presentation (up to 80% in monozygotic twins). Neither result was seen to a similar degree in dizygotic twins, offering strong favour for high genetic aetiology. Medications that influence thyroid function Certain medications or drugs have been associated with altering and interfering with thyroid function. Of these drugs, there are two main mechanisms of interference that they can have. One of the mechanism.... Discover the Yu Hashimoto popular books. Find the top 100 most popular Yu Hashimoto books.