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Hashimoto's Disease (Hashimoto's Thyroiditis)Hashimoto's disease is a common disorder. The mean incidence in women is in the order of 3.5 cases per 1000 people per year and in men is 0.8 cases per 1000 people per year. The disorder affects all ages, although the prevalence increases with age. Hashimoto's disease is the most common cause of goitrous hypothyroidism in areas of There is often a family history of Hashimoto's disease, goiter, hypothyroidism, or Graves' disease, and circulating thyroid autoantibodies may be detected in relatives without overt thyroid disease. Other diseases with autoimmune components, such as pernicious anemia, diabetes mellitus, adrenal insufficiency, rheumatoid arthritis, chronic active hepatitis, vitiligo, early graying of the hair, biliary cirrhosis, and Sjogren's syndrome, may occur in patients with Hashimoto's disease and in their relatives more often Hashimoto's Disease, Hashimoto's Thyroiditis, hashimoto disease, hashimoto thyroiditis, Hashimotos thyroiditis, Hashimotos disease. PATHOGENESIS.The presence of lymphocytic infiltration of the thyroid, circulating thyroid autoantibodies, and clinical or immunologic overlap with other diseases with autoimmune components indicates that Hashimoto's disease is an autoimmune thyroid disorder. The current understanding of GENETIC SUSCEPTIBILITY.Reference has already been made to the familial predisposition to autoimmune disease in patients with Hashimoto's disease. As with Graves' disease, there is a significant but weak association between HISTOPATHOLOGY.The thyroid is pale and firm. The histopathologic changes vary in type and extent but usually consist of diffuse lymphocytic infiltration with germinal center formation, obliteration of thyroid follicles, and PATHOPHYSIOLOGY.Impairment of hormone synthesis is due to the autoimmune destruction of the thyroid cells and involves a defect in organic binding of thyroid iodide, as evidenced by a positive perchlorate discharge test, and CLINICAL PICTURE.Goiter, the hallmark of Hashimoto's disease, usually develops gradually and may be found during routine examination. On occasion, the thyroid enlarges rapidly and, when accompanied by pain and tenderness, may mimic de Quervain's or subacute thyroiditis. Some patients, particularly those with the fibrous variant, are Although atrophic hypothyroidism (see later) is thought to be the end result of autoimmune destruction of the thyroid, the progression of goitrous Hashimoto's disease to the atrophied state is not often seen in LABORATORY TESTS.The results of the common tests of thyroid function depend on the stage of the disease. At first, the tests may suggest thyroid hyperfunction with a suppressed TSH but without overproduction of hormone. The RAIU may be increased, but serum T4 and T3 levels may remain normal. At this stage, the patient may TREATMENT.In many patients no treatment is required because the goiter is small and the disease is asymptomatic, with the TSH remaining in the normal range (type 1). In others, treatment with thyroid hormone is directed at alleviating goiter, hypothyroidism, or both (type 2). Levothyroxine treatment is indicated in Surgery is justified if pressure symptoms or unsightly enlargement persists after a |