Editing Hashimoto's thyroiditis (section)

{{short description|Autoimmune disease}}
{{Redirect|Hashimoto's disease|the encephalopathy|Hashimoto's encephalopathy}}
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{{Use dmy dates|date=April 2020}}
{{Infobox medical condition (new)
| name = Hashimoto's thyroiditis
| image = Hashimoto thyroiditis - alt -- very low mag.jpg
| caption = A [[micrograph]] of the [[thyroid]] of someone with Hashimoto's thyroiditis
| synonyms = Chronic lymphocytic thyroiditis, autoimmune thyroiditis, struma lymphomatosa, Hashimoto's disease
| field = [[Endocrinology]]
| symptoms = [[Weight gain]], [[fatigue (medical)|feeling tired]], [[constipation]], joint and muscle pain, cold intolerance, [[dry skin]], [[hair loss]], [[bradycardia|slowed heart rate]]<ref name="niddk2024"/>
| complications = [[Thyroid lymphoma]].<ref name=Nou2015/>
| onset = 30–50 years old<ref name=NIH2014/><ref name=Hir2013/>
| duration = 
| causes = [[Genetics|Genetic]] and [[environmental factors]].<ref name="Ramos-Levi2023" />
| risks = Family history, another [[autoimmune disease]]<ref name=NIH2014/>
| diagnosis = [[Thyroid-stimulating hormone|TSH]], T4, [[anti-thyroid autoantibodies]], ultrasound<ref name=NIH2014/>
| differential = [[Graves' disease]], [[nontoxic nodular goiter]]<ref name=Ak2000/>
| prevention = 
| treatment = [[Levothyroxine]], surgery<ref name=NIH2014/><ref name=Ak2000/>
| medication = 
| prognosis = 
| frequency = 2% at some point<ref name="Ramos-Levi2023" />
| deaths = 
}}

'''Hashimoto's thyroiditis''', also known as '''chronic lymphocytic thyroiditis''', '''Hashimoto's disease''' and '''autoimmune thyroiditis''', is an [[autoimmune disease]] in which the [[thyroid|thyroid gland]] is gradually destroyed.<ref name="AR">{{cite web |title=Autoimmune thyroiditis |url=https://www.autoimmuneregistry.org/autoimmune-thyroiditis |access-date=15 June 2022 |website=Autoimmune Registry Inc. |archive-date=25 February 2020 |archive-url=https://web.archive.org/web/20200225140353/https://www.autoimmuneregistry.org/autoimmune-thyroiditis |url-status=live }}</ref><ref name="niddk2024">{{cite web |title=Hashimoto's Disease |url=https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease |website=National Institute of Diabetes and Digestive and Kidney Diseases |access-date=4 December 2024}}</ref>

Early on, symptoms may not be noticed.<ref name=NIH2014>{{cite web|title=Hashimoto's Disease|url=https://www.niddk.nih.gov/health-information/health-topics/endocrine/hashimotos-disease/Pages/fact-sheet.aspx|website=National Institute of Diabetes and Digestive and Kidney Diseases|access-date=9 August 2016|date=May 2014|url-status=live|archive-url=https://web.archive.org/web/20160822021514/https://www.niddk.nih.gov/health-information/health-topics/endocrine/hashimotos-disease/Pages/fact-sheet.aspx|archive-date=22 August 2016}}</ref> Over time, the thyroid may enlarge, forming a painless [[goiter]].<ref name=NIH2014/> Most people eventually develop [[hypothyroidism]] with accompanying [[weight gain]], [[fatigue (medical)|fatigue]], [[constipation]], [[hair loss]], and general pains.<ref name="niddk2024"/> After many years the thyroid typically shrinks in size.<ref name="niddk2024"/> Potential complications include [[thyroid lymphoma]].<ref name=Nou2015>{{cite journal | vauthors = Noureldine SI, Tufano RP | title = Association of Hashimoto's thyroiditis and thyroid cancer | journal = Current Opinion in Oncology | volume = 27 | issue = 1 | pages = 21–25 | date = January 2015 | pmid = 25390557 | doi = 10.1097/cco.0000000000000150 | s2cid = 32109200 }}</ref> Further complications of hypothyroidism can include [[high cholesterol]], [[heart disease]], [[heart failure]], [[high blood pressure]], [[myxedema]], and potential problems in pregnancy.<ref name="niddk2024"/>

<!-- Cause and diagnosis -->
Hashimoto's thyroiditis is thought to be due to a combination of [[Genetics|genetic]] and [[environmental factors]].<ref name="Ramos-Levi2023" /><ref name="Winther-2020">{{cite journal | vauthors = Winther KH, Rayman MP, Bonnema SJ, Hegedüs L | title = Selenium in thyroid disorders - essential knowledge for clinicians | journal = Nature Reviews. Endocrinology | volume = 16 | issue = 3 | pages = 165–176 | date = March 2020 | pmid = 32001830 | doi = 10.1038/s41574-019-0311-6 }}</ref> Risk factors include a family history of the condition and having another autoimmune disease.<ref name=NIH2014/> Diagnosis is confirmed with blood tests for [[Thyroid-stimulating hormone|TSH]], [[Thyroxine]] ([[Thyroxine|T<sub>4</sub>]]), [[antithyroid autoantibodies]], and [[ultrasound]].<ref name=NIH2014/> Other conditions that can produce similar symptoms include [[Graves' disease]] and [[nontoxic nodular goiter]].<ref name=Ak2000>{{cite book |vauthors=Akamizu T, Amino N, Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dungan K, Grossman A, Hershman JM, Hofland J, Kaltsas G, Koch C, Kopp P, Korbonits M, McLachlan R, Morley JE, New M, Purnell J, Singer F, Stratakis CA, Trence DL, Wilson DP |date=2000 |pmid=25905412 |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK285557/ |veditors=Akamizu T, Amino N |title=Endotext |publisher=MDText |url=https://www.ncbi.nlm.nih.gov/books/NBK285557/ |chapter=Hashimoto's Thyroiditis |access-date=31 January 2021 |archive-date=24 September 2020 |archive-url=https://web.archive.org/web/20200924130429/https://www.ncbi.nlm.nih.gov/books/NBK285557/ |url-status=live }}</ref>

<!-- Treatment -->
Hashimoto's is typically not treated unless there is hypothyroidism, or the presence of a goiter, when it may be treated with [[levothyroxine]].<ref name=Ak2000/><ref name=NIH2014/> Those affected should avoid eating large amounts of [[iodine]]; however, sufficient iodine is required especially during pregnancy.<ref name=NIH2014/> Surgery is rarely required to treat the goiter.<ref name=Ak2000/>

<!-- Epidemiology and history -->
Hashimoto's thyroiditis has a global prevalence of 7.5%, and varies greatly by region.<ref name="Hu"/> The highest rate is in Africa, and the lowest in Asia.<ref name="Hu"/> In the US white people are affected more often than black. It is more common in low to middle income groups. Females are more susceptible with a 17.5% rate of prevalence compared to 6% in males.<ref name="Hu"/>  It is the most common cause of hypothyroidism in [[Developed country|developed countries]].<ref name="Mincer2022">{{cite book | vauthors = Mincer DL, Jialal I | chapter = Hashimoto Thyroiditis |date=2022 | title = StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK459262/ |access-date=2023-01-23 |archive-url=https://web.archive.org/web/20231004133211/https://www.ncbi.nlm.nih.gov/books/NBK459262/ |archive-date=4 October 2023 |url-status=live |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29083758}}</ref> It typically begins between the ages of 30 and 50.<ref name=NIH2014/><ref name=Hir2013>{{cite journal | vauthors = Hiromatsu Y, Satoh H, Amino N | title = Hashimoto's thyroiditis: history and future outlook | journal = Hormones | volume = 12 | issue = 1 | pages = 12–18 | date = January 2013 | pmid = 23624127 | doi = 10.1007/BF03401282 | s2cid = 38996783 }}</ref> Rates of the disease have increased.<ref name="Hu"/> It was first described by the [[Japan]]ese physician [[Hakaru Hashimoto]] in 1912.<ref>{{cite book | veditors = Shoenfeld Y, Cervera R, Gershwin ME |title=Diagnostic Criteria in Autoimmune Diseases |date=2010 |publisher=Springer Science & Business Media |isbn=978-1-60327-285-8 |page=216 |url=https://books.google.com/books?id=A_vtzMxtd9AC&pg=PA216 }}</ref> Studies in 1956 discovered that it was an autoimmune disorder.<ref>{{cite journal | vauthors = Ralli M, Angeletti D, Fiore M, D'Aguanno V, Lambiase A, Artico M, de Vincentiis M, Greco A | title = Hashimoto's thyroiditis: An update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation | journal = Autoimmunity Reviews | volume = 19 | issue = 10 | pages = 102649 | date = October 2020 | pmid = 32805423 | doi = 10.1016/j.autrev.2020.102649 }}</ref>
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