Editing Hashimoto's thyroiditis (section)

=== Signs ===
[[File:Hypothyroidism.jpg|thumb|Depiction of a goiter]]In the early stages of autoimmune thyroiditis, patients may have normal thyroid hormone levels and no [[Goitre|goiter]] or a small one.<ref name="Ramos-Levi2023" /> Enlargement of the thyroid is due to [[Lymphocyte|lymphocytic]] infiltration and [[fibrosis]].<ref name="Klubo-Gwiezdzinska-2022">{{cite journal | vauthors = Klubo-Gwiezdzinska J, Wartofsky L | title = Hashimoto thyroiditis: an evidence-based guide to etiology, diagnosis and treatment | journal = Polish Archives of Internal Medicine | volume = 132 | issue = 3 | pages = 16222 | date = March 2022 | pmid = 35243857 | pmc = 9478900 | doi = 10.20452/pamw.16222 }}</ref> Early on, thyroid autoantibodies in the blood may be the only indication of Hashimoto’s disease.<ref name="Ramos-Levi2023" /> They are thought to be the secondary products of the [[T cell]]-mediated destruction of the gland.<ref name="Ramos-Levi2023" />

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, and [[ataxia]].<ref name="Singh2020">{{Cite book |title=The Washington Manual, The Endocrinology - Subspecialty Consult |vauthors=Singh S, Clutter WE |publisher=Lippincott Williams & Wilkins |year=2020 |isbn=978-1-9751-1333-9 |edition=4th |location=Philadelphia, PA |pages=70–76 |language=English}}</ref><ref name="Mincer2022" /> Extended thyroid hormone deficiency may lead to muscle fibre changes, resulting in muscle weakness, muscle pain, stiffness, and rarely, [[pseudohypertrophy]].<ref name="Fariduddin-2024">{{cite book | vauthors = Fariduddin MM, Haq N, Bansal N | chapter = Hypothyroid Myopathy |date=2024 | title = StatPearls | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK519513/ |access-date=2024-11-30 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30137798}}</ref> 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.<ref name="niddk2024" /> [[Graves' disease|Graves disease]] may occur before or after the development of autoimmune thyroiditis.<ref name="Weetman2021">{{Cite book |title=Werner & Ingbar's The Thyroid: A Fundamental and Clinical Text |vauthors=Weetman AP |publisher=Lippincott Williams & Wilkins |year=2021 |isbn=978-1-975112-96-7 |edition=11th |location=Philadelphia, PA |pages=531–541 |language=English}}</ref>

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 system|endocrine]] emergency.<ref name="Mincer2022" />