Editing Hashimoto's thyroiditis (section)

==Prognosis==
Overt, symptomatic thyroid dysfunction is the most common [[Complication (medicine)|complication]], with about 5% of people with [[subclinical hypothyroidism]] and chronic autoimmune thyroiditis progressing to thyroid failure every year. Transient periods of [[thyrotoxicosis]] (over-activity of the thyroid) sometimes occur, and rarely the illness may progress to full hyperthyroid [[Graves' disease]] with active [[Graves' ophthalmopathy|orbitopathy]] (bulging, inflamed eyes).<ref name=":1">{{Cite book | vauthors = Monaco F |title=Thyroid Diseases |date=2012 |publisher=CRC Press |isbn=978-1-4398-6839-3 |location=Hoboken |pages=77–97}}</ref>

Rare cases of fibrous autoimmune thyroiditis present with severe [[dyspnea|shortness of breath]] and [[dysphagia|difficulty swallowing]], resembling aggressive thyroid tumors, but such symptoms always improve with surgery or [[corticosteroid]] therapy. Although primary thyroid [[B-cell lymphoma]] affects fewer than one in 1000 persons, it is more likely to affect those with long-standing autoimmune thyroiditis,<ref name=":1" /> as there is a 67- to 80-fold increased risk of developing primary thyroid lymphoma in patients with Hashimoto's thyroiditis.<ref>{{cite journal | vauthors = Noureldine SI, Tufano RP | title = Association of Hashimoto's thyroiditis and thyroid cancer | language = en-US | 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>

[[Myopathy]] as a result of muscle fibre changes due to thyroid hormone deficiency may take months or years of thyroid hormone treatment to resolve.<ref name="Fariduddin-2024" /><ref>{{cite journal | vauthors = Winter S, Heiling B, Eckardt N, Kloos C, Axer H | title = Hoffmann's syndrome in the differential work-up of myopathic complaints: a case report | journal = Journal of Medical Case Reports | volume = 17 | issue = 1 | pages = 473 | date = October 2023 | pmid = 37907975 | pmc = 10617199 | doi = 10.1186/s13256-023-04184-6 | doi-access = free }}</ref>

=== Anti-thyroid antibodies ===
[[Antithyroid autoantibodies|Thyroid peroxidase antibodies]] typically (but not always) decline in patients treated with levothyroxine,<ref name=":0" /> with decreases varying between 10% and 90% after a follow-up of 6 to 24 months.<ref name="Schmidt-2008">{{cite journal | vauthors = Schmidt M, Voell M, Rahlff I, Dietlein M, Kobe C, Faust M, Schicha H | title = Long-term follow-up of antithyroid peroxidase antibodies in patients with chronic autoimmune thyroiditis (Hashimoto's thyroiditis) treated with levothyroxine | journal = Thyroid | volume = 18 | issue = 7 | pages = 755–760 | date = July 2008 | pmid = 18631004 | doi = 10.1089/thy.2008.0008 }}</ref> <!-- This study is being cited as a secondary source for its discussion of other studies. -->One study of patients treated with levothyroxine observed that 35 out of 38 patients (92%) had declines in thyroid peroxidase antibody levels over five years, lowering by 70% on average. 6 of the 38 patients (16%) had thyroid peroxidase antibody levels return to normal.<ref name="Schmidt-2008" />

=== Children ===
Many children diagnosed with Hashimoto's disease will experience the same progressive course of the disease that adults do.<ref name="De Luca-2013">{{cite journal | vauthors = De Luca F, Santucci S, Corica D, Pitrolo E, Romeo M, Aversa T | title = Hashimoto's thyroiditis in childhood: presentation modes and evolution over time | journal = Italian Journal of Pediatrics | volume = 39 | issue = 1 | pages = 8 | date = January 2013 | pmid = 23363471 | pmc = 3567976 | doi = 10.1186/1824-7288-39-8 | doi-access = free }}</ref> However, of children who develop anti-thyroid antibodies and hypothyroidism, up to 50% are later observed to have normal antibodies and thyroid hormone levels.<ref name="Ramos-Levi2023" /> One case of true [[Remission (medicine)|remission]] has been observed in a 12-year-old girl. Her thyroid was observed via [[ultrasound]] to progress from early [[inflammation]] to severe end-stage Hashimoto's thyroiditis with hypothyroidism, and then return to "almost normal with only minimal features of inflammation" and euthyroidism.<ref>{{cite journal | vauthors = Wu G, Zou D, Cai H, Liu Y | title = Ultrasonography in the diagnosis of Hashimoto's thyroiditis | journal = Frontiers in Bioscience | volume = 21 | issue = 5 | pages = 1006–1012 | date = June 2016 | pmid = 27100487 | doi = 10.2741/4437 }}</ref>