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Chronic Lymphocytic Thyroiditis (Hashimoto's Disease)

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Hashimoto's disease appears to be an inherited condition. As with Graves' disease, you probably must inherit a gene or set of genes to be able to develop this disorder. However, even though you may inherit this genetic tendency, you still may never actually develop the disease itself. Therefore, there must be other factors which cause this condition to develop.

These other factors include being a woman, your age, and your body's immune system.

Thus, women are affected about eight times more often than men, and although you may develop this form of thyroiditis in childhood or adolescence, it is most commonly diagnosed after the age of forty, for this is when affected patients usually become hypothyroid. Your body's immune system plays a role in the production of the thyroid inflammation and tissue destruction that occurs in chronic lymphocytic thyroiditis.

Substances known as autoantibodies, made by white blood cells called lymphocytes, appear in your blood in this condition. Although we do not yet fully understand how or why these lymphocytes and antibodies work, the final result is damage to thyroid tissue. When enough tissue has been destroyed, your thyroid hormone production falls below normal, and symptoms of hypothyroidism appear.

The most sensitive test for hypothyroidism is a blood test that measures the level of the pituitary's thyroid stimulating hormone (TSH ). When TSH tests are carried out on large numbers of people, we find that about 10 percent of women and 4 percent of men over the age of fifty have an elevated blood level of TSH. By age sixty, TSH is increased in as many as 16.9 percent of women and 8.2 percent of men. Put another way, at least one woman in six and one man in 12 will develop Hashimoto's disease in their lifetime. Each could potentially develop subsequent hypothyroidism and should be watched for signs of thyroid failure.

If you develop this condition, your thyroid inflammation will probably be so mild that at first you won't even know that anything is wrong. The first indication of a problem may be a goiter : You may develop a gradual painless enlargement of your thyroid gland. During this period, your thyroid gland is becoming infiltrated with lymphocytes, which start gradual thyroid destruction and scarring that may result in subsequent thyroid failure.

When hypothyroidism occurs, you probably will feel sluggish and run down, but the disease progresses slowly, so you may not realize that anything is wrong. Constipation, leg cramps, hair loss and mental dullness may appear, together with other symptoms and signs of thyroid failure. However, since chronic lymphocytic thyroiditis tends to be a progressive condition, your thyroid hormone level will probably continue to fall, causing your symptoms of hypothyroidism to worsen until your disease is recognized and treated.

Your physician can confirm the presence of hypothyroidism by means of a blood test that shows a low level of thyroid hormone (T4 ) and a high blood level of thyroid stimulating hormone (TSH). The elevated TSH level is the more important test, for it is more sensitive and proves that your thyroid, not your pituitary, has failed. Also, a blood test demonstrating the presence of antithyroid antibodies provides strong evidence of thyroiditis.

Since this condition may be progressive, lifelong follow-up is essential, but this usually amounts to no more than your physician examining your thyroid and testing your blood levels of T4 and TSH at your annual health checkup. As your thyroid gland's function declines, your thyroid hormone dosage may be increased appropriately. On the other hand, the dosage may actually decrease in some elderly persons.

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