American Medical Association Family Medical Guide - American Medical Association [639]
Hashimoto’s Disease
Hashimoto’s disease (also called Hashimoto’s thyroiditis) is an autoimmune disorder in which the immune system mistakenly attacks the thyroid gland. Hashimoto’s disease can lead to hypothyroidism (see page 903), a condition in which the thyroid gland becomes underactive and produces too little thyroxine, the thyroid hormone that regulates metabolism (all of the chemical processes that take place in the body). Although anyone can develop Hashimoto’s disease, the disorder usually occurs in women between ages 30 and 50. The cause of Hashimoto’s disease is unknown, but it tends to run in families.
Symptoms
Many people who have Hashimoto’s disease have no symptoms. Others may develop symptoms of hypothyroidism, including an enlarged thyroid gland, increased sensitivity to cold, high cholesterol, loss of appetite accompanied by weight gain, a slow heart rate, and fatigue. Symptoms can also include dry skin, brittle fingernails, swollen ankles, or constipation. Some people may also experience muscle stiffness or weakness, muscle cramps, memory problems, or depression.
Diagnosis
To make a diagnosis of Hashimoto’s disease, your doctor will take a health history, ask you to describe your symptoms, and perform a physical examination. The doctor will order blood tests to evaluate how well your thyroid gland is functioning and may recommend specialized blood tests to check for Hashimoto’s disease.
Treatment
If Hashimoto’s disease results in hypothyroidism, the doctor will prescribe synthetic thyroid hormone to relieve and control your symptoms. You will probably need to take the medication for the rest of your life. Your doctor will perform blood tests and physical examinations regularly to monitor your treatment and the functioning of your thyroid gland. He or she may need to adjust the dose of your medication from time to time, depending on your health and the results of the blood tests.
Polymyalgia Rheumatica
Polymyalgia rheumatica is a disorder that causes pain and stiffness in large muscle groups, primarily in the neck, shoulders, and hips. The disorder, which usually occurs after age 50, affects twice as many women as men, and the incidence increases with age. The cause of the disorder is not known, but it may have a hereditary component. It seems to be an autoimmune disorder brought on by a faulty immune response that attacks muscle cells. About 15 percent of people who have polymyalgia rheumatica develop a type of vasculitis called temporal arteritis (see page 927), also known as giant cell arteritis.
Symptoms
The main symptoms of polymyalgia rheumatica are moderate to severe pain and stiffness in the neck, shoulders, and hips, especially in the morning or after a period of inactivity. The pain and stiffness usually last longer than 30 minutes. Other symptoms may include slight fever, fatigue, depression, and weight loss. Symptoms of temporal arteritis include headaches, pain in the temples, jaw pain, and blurred or double vision. The disorder can lead to permanent blindness.
Diagnosis
To diagnose polymyalgia rheumatica, a doctor will take a detailed health history and order blood tests. One of these diagnostic blood tests, called the elevated erythrocyte sedimentation rate, measures how fast red blood cells fall to the bottom of a test tube. Rapidly falling red blood cells signal inflammation in the body. Because polymyalgia rheumatica can resemble other conditions, the doctor will want to rule out any other illnesses by ordering additional blood tests. If you also have symptoms of temporal arteritis, the doctor will recommend a biopsy of one of the temporal arteries at the side of your head to look for abnormal cells in the artery