A 67-year-old woman has had fatigue, dry skin, brittle hair, swelling of the ankles, and cold intolerance for 1 year; she has gained 9 kg (20 lb) during this period. Her pulse is 55/min, and blood pressure is 150/90 mm Hg. She appears lethargic. Examination shows dry skin and a nontender thyroid gland that is enlarged to two times its normal size. There is mild edema of the ankles bilaterally. The relaxation phase of the Achilles reflex is greatly prolonged. Which of the following is the most likely diagnosis?(A) Chronic lymphocytic thyroiditis (Hashimoto disease)(B) Defect in thyroxine (T4) biosynthesis(C) Graves disease(D) Multinodular goiter(E) Riedel thyroiditis(F) Thyroid cyst(G) Thyroid lymphoma(H) Thyroiditis

the woman have symptoms similar to those experienced by people with chronic lymphocytic thyroiditis, which is an autoimmune disease in which the body makes antibodies against thyroid cells. Symptoms usually appear when hypothyroidism is already installed.

Chronic lymphocytic thyroiditis is an autoimmune disease, whose main feature is inflammation of the thyroid caused by an immune system error. In this condition, also known as Hashimoto's disease, the body makes antibodies against thyroid cells. These antibodies cause the gland to be destroyed or reduced, which can lead to hypothyroidism due to the lack of T3 and T4 hormones.

As Hashimoto's disease progresses, the symptoms get worse. The person feels increasingly tired and with less energy. It may also present an increase in thyroid size and, consequently, the formation of goiter (mumps).

The treatment of Hashimoto's disease is almost always lengthy and requires hormone level measurement a few times a year. The dose of thyroid hormone supplementation, called levothyroxine, varies according to the degree of deficiency of thyroid hormone production.