Hypothayoidism is seen in

Refer Robbins page no 1087 Hashimoto thyroiditis most often comes to clinical attention as painless enlargement of the thyroid, usually associated with some degree of hypothyroidism, in a middle-aged woman. The enlargement of the gland is usually symmetric and diffuse, but in some cases it may be sufficiently localized to raise the suspicion of a neoplasm. In the usual case, hypothyroidism develops gradually. In some patients, however, it may be preceded by transient thyrotoxicosis caused by disruption of thyroid follicles, leading to release of thyroid hormones ("hashitoxicosis"). During this phase, free T4 and T3 levels are elevated, TSH is diminished, and radioactive iodine uptake is decreased. As hypothyroidism supervenes, T4 and T3 levels fall, accompanied by a compensatory increase in TSH.