Hashimoto's disease, also called Hashimoto's thyroiditis, is an autoimmune disease that causes hypothyroidism (underactive thyroid). Symptoms include fatigue, weight gain, depression, constipation, irregular and heavier-than-normal menstrual periods, dry skin, puffy face, brittle nails, hair loss/thinning hair, enlarged tongue, and joint pain. The exact cause of this disease has yet to be identified, however it is believed that individuals with a family history of the disease, and women who have recently had a baby are at higher risk of Hashimoto's disease. Having another autoimmune disease — such as rheumatoid arthritis, type 1 diabetes or lupus also increases the risk of developing Hashimoto's disease. Excessive exposure to environmental radiation, and an excessive use of iodine can increase the risk of Hashimoto's disease. Hashimoto's disease affects more women than men, and if left untreated can cause pregnancy complications. Specifically, hypothyroidism can make it harder for women to get pregnant, and cause a miscarriage or birth defects in the unborn child. For many, the symptoms of Hashimoto's disease are delayed for years, and the first sign usually manifests in the form of an enlarged thyroid, called a goiter. The goiter is generally not painful, but it can cause the front of the neck to look swollen and make it difficult to swallow. Decreased sexual desire (libido) in both men and women and myxedema (drowsiness followed by profound lethargy and unconsciousness) are also associated with hypothyroidism. Diagnosis of this disease involves a thyroid function test and an antibody test. A thyroid function test is a blood test that determines whether the body is producing the correct amounts of thyroid stimulating hormone (TSH). A high level of TSH indicates an underactive thyroid. The antibody test checks for the presence of thyroperoxidase antibodies (TPO) which is common with Hashimoto’s disease. The most common treatment of Hashimoto’s disease is levothyroxine medication. Levothyroxine is the same hormone produced by the thyroid, and is a life-long treatment.