<prompt> A 36 year old female presents to the outpatient department with generalized weakness and weight gain. On examination, diffuse non-tender enlargement of thyroid gland is present. Fine needle aspiration cytology shows lymphocytic infiltration with germinal centers and epithelial hurthle cells. Which of the following is most likely associated with this patient?Anti histone antibodyAnti mitochondrial antibodyAnti TSH receptor antibodyAnti microsomal antibody  <response>: Answer: d Anti-microsomal antibodyCHRONIC LYMPHOCYTIC or HASHIMOTOS THYROIDITIS or NON GOITROUS or STRUMA LYMPHOMATOSAMost common cause of hypothyroidism in non-iodine deficiency regionsChronic autoimmune disorder with family history of autoimmune diseaseMC in women at menopausePainless enlargement of both lobes, which are firm, rubbery, firm and tenderPolymorphisms in immune regulation-associated genes, including cytotoxic T lymphocyte- associated antigen-4 CTLA4 and protein tyrosine phosphatase-22 PTPN22Association with HLA DR 5 is seenMechanism of thyroid cell deathCD8 cytotoxic T cell-mediated cell deathCytokine-mediated cell deathAutoantibodiesAnti microosomal antibodiesAnti thyroid peroxidase antibodiesAnti thyroglobulin antibodiesPathologyExtensive lymphocytic infiltration with germinal cells epithelial hurthle cellsAskanazy cellsNo colloid in the follicleMild hyperthyroidism present initially but hypothyroidism is inevitableOccasionally predisposes to papillary CA risk of development of extranodal marginal zone B-cell lymphomas within the thyroid gland 