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The concordance rate for Hashimotos disease is 55 percent in identical twins (and 30-35 percent for Graves, while thyroid antibodies have an 80 percent rate)

2011 Feb;69(2):3529

Some of the common side effects include: Nausea Fatigue Dry mouth Increased sweating Constipation Drowsiness Though Cymbalta can help relieve some fibromyalgia symptoms, some patients may find that the side effects, such as constant fatigue or drowsiness, can make it difficult to maintain a normal routine

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Oral administration faces hepatic first-pass metabolism, reducing bioavailability to approximately 4050% of subcutaneous routes, but offers convenience for longer-term studies where daily injections create compliance challenges

Injection site reactions: Mild redness, swelling, or soreness can show up at the site