Differentiating goiter from other diseases
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]
Overview
As goiter manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype.
Differentiating Goiter from other Diseases
- As goiter manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. The following are the various differential diagnoses: [1]
- Anaplastic Thyroid Carcinoma
- Follicular Thyroid Carcinoma
- Medullary Thyroid Carcinoma
- Papillary Thyroid Carcinoma
- Sarcoma
- Lipomas
- Fibroma
- Thyroid lymphoma
- Hashimoto thyroiditis
- Riedel thyroiditis
- Subacute thyroiditis
- Infectious thyroiditis
- Parathyroid adenoma
- Parathyroid cyst
- Thyroglossal duct cyst
- Branchial cleft cyst
- Pseudo-goiter
- Thyroid abscess
- Thyroid nodule
- Granulomatous disease of the thyroid
- Lymphadenopathy
- Carotid artery aneurysm
- Lymphatic malformation (cystic hygroma)
- Tumors of other structures in the neck
Differentials of thyroid gland enlargement
The table below outlines the differential diagnoses of neck swelling due to thyroid gland enlargement:[2]
| Disease | Findings |
|---|---|
| Multinodular goiter | Multinodular goiter is the multinodular enlargement of the thyroid gland. They are large nodules of more than 1 cm that produces symptoms of hyperthyroidism. |
| Grave's disease | Grave's disease is an autoimmune disease that affects the thyroid. It frequently results in hyperthyroidism and an enlarged thyroid. Pretibial myxedema and ophthalmopathy are some of the findings of grave's disease. |
| Hashimoto's disease | Hashimoto's disease is an autoimmune disease in which the thyroid gland is attacked by a variety of cell-mediated and antibody-mediated immune processes, causing primary hypothyroidism. |
| Medullary thyroid carcinoma | Medullary thyroid carcinoma is a form of thyroid carcinoma which originates from the parafollicular cells (C cells), which produce the hormone calcitonin. |
| Thyroid lymphoma | Thyroid lymphoma is a rare malignant tumor which manifests as rapidly enlarging neck mass causing respiratory difficulty. |
| De Quervain's thyroiditis | De Quervain's thyroiditis is a subacute granulomatous thyroiditis preceded by an upper respiratory tract infection. |
| Acute suppurative thyroiditis | Acute suppurative thyroiditis is an uncommon thyroid disorder usually caused by bacterial infection. |
| Toxic adenoma | Toxic adenoma and toxic multinodular goiter are results of focal/diffuse hyperplasia of thyroid follicular cells independent of TSH regulation. Findings of single or multiple nodules are seen on physical examination or thyroid scan.[3] |
| Direct chemical toxicity with inflammation | Amiodarone, sunitinib, pazopanib, axitinib, and other tyrosine kinase inhibitors may also be associated with a destructive thyroiditis.[4][5] |
| Palpation thyroiditis | Manipulation of the thyroid gland during thyroid biopsy or neck surgery and vigorous palpation during the physical examination may cause transient hyperthyroidism. |
Differentials of thyroid gland enlargement and thyrotoxicosis
The following table summarizes the various differential diagnoses of thyroid gland enlargement plus thyrotoxicosis and their major features:
| Cause of thyrotoxicosis | TSH receptor antibodies | Thyroid US | Color flow Doppler | Radioactive iodine uptake/Scan | Other features |
|---|---|---|---|---|---|
| Graves' disease | + | Hypoechoic pattern | ↑ | ↑ | Ophthalmopathy, dermopathy, acropachy |
| Toxic nodular goiter | - | Multiple nodules | - | Hot nodules at thyroid scan | - |
| Toxic adenoma | - | Single nodule | - | Hot nodule | - |
| Subacute thyroiditis | - | Heterogeneous hypoechoic areas | Reduced/absent flow | ↓ | Neck pain, fever, and elevated inflammatory index |
| Painless thyroiditis | - | Hypoechoic pattern | Reduced/absent flow | ↓ | - |
| Amiodarone induced thyroiditis-Type 1 | - | Diffuse or nodular goiter | ↓/Normal/↑ | ↓ but higher than in Type 2 | High urinary iodine |
| Amiodarone induced thyroiditis-Type 2 | - | Normal | Absent | ↓/absent | High urinary iodine |
| Central hyperthyroidism | - | Diffuse or nodular goiter | Normal/↑ | ↑ | Inappropriately normal or high TSH |
| Factitious thyrotoxicosis | - | Variable | Reduced/absent flow | ↓ | ↓ Serum thyroglobulin |
References
- ↑ Mahoney CP (1987). "Differential diagnosis of goiter". Pediatr Clin North Am. 34 (4): 891–905. PMID 3302898.
- ↑ Thyroid adenoma. Wikipedia. https://en.wikipedia.org/wiki/Thyroid_adenoma Accessed on October 11, 2015
- ↑ Laurberg P, Pedersen KM, Vestergaard H, Sigurdsson G (1991). "High incidence of multinodular toxic goitre in the elderly population in a low iodine intake area vs. high incidence of Graves' disease in the young in a high iodine intake area: comparative surveys of thyrotoxicosis epidemiology in East-Jutland Denmark and Iceland". J. Intern. Med. 229 (5): 415–20. PMID 2040867.
- ↑ Lambert M, Unger J, De Nayer P, Brohet C, Gangji D (1990). "Amiodarone-induced thyrotoxicosis suggestive of thyroid damage". J. Endocrinol. Invest. 13 (6): 527–30. PMID 2258582.
- ↑ Ahmadieh H, Salti I (2013). "Tyrosine kinase inhibitors induced thyroid dysfunction: a review of its incidence, pathophysiology, clinical relevance, and treatment". Biomed Res Int. 2013: 725410. doi:10.1155/2013/725410. PMC 3824811. PMID 24282820.