Differentiating goiter from other diseases: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Goiter]] | |||
{{CMG}}; {{AE}} {{ARK}} | {{CMG}}; {{AE}} {{ARK}} | ||
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==Differentiating Goiter from other Diseases== | ==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: | *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: <ref name="pmid3302898">{{cite journal| author=Mahoney CP| title=Differential diagnosis of goiter. | journal=Pediatr Clin North Am | year= 1987 | volume= 34 | issue= 4 | pages= 891-905 | pmid=3302898 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3302898 }} </ref> | ||
**Anaplastic Thyroid Carcinoma | **[[Anaplastic thyroid cancer|Anaplastic Thyroid Carcinoma]] | ||
**Follicular Thyroid Carcinoma | **[[Follicular thyroid cancer|Follicular Thyroid Carcinoma]] | ||
**Medullary Thyroid Carcinoma | **[[Medullary thyroid cancer|Medullary Thyroid Carcinoma]] | ||
**Papillary Thyroid Carcinoma | **[[Papillary thyroid cancer|Papillary Thyroid Carcinoma]] | ||
**[[Sarcoma]] | **[[Sarcoma]] | ||
**[[Lipomas]] | **[[Lipomas]] | ||
**[[Fibroma]] | **[[Fibroma]] | ||
**Thyroid lymphoma | **[[Thyroid]] [[lymphoma]] | ||
**[[Hashimoto Thyroiditis|Hashimoto thyroiditis]] | **[[Hashimoto Thyroiditis|Hashimoto thyroiditis]] | ||
**[[Riedel's thyroiditis|Riedel thyroiditis]] | **[[Riedel's thyroiditis|Riedel thyroiditis]] | ||
**Subacute thyroiditis | **[[Subacute thyroiditis]] | ||
**Infectious thyroiditis | **Infectious thyroiditis | ||
**Parathyroid adenoma | **[[Parathyroid adenoma]] | ||
**Parathyroid cyst | **[[Parathyroid]] cyst | ||
**Thyroglossal duct cyst | **[[Thyroglossal duct cyst]] | ||
**Branchial cleft cyst | **[[Branchial cleft cyst]] | ||
**Pseudo-goiter | **Pseudo-goiter | ||
**Thyroid abscess | **Thyroid abscess | ||
**Thyroid nodule | **[[Thyroid nodule]] | ||
**Granulomatous disease of the thyroid | **Granulomatous disease of the [[thyroid]] | ||
**[[Lymphadenopathy]] | **[[Lymphadenopathy]] | ||
**Carotid artery aneurysm | **Carotid artery aneurysm | ||
**Lymphatic malformation ([[cystic hygroma]]) | **Lymphatic malformation ([[cystic hygroma]]) | ||
**Tumors of other structures in the neck | **[[Tumors]] of other structures in the [[neck]] | ||
The table below | === Differentials of thyroid gland enlargement === | ||
The table below outlines the differential diagnoses of neck swelling due to [[thyroid gland]] enlargement:<ref>Thyroid adenoma. Wikipedia. https://en.wikipedia.org/wiki/Thyroid_adenoma Accessed on October 11, 2015</ref> | |||
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center" | {| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center" | ||
| valign="top" | | | valign="top" | | ||
| Line 60: | Line 61: | ||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Acute suppurative thyroiditis | | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Acute suppurative thyroiditis | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Acute suppurative thyroiditis is an uncommon [[thyroid]] disorder usually caused by [[bacterial infection]]. | | style="padding: 5px 5px; background: #F5F5F5;" |Acute suppurative thyroiditis is an uncommon [[thyroid]] disorder usually caused by [[bacterial infection]]. | ||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |'''Toxic adenoma''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |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.<ref name="pmid2040867">{{cite journal |vauthors=Laurberg P, Pedersen KM, Vestergaard H, Sigurdsson G |title=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 |journal=J. Intern. Med. |volume=229 |issue=5 |pages=415–20 |year=1991 |pmid=2040867 |doi= |url=}}</ref> | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Direct chemical toxicity with inflammation | |||
| style="padding: 5px 5px; background: #F5F5F5;" |[[Amiodarone]], [[sunitinib]], [[pazopanib]], [[axitinib]], and other [[tyrosine kinase inhibitors]] may also be associated with a destructive [[thyroiditis]].<ref name="pmid2258582">{{cite journal |vauthors=Lambert M, Unger J, De Nayer P, Brohet C, Gangji D |title=Amiodarone-induced thyrotoxicosis suggestive of thyroid damage |journal=J. Endocrinol. Invest. |volume=13 |issue=6 |pages=527–30 |year=1990 |pmid=2258582 |doi= |url=}}</ref><ref name="pmid24282820">{{cite journal |vauthors=Ahmadieh H, Salti I |title=Tyrosine kinase inhibitors induced thyroid dysfunction: a review of its incidence, pathophysiology, clinical relevance, and treatment |journal=Biomed Res Int |volume=2013 |issue= |pages=725410 |year=2013 |pmid=24282820 |pmc=3824811 |doi=10.1155/2013/725410 |url=}}</ref> | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Palpation thyroiditis | |||
| style="padding: 5px 5px; background: #F5F5F5;" |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: | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | {| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | ||
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Cause of thyrotoxicosis}} | ! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Cause of thyrotoxicosis}} | ||
| Line 75: | Line 87: | ||
| style="padding: 5px 5px; background: #F5F5F5;" | ↑ | | style="padding: 5px 5px; background: #F5F5F5;" | ↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" | ↑ | | style="padding: 5px 5px; background: #F5F5F5;" | ↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Ophthalmopathy, dermopathy, acropachy | | style="padding: 5px 5px; background: #F5F5F5;" | Ophthalmopathy, [[dermopathy]], acropachy | ||
|- | |- | ||
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic nodular goiter}} | | colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic nodular goiter}} | ||
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| style="padding: 5px 5px; background: #F5F5F5;" | ↑ | | style="padding: 5px 5px; background: #F5F5F5;" | ↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Inappropriately normal or high TSH | | style="padding: 5px 5px; background: #F5F5F5;" | Inappropriately normal or high TSH | ||
|- | |- | ||
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Factitious thyrotoxicosis}} | | colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Factitious thyrotoxicosis}} | ||
| Line 139: | Line 144: | ||
| style="padding: 5px 5px; background: #F5F5F5;" | ↓ | | style="padding: 5px 5px; background: #F5F5F5;" | ↓ | ||
| style="padding: 5px 5px; background: #F5F5F5;" | ↓ Serum thyroglobulin | | style="padding: 5px 5px; background: #F5F5F5;" | ↓ Serum thyroglobulin | ||
|} | |} | ||
Latest revision as of 19:08, 25 February 2019
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.