Graves' disease diagnostic approach: Difference between revisions
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{{CMG}};{{AE}}{{MehdiP}} | {{CMG}};{{AE}}{{MehdiP}} | ||
==Overview== | ==Overview== | ||
A | A detailed evaluation of a patient with clinical symptoms of hyperthyrodism must be done in order to make an accurate diagnosis. | ||
==Diagnostic approach== | ==Diagnostic approach== | ||
*In the presence of relative clinical symptoms and signs for hyperthyroidism, a diagnostic approach must be taken to | *In the presence of relative clinical symptoms and signs for hyperthyroidism, a diagnostic approach must be taken to accurately diagnosis and manage the disease.<ref name="pmid22776786">{{cite journal |vauthors=Tozzoli R, Bagnasco M, Giavarina D, Bizzaro N |title=TSH receptor autoantibody immunoassay in patients with Graves' disease: improvement of diagnostic accuracy over different generations of methods. Systematic review and meta-analysis |journal=Autoimmun Rev |volume=12 |issue=2 |pages=107–13 |year=2012 |pmid=22776786 |doi=10.1016/j.autrev.2012.07.003 |url=}}</ref><ref name="pmid">{{cite journal |vauthors=Pedersen IB, Knudsen N, Perrild H, Ovesen L, Laurberg P |title=TSH-receptor antibody measurement for differentiation of hyperthyroidism into Graves' disease and multinodular toxic goitre: a comparison of two competitive binding assays |journal=Clin. Endocrinol. (Oxf) |volume=55 |issue=3 |pages=381–90 |year=2001 |pmid= |doi= |url=}}</ref><ref>{{Cite journal | ||
| author = [[Terry J. Smith]] & [[Laszlo Hegedus]] | | author = [[Terry J. Smith]] & [[Laszlo Hegedus]] | ||
| title = Graves' Disease | | title = Graves' Disease | ||
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}}</ref> | }}</ref> | ||
* | *The following algorithm summarizes the diagnostic approach for suspected hyperthyroidism. | ||
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{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | | | | | | | | A01 | | | | | |A01=Suspected | {{familytree | | | | | | | | | | | | | | A01 | | | | | |A01=Suspected Hyperthyroidism}} | ||
{{familytree | | | | | | | | | | | | | | |!| | | | | | | | }} | {{familytree | | | | | | | | | | | | | | |!| | | | | | | | }} | ||
{{familytree | | | | | | | | | | | | | | B01 | | | | | |B01=Measure serum TSH and free T4}} | {{familytree | | | | | | | | | | | | | | B01 | | | | | |B01=Measure serum TSH and free T4}} | ||
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{{familytree | | | | | | | G01 | | G02 | | | | G03 | | G04 | |G01=Present|G02=Absent|G03=T3 Toxicosis|G04=Sub-clinical Hyperthyrodism}} | {{familytree | | | | | | | G01 | | G02 | | | | G03 | | G04 | |G01=Present|G02=Absent|G03=T3 Toxicosis|G04=Sub-clinical Hyperthyrodism}} | ||
{{familytree | | | | | | | |!| | | |!| | | | | | | | | |!| | | | }} | {{familytree | | | | | | | |!| | | |!| | | | | | | | | |!| | | | }} | ||
{{familytree | | | | | | | H01 | | H02 | | | | | | | | H03 | |H01=<div style=" background: #FA8072"> {{fontcolor|#F8F8FF|'''Graves' Disease'''}}</div>|H02=Assess radioiodine uptake<br>obtain radionuclide scan<br> or both|H03=Evolving Graves' disease<br>Evolving toxic nodular goiter<br>Excess thyroid hormone intake<br>Non thyroidal illness }} | {{familytree | | | | | | | H01 | | H02 | | | | | | | | H03 | |H01=<div style=" background: #FA8072"> {{fontcolor|#F8F8FF|'''Graves' Disease'''}}</div>|H02=Assess radioiodine uptake,<br> obtain radionuclide scan,<br> or both|H03=Evolving Graves' disease, <br>Evolving toxic nodular goiter, <br>Excess thyroid hormone intake, or <br>Non thyroidal illness }} | ||
{{familytree | | | | | | | | | | | |!| | | | | | | | | | | | | | }} | {{familytree | | | | | | | | | | | |!| | | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | |,|-|-|-|+|-|-|-|.| | | | | | | | | | }} | {{familytree | | | | | | | |,|-|-|-|+|-|-|-|.| | | | | | | | | | }} | ||
{{familytree | | | | | | | I01 | | I02 | | I03 | | | | | | | | |I01=Homogeneous<br>increased uptake|I02=Patchy uptake<br>or single nodule|I03=Low or no uptake}} | {{familytree | | | | | | | I01 | | I02 | | I03 | | | | | | | | |I01=Homogeneous<br>increased uptake|I02=Patchy uptake<br>or single nodule|I03=Low or no uptake}} | ||
{{familytree | | | | | | | |!| | | |!| | | |!| | | | | | | | | | }} | {{familytree | | | | | | | |!| | | |!| | | |!| | | | | | | | | | }} | ||
{{familytree | | | | | | | J01 | | J02 | | J03 | | | | | | | | |J01=Graves' | {{familytree | | | | | | | J01 | | J02 | | J03 | | | | | | | | |J01=<div style=" background: #FA8072"> {{fontcolor|#F8F8FF|'''Graves disease'''}}</div>|J02=Toxic nodular goiter|J03=Subacute thyroiditis,<br>Excess thyroid hormone intake, or <br>HCG secreting tumor}} | ||
{{familytree/end}} | {{familytree/end}} | ||
The presence of at least one of the following findings in a hyperthyroid patient is definitive for Graves' disease:<ref>{{cite book | last = Shoenfeld | first = Yehuda | title = Diagnostic criteria in autoimmune diseases | publisher = Humana | location = Place of publication not identified | year = 2014 | isbn = 978-1627038584 }}</ref> | |||
* Detectable TSH receptor antibodies (TRAbs) in the serum | |||
* Evidence of ophthalmopathy and/or dermopathy | |||
* Diffuse and increased RAIU | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
[[Category:Medicine]] | [[Category:Medicine]] | ||
Latest revision as of 21:56, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
A detailed evaluation of a patient with clinical symptoms of hyperthyrodism must be done in order to make an accurate diagnosis.
Diagnostic approach
- In the presence of relative clinical symptoms and signs for hyperthyroidism, a diagnostic approach must be taken to accurately diagnosis and manage the disease.[1][2][3]
- The following algorithm summarizes the diagnostic approach for suspected hyperthyroidism.
| Suspected Hyperthyroidism | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Measure serum TSH and free T4 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Normal TSH & free T4 | ↓ TSH & ↑ free T4 | ↓ TSH & Normal free T4 | Normal or ↑ TSH & ↑ free T4 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hyperthyroidism ruled out | Hyperthyrodism | Measure free T3 | TSH secreting pituitary tumor, Thyroid hormone resistance or Assay interference | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Measure TSH receptor antibodies | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ↑ free T3 | Normal free T3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Present | Absent | T3 Toxicosis | Sub-clinical Hyperthyrodism | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Graves' Disease | Assess radioiodine uptake, obtain radionuclide scan, or both | Evolving Graves' disease, Evolving toxic nodular goiter, Excess thyroid hormone intake, or Non thyroidal illness | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Homogeneous increased uptake | Patchy uptake or single nodule | Low or no uptake | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Graves disease | Toxic nodular goiter | Subacute thyroiditis, Excess thyroid hormone intake, or HCG secreting tumor | |||||||||||||||||||||||||||||||||||||||||||||||||||||
The presence of at least one of the following findings in a hyperthyroid patient is definitive for Graves' disease:[4]
- Detectable TSH receptor antibodies (TRAbs) in the serum
- Evidence of ophthalmopathy and/or dermopathy
- Diffuse and increased RAIU
References
- ↑ Tozzoli R, Bagnasco M, Giavarina D, Bizzaro N (2012). "TSH receptor autoantibody immunoassay in patients with Graves' disease: improvement of diagnostic accuracy over different generations of methods. Systematic review and meta-analysis". Autoimmun Rev. 12 (2): 107–13. doi:10.1016/j.autrev.2012.07.003. PMID 22776786.
- ↑ Pedersen IB, Knudsen N, Perrild H, Ovesen L, Laurberg P (2001). "TSH-receptor antibody measurement for differentiation of hyperthyroidism into Graves' disease and multinodular toxic goitre: a comparison of two competitive binding assays". Clin. Endocrinol. (Oxf). 55 (3): 381–90.
- ↑ Terry J. Smith & Laszlo Hegedus (2016). "Graves' Disease". The New England journal of medicine. 375 (16): 1552–1565. doi:10.1056/NEJMra1510030. PMID 27797318. Unknown parameter
|month=ignored (help) - ↑ Shoenfeld, Yehuda (2014). Diagnostic criteria in autoimmune diseases. Place of publication not identified: Humana. ISBN 978-1627038584.