Silent thyroiditis differential diagnosis: Difference between revisions

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{{Silent thyroiditis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Silent_thyroiditis]]
Painless thyroiditis must be differentiated from other causes of hyperthyroidism such as Grave's disease and toxic nodular goiter.
{{CMG}} {{AE}} {{MMF}}
==Overview==
[[Silent thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis. Silent thyroiditis must also be differentiated from other diseases which cause [[hypothyroidism]]. As silent thyroiditis may cause transient [[Thyrotoxicosis|thyrotoxic]] symptoms, the diseases causing [[thyrotoxicosis]] must also be considered in the differential diagnosis.


{| align="center" style="border: 0px; font-size: 90%; margin: 3px;"
==Differentiating Silent Thyroiditis from other Diseases==
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Cause of thyrotoxicosis}}
===Differentiating silent thyroiditis from other causes of thyroiditis===
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|TSH receptor antibodies}}
*Silent thyroiditis must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis.<ref name="urlThyroiditis — NEJM">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMra021194 |title=Thyroiditis — NEJM |format= |work= |accessdate=}}</ref>
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Thyroid US}}
{| align="center"
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Color flow Doppler}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Radioactive iodine uptake/Scan}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Other features}}
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Graves' disease}}
|}
| style="padding: 5px 5px; background: #F5F5F5;" | +
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
| style="padding: 5px 5px; background: #F5F5F5;" | Hypoechoic pattern
! style="background:#4479BA; color: #FFFFFF;" | Conditions
| style="padding: 5px 5px; background: #F5F5F5;" | ?
! style="background:#4479BA; color: #FFFFFF;" |Causes
| style="padding: 5px 5px; background: #F5F5F5;" | ?
! style="background:#4479BA; color: #FFFFFF;" |Age at onset
| style="padding: 5px 5px; background: #F5F5F5;" | Ophthalmopathy, dermopathy, acropachy
! style="background:#4479BA; color: #FFFFFF;" |Pathological findings
! style="background:#4479BA; color: #FFFFFF;" |Diagnostic approach   
|-
| align="center" style="background:#DCDCDC;" |[[Silent thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Autoimmune]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*All ages, peak at 30-40
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Lymphocytic infiltration
*Lymphoid follicles
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Increased TSH]] ([[hypothyroidism]]) and/or
* [[Thyroid function tests|Decreased TSH]] (transient [[hypothyroidism]])
*[[Thyroid peroxidase|TPO antibodies]] present in high titer
*[[I-123 thyroid imaging|I-123]] uptake usually decreased
|-
| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Autoimmune]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*All ages, peak at 30-50
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Lymphocytic infiltration
*[[Germinal center|Germinal centers]]
*[[Fibrosis]] (in some variants)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Increased TSH]] ([[hypothyroidism]])
*[[Thyroid peroxidase|TPO antibodies]] present in high titer
*[[I-123 thyroid imaging|I-123]] uptake usually decreased
|-
|-
| align="center" style="background:#DCDCDC;" |[[De Quervain's thyroiditis|Painful subacute (De Quervain's) thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Unknown
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*20-60
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Giant cells
*[[Granuloma|Granulomas]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Increased TSH]] ([[hypothyroidism]]) and/or
* [[Thyroid function tests|Decreased TSH]] ([[Thyrotoxicosis]])
*[[Thyroid peroxidase|TPO antibodies]] absent or very low titer
*[[I-123 thyroid imaging|I-123]] uptake decreased
|-
| align="center" style="background:#DCDCDC;" |[[Postpartum thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Autoimmune]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Childbearing age
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Lymphocytic infiltration
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Increased TSH]] ([[hypothyroidism]]) and/or
* [[Thyroid function tests|Decreased TSH]] (transient hypothyroidism)
*[[Thyroid peroxidase|TPO antibodies]] present in high titer
*[[I-123 thyroid imaging|I-123]] uptake usually decreased
|-
| align="center" style="background:#DCDCDC;" |[[Riedel's thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Unknown
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*30-60
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Dense [[fibrosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Normal TSH]] (euthyroidism)
*[[Thyroid peroxidase|TPO antibodies]] usually present
*[[I-123 thyroid imaging|I-123]] uptake decreased or normal
|-
| align="center" style="background:#DCDCDC;" |[[Suppurative thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Infection]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Children, 20-40
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Abscess]] formation
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Normal TSH]] (euthyroidism)
*[[Thyroid peroxidase|TPO antibodies]] absent
*[[I-123 thyroid imaging|I-123]] uptake normal
|}
 
===Differentiating silent thyroiditis from other causes of hypothyroidism===
*Silent thyroiditis must be differentiated from other causes of [[hypothyroidism]] on the basis of history and symptoms and laboratory findings:<ref name="pmid16734054">{{cite journal |vauthors=Bindra A, Braunstein GD |title=Thyroiditis |journal=Am Fam Physician |volume=73 |issue=10 |pages=1769–76 |year=2006 |pmid=16734054 |doi= |url=}}</ref><ref name="pmid19949140">{{cite journal |vauthors=McDermott MT |title=In the clinic. Hypothyroidism |journal=Ann. Intern. Med. |volume=151 |issue=11 |pages=ITC61 |year=2009 |pmid=19949140 |doi=10.7326/0003-4819-151-11-200912010-01006 |url=}}</ref><ref name="urlThyroiditis — NEJM">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMra021194 |title=Thyroiditis — NEJM |format= |work= |accessdate=}}</ref><ref name="pmid18177256">{{cite journal |vauthors=Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR |title=Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002) |journal=Thyroid |volume=17 |issue=12 |pages=1211–23 |year=2007 |pmid=18177256 |doi=10.1089/thy.2006.0235 |url=}}</ref><ref name="pmid18415684">{{cite journal |vauthors=Lania A, Persani L, Beck-Peccoz P |title=Central hypothyroidism |journal=Pituitary |volume=11 |issue=2 |pages=181–6 |year=2008 |pmid=18415684 |doi=10.1007/s11102-008-0122-6 |url=}}</ref><ref name="pmid25905413">{{cite journal |vauthors=De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Stockigt J |title=Clinical Strategies in the Testing of Thyroid Function |journal= |volume= |issue= |pages= |year= |pmid=25905413 |doi= |url=}}</ref>
 
{| class="wikitable" align="center" style="border: 0px; margin: 3px;"
! colspan="2" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease
! colspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |History and symptoms
! colspan="7" align="center" style="background: #4479BA; color: #FFFFFF; " |Laboratory findings
! rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Additional findings
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic nodular goiter}}
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Fever 
| style="padding: 5px 5px; background: #F5F5F5;" | -
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Pain
| style="padding: 5px 5px; background: #F5F5F5;" | Multiple nodules
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TSH
| style="padding: 5px 5px; background: #F5F5F5;" | -
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Free T4
| style="padding: 5px 5px; background: #F5F5F5;" | Hot nodules at thyroid scan
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3
| style="padding: 5px 5px; background: #F5F5F5;" | -
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3RU<small>†
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Thyroglobin
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TRH
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TPOAb^
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic adenoma}}
| rowspan="3" style="background:#DCDCDC;" |[[Hypothyroidism|Transient hypothyroidism]]
| style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="background:#DCDCDC;" |[[Silent thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" | Single nodule
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| style="padding: 5px 5px; background: #F5F5F5;" | Hot nodule
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓
| style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer)
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*May present primarily with [[hyperthyroidism]]
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Subacute thyroiditis}}
| align="center" style="background:#DCDCDC;" |[[Postpartum thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" | Heterogeneous hypoechoic areas
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓
| style="padding: 5px 5px; background: #F5F5F5;" | ?
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑'''
| style="padding: 5px 5px; background: #F5F5F5;" | Neck pain, fever, and<br> elevated inflammatory index
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer)
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*May present primarily with [[hyperthyroidism]]
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Painless thyroiditis}}
| align="center" style="background:#DCDCDC;" |[[De Quervain's thyroiditis|Subacute (de Quervain's) thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" | Hypoechoic pattern
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓
| style="padding: 5px 5px; background: #F5F5F5;" | ?
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑'''
| style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Low/absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*May present primarily with [[hyperthyroidism]]
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Amiodarone induced thyroiditis-Type 1}}
| rowspan="3" style="background:#DCDCDC;" |[[Primary hypothyroidism]]
| style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis|Autoimmune]] ([[Hashimoto's thyroiditis]])
| style="padding: 5px 5px; background: #F5F5F5;" | Diffuse or nodular goiter
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| style="padding: 5px 5px; background: #F5F5F5;" | ?/Normal/?
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| style="padding: 5px 5px; background: #F5F5F5;" | ? but higher than in Type 2
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''<small>*
| style="padding: 5px 5px; background: #F5F5F5;" | High urinary iodine
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer)
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* May be accompanied by other [[autoimmune diseases]]
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Amiodarone induced thyroiditis-Type 2}}
| align="center" style="background:#DCDCDC;" |[[Riedel's thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| style="padding: 5px 5px; background: #F5F5F5;" | Normal  
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| style="padding: 5px 5px; background: #F5F5F5;" | Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
| style="padding: 5px 5px; background: #F5F5F5;" | ?/absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↓
| style="padding: 5px 5px; background: #F5F5F5;" | High urinary iodine
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Usually present
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*[[Riedel's thyroiditis]] usually presents with hard and fixed [[thyroid]] mass.
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Central hyperthyroidism}}
| align="center" style="background:#DCDCDC;" |[[Infectious thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| style="padding: 5px 5px; background: #F5F5F5;" | Diffuse or nodular goiter
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| style="padding: 5px 5px; background: #F5F5F5;" | Normal/?
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" | ?
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" | Inappropriately normal or high TSH
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*[[Thyroiditis|Infectious thyroiditis]] associated with [[neck pain]]
 
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Trophoblastic disease}}
| rowspan="8" style="background:#DCDCDC;" |Others
| style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="background:#DCDCDC;" |Drug-induced
| style="padding: 5px 5px; background: #F5F5F5;" | Diffuse or nodular goiter
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| style="padding: 5px 5px; background: #F5F5F5;" | Normal/?
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| style="padding: 5px 5px; background: #F5F5F5;" | ?
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''/↓
| style="padding: 5px 5px; background: #F5F5F5;" | -
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''/↑
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent**
| rowspan="5" align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* History of [[hyperthyroidism]]
* History of [[trauma]]
*History of drug use, [[surgery]], or [[radiation]]
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Factitious thyrotoxicosis}}
| align="center" style="background:#DCDCDC;" |Radiation-induced
| style="padding: 5px 5px; background: #F5F5F5;" | -
|-
| style="padding: 5px 5px; background: #F5F5F5;" | Variable
| align="center" style="background:#DCDCDC;" |Trauma induced
| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
|-
| style="padding: 5px 5px; background: #F5F5F5;" | ?
| align="center" style="background:#DCDCDC;" |Radioiodine induced
| style="padding: 5px 5px; background: #F5F5F5;" | ? Serum thyroglobulin
|-
| align="center" style="background:#DCDCDC;" |[[Thyroidectomy]]
|-
| align="center" style="background:#DCDCDC;" |Subclinical hypothyroidism
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* Asymptomatic
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Struma ovarii}}
| style="padding: 5px 5px; background: #F5F5F5;" | -
| style="padding: 5px 5px; background: #F5F5F5;" | Variable
| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
| style="padding: 5px 5px; background: #F5F5F5;" | ?
| style="padding: 5px 5px; background: #F5F5F5;" | Abdominal RAIU
|}
|}


{| align="center" style="border: 0px; font-size: 90%; margin: 3px;"
===Differentiating silent thyroiditis from other causes of thyrotoxicosis===
! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Disease}}
*Silent thyroiditis can initially present with [[thyrotoxicosis]] which must be differentiated from other causes of [[thyrotoxicosis]].<ref name="pmid16734054">{{cite journal |vauthors=Bindra A, Braunstein GD |title=Thyroiditis |journal=Am Fam Physician |volume=73 |issue=10 |pages=1769–76 |year=2006 |pmid=16734054 |doi= |url=}}</ref><ref name="pmid19949140">{{cite journal |vauthors=McDermott MT |title=In the clinic. Hypothyroidism |journal=Ann. Intern. Med. |volume=151 |issue=11 |pages=ITC61 |year=2009 |pmid=19949140 |doi=10.7326/0003-4819-151-11-200912010-01006 |url=}}</ref><ref name="urlThyroiditis — NEJM">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMra021194 |title=Thyroiditis — NEJM |format= |work= |accessdate=}}</ref><ref name="pmid18177256">{{cite journal |vauthors=Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR |title=Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002) |journal=Thyroid |volume=17 |issue=12 |pages=1211–23 |year=2007 |pmid=18177256 |doi=10.1089/thy.2006.0235 |url=}}</ref><ref name="pmid18415684">{{cite journal |vauthors=Lania A, Persani L, Beck-Peccoz P |title=Central hypothyroidism |journal=Pituitary |volume=11 |issue=2 |pages=181–6 |year=2008 |pmid=18415684 |doi=10.1007/s11102-008-0122-6 |url=}}</ref><ref name="pmid25905413">{{cite journal |vauthors=De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Stockigt J |title=Clinical Strategies in the Testing of Thyroid Function |journal= |volume= |issue= |pages= |year= |pmid=25905413 |doi= |url=}}</ref><ref name="urlClinical Finding and Thyroid Function in Women with Struma Ovarii">{{cite web |url=https://www.hindawi.com/archive/2013/717584/ |title=Clinical Finding and Thyroid Function in Women with Struma Ovarii |format= |work= |accessdate=}}</ref><ref name="pmid25146390">{{cite journal |vauthors=Vaidya B, Pearce SH |title=Diagnosis and management of thyrotoxicosis |journal=BMJ |volume=349 |issue= |pages=g5128 |year=2014 |pmid=25146390 |doi= |url=}}</ref><ref name="urlThink thyrotoxicosis factitia - measure thyroglobulin | The BMJ">{{cite web |url=http://www.bmj.com/content/349/bmj.g5128/rr/763450 |title=Think thyrotoxicosis factitia - measure thyroglobulin &#124; The BMJ |format= |work= |accessdate=}}</ref>
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Findings}}
{| class="wikitable" align="center" style="border: 0px; margin: 3px;"
! colspan="2" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease
! colspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |History and symptoms
! colspan="8" align="center" style="background: #4479BA; color: #FFFFFF; " |Laboratory findings
! rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Additional findings
|-
|-
| colspan="1" rowspan="5" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Thyroiditis}}
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Fever 
| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Direct chemical toxicity with inflammation}}
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Pain
| 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>
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TSH
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Free T4
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3RU<small>†
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Thyroglobin
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TRH
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TSH Receptor Antibody
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TPOAb^
|-
|-
| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Radiation thyroiditis}}
| rowspan="4" style="background:#DCDCDC;" |[[Thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" | Patients treated with [[radioiodine]] may develop thyroid pain and tenderness 5 to 10 days later, due to radiation-induced injury and necrosis of thyroid follicular cells and associated [[inflammation]].
| align="center" style="background:#DCDCDC;" |[[Silent thyroiditis]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer)
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*May present with [[hypothyroidism]]
|-
|-
| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Drugs that interfere with the immune system}}
| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis]] (Hashitoxicosis)
| style="padding: 5px 5px; background: #F5F5F5;" | [[Interferon alfa-2a clinical pharmacology|Interferon-alfa]] is a well-known cause of [[thyroid]] abnormality. It mostly leads to the development of de novo [[antithyroid]] [[antibodies]].<ref name="pmid8351956">{{cite journal |vauthors=Vialettes B, Guillerand MA, Viens P, Stoppa AM, Baume D, Sauvan R, Pasquier J, San Marco M, Olive D, Maraninchi D |title=Incidence rate and risk factors for thyroid dysfunction during recombinant interleukin-2 therapy in advanced malignancies |journal=Acta Endocrinol. |volume=129 |issue=1 |pages=31–8 |year=1993 |pmid=8351956 |doi= |url=}}</ref>
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''<small>*
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer)
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* May be accompanied by other [[autoimmune diseases]]
|-
|-
| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Lithium}}
| align="center" style="background:#DCDCDC;" |[[De Quervain's thyroiditis|Subacute (de Quervain's) thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" | Patients treated with [[lithium]] are at a high risk of developing [[Thyroiditis|painless thyroiditis]] and [[Graves' disease]].
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Low/absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*May present with [[hypothyroidism]]
|-
|-
| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Palpation thyroiditis}}
| align="center" style="background:#DCDCDC;" |[[Postpartum 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.
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer)
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*May present with [[hypothyroidism]]
|-
|-
| colspan="1" rowspan="4" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Exogenous and ectopic hyperthyroidism }}
| rowspan="2" style="background:#DCDCDC;" |[[hyperthyroidism|Primary hyperthyroidism]]
| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Factitious ingestion of thyroid hormone}}
| align="center" style="background:#DCDCDC;" |[[Grave's disease]]
| style="padding: 5px 5px; background: #F5F5F5;" |The diagnosis is based on the clinical features, laboratory findings, and 24-hour [[radioiodine]] uptake.<ref name="pmid2666114">{{cite journal |vauthors=Cohen JH, Ingbar SH, Braverman LE |title=Thyrotoxicosis due to ingestion of excess thyroid hormone |journal=Endocr. Rev. |volume=10 |issue=2 |pages=113–24 |year=1989 |pmid=2666114 |doi=10.1210/edrv-10-2-113 |url=}}</ref>
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''''↑'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* Patient may have [[Grave's opthalmopathy|opthalmopathy]] and [[dermopathy]]
|-
|-
| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Acute hyperthyroidism from a levothyroxine overdose}}
| align="center" style="background:#DCDCDC;" |[[Toxic thyroid nodule]]
| style="padding: 5px 5px; background: #F5F5F5;" |The diagnosis is based on the clinical features, laboratory findings, and 24-hour [[radioiodine]] uptake.<ref name="pmid23067331">{{cite journal |vauthors=Jha S, Waghdhare S, Reddi R, Bhattacharya P |title=Thyroid storm due to inappropriate administration of a compounded thyroid hormone preparation successfully treated with plasmapheresis |journal=Thyroid |volume=22 |issue=12 |pages=1283–6 |year=2012 |pmid=23067331 |doi=10.1089/thy.2011.0353 |url=}}</ref>
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑(hot [[Thyroid nodule|nodule]])
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
-
|-
|-
| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Struma ovarii}}
| rowspan="1" style="background:#DCDCDC;" |[[Hyperthyroidism|Secondary hyperthyroidism]]
| style="padding: 5px 5px; background: #F5F5F5;" |Functioning [[thyroid]] tissue is present in an [[ovarian neoplasm]].
| align="center" style="background:#DCDCDC;" |[[Pituitary adenoma]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*Inappropriately normal or increased [[TSH]]
|-
|-
| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Functional thyroid cancer metastases}}
| rowspan="1" style="background:#DCDCDC;" |[[Hyperthyroidism|Tertiary hyperthyroidism]]
| style="padding: 5px 5px; background: #F5F5F5;" |Large bony [[metastases]] from widely metastatic [[follicular thyroid cancer]] cause symptomatic hyperthyroidism.
| align="center" style="background:#DCDCDC;" |[[Hyperthyroidism|Tertiary hyperthyroidism]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*Inappropriately normal or increased [[TSH]]
|-
|-
| colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Hashitoxicosis }}
| rowspan="2" style="background:#DCDCDC;" |Drug induced
| style="padding: 5px 5px; background: #F5F5F5;" |It is an autoimmune thyroid disease that initially presents with hyperthyroidism and a high [[radioiodine]] uptake caused by [[TSH receptor|TSH-receptor]] antibodies similar to [[Graves' disease]]. It is then followed by the development of [[hypothyroidism]] due to the infiltration of the [[thyroid gland]] with [[Lymphocyte|lymphocytes]] and the resultant autoimmune-mediated destruction of [[thyroid]] tissue, similar to chronic [[lymphocytic thyroiditis]].<ref name="pmid5171000">{{cite journal |vauthors=Fatourechi V, McConahey WM, Woolner LB |title=Hyperthyroidism associated with histologic Hashimoto's thyroiditis |journal=Mayo Clin. Proc. |volume=46 |issue=10 |pages=682–9 |year=1971 |pmid=5171000 |doi= |url=}}</ref>
| align="center" style="background:#DCDCDC;" |[[Amiodarone| Amiodarone type 1]]
|-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic adenoma and toxic multinodular goiter}}
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| 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>
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*High urinary [[iodine]]
|-
|-
| colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Iodine-induced hyperthyroidism  }}
| align="center" style="background:#DCDCDC;" |[[Amiodarone|Amiodarone type 2]]
| style="padding: 5px 5px; background: #F5F5F5;" |It is uncommon but can develop after an [[iodine]] load, such as administration of contrast agents used for [[angiography]] or [[Computed tomography|computed tomography (CT)]], or [[iodine]]-rich drugs such as [[amiodarone]].
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent/↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*High urinary [[iodine]]
|-
| rowspan="3" style="background:#DCDCDC;" |Others
| align="center" style="background:#DCDCDC;" |[[Thyrotoxicosis factitia|Factitious thyrotoxicosis]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*Decreased [[thyroglobulin]]
|-
| align="center" style="background:#DCDCDC;" |[[Trophoblastic disease]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
-
|-
| align="center" style="background:#DCDCDC;" |[[Struma ovarii]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
-
|-
|-
| colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Trophoblastic disease and germ cell tumors }}
| style="padding: 5px 5px; background: #F5F5F5;" |[[Thyroid-stimulating hormone]] and [[HCG]] have a common alpha-subunit and a beta-subunit with considerable homology. As a result, [[HCG]] has weak thyroid-stimulating activity and high [[titer]] [[HCG]] may mimic hyperthyroidism.<ref name="pmid19605510">{{cite journal |vauthors=Oosting SF, de Haas EC, Links TP, de Bruin D, Sluiter WJ, de Jong IJ, Hoekstra HJ, Sleijfer DT, Gietema JA |title=Prevalence of paraneoplastic hyperthyroidism in patients with metastatic non-seminomatous germ-cell tumors |journal=Ann. Oncol. |volume=21 |issue=1 |pages=104–8 |year=2010 |pmid=19605510 |doi=10.1093/annonc/mdp265 |url=}}</ref>
|}
|}
<small>''(†)T3RU; Triiodothyronine Resin uptake. (^)TPOAb; [[Thyroid peroxidase]] antibodies.''</small>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 00:11, 30 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]

Overview

Silent thyroiditis must be differentiated from other causes of thyroiditis, such as De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis, and suppurative thyroiditis. Silent thyroiditis must also be differentiated from other diseases which cause hypothyroidism. As silent thyroiditis may cause transient thyrotoxic symptoms, the diseases causing thyrotoxicosis must also be considered in the differential diagnosis.

Differentiating Silent Thyroiditis from other Diseases

Differentiating silent thyroiditis from other causes of thyroiditis

Conditions Causes Age at onset Pathological findings Diagnostic approach
Silent thyroiditis
  • All ages, peak at 30-40
  • Lymphocytic infiltration
  • Lymphoid follicles
Hashimoto's thyroiditis
  • All ages, peak at 30-50
Painful subacute (De Quervain's) thyroiditis
  • Unknown
  • 20-60
Postpartum thyroiditis
  • Childbearing age
  • Lymphocytic infiltration
Riedel's thyroiditis
  • Unknown
  • 30-60
Suppurative thyroiditis
  • Children, 20-40

Differentiating silent thyroiditis from other causes of hypothyroidism

Disease History and symptoms Laboratory findings Additional findings
Fever Pain TSH Free T4 T3 T3RU† Thyroglobin TRH TPOAb^
Transient hypothyroidism Silent thyroiditis - - ↑/↓ ↓/↑ Normal ↓ ↑ Normal Present (high titer)
Postpartum thyroiditis +/- +/- ↑/↓ ↓/↑ Normal ↓ ↑ Normal/↑ Present (high titer)
Subacute (de Quervain's) thyroiditis +/- +/- ↑/↓ ↓/↑ Normal ↓ ↑ Normal Low/absent
Primary hypothyroidism Autoimmune (Hashimoto's thyroiditis) - - ↑* ↓ Normal/↓ Normal/↓ Normal/↑ Normal Present (high titer)
Riedel's thyroiditis - - Normal/↑ Normal/↓ Normal/↓ Normal/↓ Normal Normal Usually present
Infectious thyroiditis + + Normal Normal Normal Normal Normal Normal Absent
Others Drug-induced - - ↑/↓ ↓/↑ Normal ↓ Normal/↑ Normal Absent**
Radiation-induced
Trauma induced
Radioiodine induced
Thyroidectomy
Subclinical hypothyroidism - - ↑ Normal Normal Normal Normal Normal Normal/↑
  • Asymptomatic

Differentiating silent thyroiditis from other causes of thyrotoxicosis

Disease History and symptoms Laboratory findings Additional findings
Fever Pain TSH Free T4 T3 T3RU† Thyroglobin TRH TSH Receptor Antibody TPOAb^
Thyroiditis Silent thyroiditis - - ↑/↓ ↓/↑ Normal ↓ ↑ Normal Absent Present (high titer)
Hashimoto's thyroiditis (Hashitoxicosis) - - ↑* ↓ Normal/↓ Normal/↓ Normal/↑ Normal Absent Present (high titer)
Subacute (de Quervain's) thyroiditis +/- +/- ↑/↓ ↓/↑ Normal ↓ ↑ Normal Absent Low/absent
Postpartum thyroiditis +/- +/- ↑/↓ ↓/↑ Normal ↓ ↑ Normal/↑ Absent Present (high titer)
Primary hyperthyroidism Grave's disease - - ↓ ↑ Normal/↑ ↑ ↑ Normal Present Absent
Toxic thyroid nodule - - ↓ ↑ Normal/↑ ↑(hot nodule) Normal/↑ Normal Absent Absent

-

Secondary hyperthyroidism Pituitary adenoma - - ↑ ↑ Normal/↑ ↑ Normal/↑ Normal Absent Absent
  • Inappropriately normal or increased TSH
Tertiary hyperthyroidism Tertiary hyperthyroidism - - ↑ ↑ ↑ ↑ Normal/↑ ↑ Absent Absent
  • Inappropriately normal or increased TSH
Drug induced Amiodarone type 1 - - ↓ ↑ Normal/↑ ↓ Normal/↑ Normal Absent Absent
Amiodarone type 2 - - ↓ ↑ Normal/↑ Absent/↓ Normal/↑ Normal Absent Absent
Others Factitious thyrotoxicosis - - ↓ ↑ Normal/↑ ↓ ↓ Normal Absent Absent
Trophoblastic disease - - ↓ ↑ Normal/↑ ↑ - Normal Absent Absent

-

Struma ovarii - - ↓ ↑ Normal/↑ ↓ - Normal Absent Absent

-

(†)T3RU; Triiodothyronine Resin uptake. (^)TPOAb; Thyroid peroxidase antibodies.

References

  1. ↑ 1.0 1.1 1.2 "Thyroiditis — NEJM".
  2. ↑ 2.0 2.1 Bindra A, Braunstein GD (2006). "Thyroiditis". Am Fam Physician. 73 (10): 1769–76. PMID 16734054.
  3. ↑ 3.0 3.1 McDermott MT (2009). "In the clinic. Hypothyroidism". Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.
  4. ↑ 4.0 4.1 Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR (2007). "Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002)". Thyroid. 17 (12): 1211–23. doi:10.1089/thy.2006.0235. PMID 18177256.
  5. ↑ 5.0 5.1 Lania A, Persani L, Beck-Peccoz P (2008). "Central hypothyroidism". Pituitary. 11 (2): 181–6. doi:10.1007/s11102-008-0122-6. PMID 18415684.
  6. ↑ 6.0 6.1 De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Stockigt J. "Clinical Strategies in the Testing of Thyroid Function". PMID 25905413.
  7. ↑ "Clinical Finding and Thyroid Function in Women with Struma Ovarii".
  8. ↑ Vaidya B, Pearce SH (2014). "Diagnosis and management of thyrotoxicosis". BMJ. 349: g5128. PMID 25146390.
  9. ↑ "Think thyrotoxicosis factitia - measure thyroglobulin | The BMJ".

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