De Quervain's thyroiditis from other diseases: Difference between revisions

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__NOTOC__
__NOTOC__
{{De Quervain's thyroiditis }}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/De_Quervain%27s_thyroiditis]]
{{CMG}} {{AE}} {{MMF}}
{{CMG}} {{AE}} {{MMF}}
==Overview==
==Overview==
[[De Quervain's thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis.
De Quervain's thyroiditis must be differentiated from other causes of [[thyroiditis]], such as [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and [[suppurative]] thyroiditis. De Quervain's thyroiditis must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis. De Quervain's thyroiditis must also be differentiated from other diseases which cause [[hypothyroidism]]. As de Quervain's thyroiditis may cause transient thyrotoxic symptoms, the diseases causing [[thyrotoxicosis]] must also be considered in the differential diagnosis.
 
==Differentiating De Quervain's thyroiditis from other diseases==
==Differentiating De Quervain's thyroiditis from other diseases==
*[[De Quervain's thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[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>
*[[De Quervain's thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[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>
 
<br>
{| align="center"
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{| style="border: 0px; font-size: 90%; margin: 6px;" align="center"
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
! style="background:#4479BA; color: #FFFFFF;" | Conditions
! style="background:#4479BA; color: #FFFFFF;" |Conditions
! style="background:#4479BA; color: #FFFFFF;" |Causes
! style="background:#4479BA; color: #FFFFFF;" |Causes
! style="background:#4479BA; color: #FFFFFF;" |Age at onset
! style="background:#4479BA; color: #FFFFFF;" |Age at onset
! style="background:#4479BA; color: #FFFFFF;" |Pathological findings
! style="background:#4479BA; color: #FFFFFF;" |Pathological findings
! style="background:#4479BA; color: #FFFFFF;" |Diagnostic approach     
! style="background:#4479BA; color: #FFFFFF;" |Diagnostic approach     
|-
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| align="center" style="background:#DCDCDC;" |[[De Quervain's thyroiditis|Painful subacute (De Quervain's) thyroiditis]]
| align="center" style="background:#DCDCDC;" |[[De Quervain's thyroiditis|Painful subacute (De Quervain's) thyroiditis]]
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*20-60
*20-60
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Giant cells
*[[Giant cells]]
*Granulomas
*[[Granulomas]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Increased TSH]] (hypothyroidism) and/or
*[[Thyroid function tests|Increased TSH]] ([[hypothyroidism]]) and/or
* [[Thyroid function tests|Decreased TSH]] (Thyrotoxicosis)
* [[Thyroid function tests|Decreased TSH]] ([[Hyperthyroidism|Thyrotoxicosis]])
*[[Thyroid peroxidase|TPO antibodies]] absent or very low titer
*[[Thyroid peroxidase|TPO antibodies]] absent or very low titer
*[[I-123 thyroid imaging|I-123]] uptake decreased
*[[I-123 thyroid imaging|I-123]] uptake decreased
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*All ages, peak at 30-50
*All ages, peak at 30-50
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Lymphocytic infiltration
*[[Lymphocytic]] infiltration
*Germinal centers
*[[Germinal centers]]
*Fibrosis (in some variants)
*[[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;" |[[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;" |[[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" |
*[[Lymphocyte|Lymphocytic]] infiltration
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Increased TSH]] (hypothyroidism)
*[[Thyroid function tests|Increased TSH]] ([[hypothyroidism]]) and/or
* [[Thyroid function tests|Decreased TSH]] (transient [[hypothyroidism]])
*[[Thyroid peroxidase|TPO antibodies]] present in high titer
*[[Thyroid peroxidase|TPO antibodies]] present in high titer
*[[I-123 thyroid imaging|I-123]] uptake usually decreased
*[[I-123 thyroid imaging|I-123]] uptake usually decreased
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*30-60
*30-60
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Dense fibrosis
*Dense [[fibrosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Normal TSH]] (euthyroidism)
*[[Thyroid function tests|Normal TSH]] (euthyroidism)
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*[[I-123 thyroid imaging|I-123]] uptake decreased or normal  
*[[I-123 thyroid imaging|I-123]] uptake decreased or normal  
|-
|-
| align="center" style="background:#DCDCDC;" |[[Suppurative thyroiditis]]
| align="center" style="background:#DCDCDC;" |Suppurative [[thyroiditis]] (Infectious Thyroiditis)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Infection
*Infection
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*Children, 20-40
*Children, 20-40
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Abscess formation
*[[Abscess]] formation
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Normal TSH]] (euthyroidism)
*[[Thyroid function tests|Normal TSH]] (euthyroidism)
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<br style="clear:left" />
*De Quervain's 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>
De Quervain's thyroiditis can be differentiated from the conditions causing thyrotoxicosis on the basis of following features:
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
{| class="wikitable" align="center" style="border: 0px; margin: 3px;"
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Cause of thyrotoxicosis}}
! colspan="2" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|TSH receptor Antibodies}}
! colspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |History and symptoms
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Thyroid US}}
! colspan="7" align="center" style="background: #4479BA; color: #FFFFFF; " |Laboratory findings
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Color flow Doppler}}
! rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Additional findings
! 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}}
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Fever
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Pain
! 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> TPOAb^
|-
| rowspan="3" style="background:#DCDCDC;" |[[Hypothyroidism|Transient hypothyroidism]]
| align="center" style="background:#DCDCDC;" |[[De Quervain's thyroiditis|Subacute (de Quervain's) 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;" |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|Graves' disease}}
| 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;" | Hypoechoic pattern
| 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;" |↓/'''↑'''
| style="padding: 5px 5px; background: #F5F5F5;" | Ophthalmopathy, dermopathy, acropachy
| 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|Toxic nodular goiter}}
| align="center" style="background:#DCDCDC;" |[[Silent thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| style="padding: 5px 5px; background: #F5F5F5;" | Multiple nodules
| 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 nodules at thyroid scan
| 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;" |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|Toxic adenoma}}
| 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;" | 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;" |'''↑'''<small>*
| 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;" |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|Subacute thyroiditis}}
| 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;" | 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;" |Normal/↑
| style="padding: 5px 5px; background: #F5F5F5;" | ↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↓
| 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;" |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|Painless thyroiditis}}
| align="center" style="background:#DCDCDC;" |[[Suppurative thyroiditis]] (Infectious 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;" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" | ↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| 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="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|Amiodarone induced thyroiditis-Type 1}}
| rowspan="7" 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;" | ↓ but higher than in Type 2
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''/↓
| style="padding: 5px 5px; background: #F5F5F5;" | High urinary iodine
| 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|Amiodarone induced thyroiditis-Type 2}}
| align="center" style="background:#DCDCDC;" |[[Radiation therapy|Radiation]]-induced
| style="padding: 5px 5px; background: #F5F5F5;" | -
| style="padding: 5px 5px; background: #F5F5F5;" | Normal
| style="padding: 5px 5px; background: #F5F5F5;" | Absent
| style="padding: 5px 5px; background: #F5F5F5;" | ↓/absent
| style="padding: 5px 5px; background: #F5F5F5;" | High urinary iodine
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Central hyperthyroidism}}
| align="center" style="background:#DCDCDC;" |Trauma induced
| style="padding: 5px 5px; background: #F5F5F5;" | -
| style="padding: 5px 5px; background: #F5F5F5;" | Diffuse or nodular goiter
| style="padding: 5px 5px; background: #F5F5F5;" | Normal/↑
| style="padding: 5px 5px; background: #F5F5F5;" | ↑
| style="padding: 5px 5px; background: #F5F5F5;" | Inappropriately normal or high TSH
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Trophoblastic disease}}
| align="center" style="background:#DCDCDC;" |Radioiodine induced
| style="padding: 5px 5px; background: #F5F5F5;" | -
| style="padding: 5px 5px; background: #F5F5F5;" | Diffuse or nodular goiter
| style="padding: 5px 5px; background: #F5F5F5;" | Normal/↑
| style="padding: 5px 5px; background: #F5F5F5;" | ↑
| style="padding: 5px 5px; background: #F5F5F5;" | -
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Factitious thyrotoxicosis}}
| align="center" style="background:#DCDCDC;" |[[Thyroidectomy]]
| 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;" | ↓ serum thyroglobulin
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Struma ovarii}}
| align="center" style="background:#DCDCDC;" |Subclinical [[hypothyroidism]]
| style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| style="padding: 5px 5px; background: #F5F5F5;" | Variable
| 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;" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" | Abdominal RAIU
| 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
|}
|}
<br style="clear:left" />''(†)T3RU; Triiodothyronine Resin uptake. (^)[[TPO]]Ab; [[Thyroid peroxidase]] antibodies. (*)[[TSH]] may be decreased transiently in the [[thyrotoxicosis]]. (**)[[TPO]]Ab may be present in drug-induced [[Hypothyroidism|hypo]]/[[hyperthyroidism]] such as [[Interferon-alpha]], [[Interleukin 2|interleukin-2]], and [[lithium]].''


===Prominent features in the different causes of hyperthyroidism===
===Differentiating de Quervain's thyroiditis from other causes of thyrotoxicosis===
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
*De Quervain's 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="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Disease}}
{| class="wikitable" align="center" style="border: 0px; margin: 3px;"
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Findings}}
! 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
|-
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Fever
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Pain
! 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^
|-
| rowspan="4" style="background:#DCDCDC;" |[[Thyroiditis]]
| align="center" style="background:#DCDCDC;" |[[De Quervain's thyroiditis|Subacute (de Quervain's) 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;" |Low/absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*May present with [[hypothyroidism]]
|-
| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis]] (Hashitoxicosis)
| 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]]
|-
|-
| colspan="1" rowspan="5" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Thyroiditis}}
| align="center" style="background:#DCDCDC;" |[[Postpartum thyroiditis]]
| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Direct chemical toxicity with inflammation}}
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| 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="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|Radiation thyroiditis}}
| align="center" style="background:#DCDCDC;" |[[Silent 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="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}}
| rowspan="2" style="background:#DCDCDC;" |[[hyperthyroidism|Primary hyperthyroidism]]
| 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="background:#DCDCDC;" |[[Grave's 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;" |Present
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* Patient may have opthalmopathy and dermopathy
|-
|-
| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Lithium}}
| align="center" style="background:#DCDCDC;" |[[Toxic thyroid nodule]]
| 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;" |↑(hot 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|Palpation thyroiditis}}
| rowspan="1" style="background:#DCDCDC;" |[[Hyperthyroidism|Secondary hyperthyroidism]]
| 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="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
|-
|-
| colspan="1" rowspan="4" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Exogenous and ectopic hyperthyroidism }}
| rowspan="1" style="background:#DCDCDC;" |[[Tertiary hyperthyroidism]]
| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Factitious ingestion of thyroid hormone}}
| align="center" style="background:#DCDCDC;" |[[Hyperthyroidism|Tertiary hyperthyroidism]]
| 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;" |↑
| 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
|-
|-
| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Acute hyperthyroidism from a levothyroxine overdose}}
| rowspan="2" style="background:#DCDCDC;" |Drug induced
| 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="background:#DCDCDC;" |[[Amiodarone| Amiodarone type 1]]
| 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;" |
*High urinary iodine
|-
|-
| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Struma ovarii}}
| align="center" style="background:#DCDCDC;" |[[Amiodarone|Amiodarone type 2]]
| style="padding: 5px 5px; background: #F5F5F5;" |Functioning thyroid tissue is present in an [[ovarian neoplasm]].
| 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]]
|-
|-
| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Functional thyroid cancer metastases}}
| rowspan="3" style="background:#DCDCDC;" |Others
| style="padding: 5px 5px; background: #F5F5F5;" |Large bony [[metastases]] from widely metastatic [[follicular thyroid cancer]] cause symptomatic hyperthyroidism.
| align="center" style="background:#DCDCDC;" |[[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]]
|-
|-
| colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Hashitoxicosis }}
| align="center" style="background:#DCDCDC;" |[[Trophoblastic disease]]
| 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 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="padding: 5px 5px; background: #F5F5F5;" | -
|-
| 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;" |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|Iodine-induced hyperthyroidism  }}
| align="center" style="background:#DCDCDC;" |[[Struma ovarii]]
| 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 (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;" |↓
| 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>''(†)[[T3]]RU; Triiodothyronine Resin uptake. (^)[[TPO]]Ab; [[Thyroid peroxidase]] antibodies.''</small>


==References==
==References==
{{Reflist|2}}
​
[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Up-To-Date]]

Latest revision as of 21:14, 29 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

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

Differentiating De Quervain's thyroiditis from other diseases

Conditions Causes Age at onset Pathological findings Diagnostic approach
Painful subacute (De Quervain's) thyroiditis
  • Unknown
  • 20-60
Hashimoto's thyroiditis
  • Autoimmune
  • All ages, peak at 30-50
Silent thyroiditis
  • Autoimmune
  • All ages, peak at 30-40
Postpartum thyroiditis
  • Autoimmune
  • Childbearing age
Riedel's thyroiditis
  • Unknown
  • 30-60
Suppurative thyroiditis (Infectious Thyroiditis)
  • Infection
  • Children, 20-40
  • De Quervain's thyroiditis must be differentiated from other causes of hypothyroidism on the basis of history and symptoms and laboratory findings:[2][3][1][4][5][6]
Disease History and symptoms Laboratory findings Additional findings
Fever Pain TSH Free T4 T3 T3RU† Thyroglobin TRH TPOAb^
Transient hypothyroidism Subacute (de Quervain's) thyroiditis +/- +/- ↑/↓ ↓/↑ Normal ↓ ↑ Normal Low/absent
Postpartum thyroiditis +/- +/- ↑/↓ ↓/↑ Normal ↓ ↑ Normal/↑ Present (high titer)
Silent thyroiditis - - ↑/↓ ↓/↑ Normal ↓ ↑ Normal Present (high titer)
Primary hypothyroidism Autoimmune (Hashimoto's thyroiditis) - - ↑* ↓ Normal/↓ Normal/↓ Normal/↑ Normal Present (high titer)
Riedel's thyroiditis - - Normal/↑ Normal/↓ Normal/↓ Normal/↓ Normal Normal Usually present
Suppurative thyroiditis (Infectious Thyroiditis) + + Normal Normal Normal Normal Normal Normal Absent
Others Drug-induced - - ↑/↓ ↓/↑ Normal ↓ Normal/↑ Normal Absent**
  • History of hyperthyroidism
  • History of trauma
  • History of drug use, surgery, or radiation
Radiation-induced
Trauma induced
Radioiodine induced
Thyroidectomy
Subclinical hypothyroidism - - ↑ Normal Normal Normal Normal Normal Normal/↑
  • Asymptomatic


(†)T3RU; Triiodothyronine Resin uptake. (^)TPOAb; Thyroid peroxidase antibodies. (*)TSH may be decreased transiently in the thyrotoxicosis. (**)TPOAb may be present in drug-induced hypo/hyperthyroidism such as Interferon-alpha, interleukin-2, and lithium.

Differentiating de Quervain's 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 Subacute (de Quervain's) thyroiditis +/- +/- ↑/↓ ↓/↑ Normal ↓ ↑ Normal Absent Low/absent
Hashimoto's thyroiditis (Hashitoxicosis) - - ↑* ↓ Normal/↓ Normal/↓ Normal/↑ Normal Absent Present (high titer)
Postpartum thyroiditis +/- +/- ↑/↓ ↓/↑ Normal ↓ ↑ Normal/↑ Absent Present (high titer)
Silent thyroiditis - - ↑/↓ ↓/↑ Normal ↓ ↑ Normal Absent Present (high titer)
Primary hyperthyroidism Grave's disease - - ↓ ↑ Normal/↑ ↑ ↑ Normal Present Absent
  • Patient may have opthalmopathy and dermopathy
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
  • High urinary iodine
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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