De Quervain's thyroiditis from other diseases: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/De_Quervain%27s_thyroiditis]] | |||
{{CMG}} {{AE}} {{MMF}} | {{CMG}} {{AE}} {{MMF}} | ||
==Overview== | ==Overview== | ||
[[De Quervain's 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> | ||
{| align="center" | {| align="center" | ||
|- | |- | ||
|} | |} | ||
{| style="border: 0px; font-size: 90%; margin: | {| 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 | ||
|- | |- | ||
| 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;" |[[ | | 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 | ||
| 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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|} | |} | ||
*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> | *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> | ||
{| class="wikitable" align="center" style="border: 0px; margin: 3px;" | {| class="wikitable" align="center" style="border: 0px; margin: 3px;" | ||
! colspan="2" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease | ! colspan="2" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease | ||
! colspan=" | ! colspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |History and symptoms | ||
! colspan=" | ! colspan="7" align="center" style="background: #4479BA; color: #FFFFFF; " |Laboratory findings | ||
! rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Additional 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> Fever | ||
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Pain | ! 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> TSH | ||
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Free T4 | ! 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> T3 | ||
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3RU | ! 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> Thyroglobin | ||
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TRH | ! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TRH | ||
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TPOAb^ | ! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TPOAb^ | ||
|- | |- | ||
| rowspan="3" style="background:#DCDCDC;" |[[Hypothyroidism|Transient hypothyroidism]] | |||
| rowspan=" | |||
| align="center" style="background:#DCDCDC;" |[[De Quervain's thyroiditis|Subacute (de Quervain's) 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;" | +/- | ||
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| 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;" |↓ | ||
| 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;" |Low/absent | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | | align="left" style="padding: 5px 5px; background: #F5F5F5;" | | ||
* May present primarily with [[hyperthyroidism]] | *May present primarily with [[hyperthyroidism]] | ||
|- | |- | ||
| align="center" style="background:#DCDCDC;" | | | align="center" style="background:#DCDCDC;" |[[Postpartum 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;" |'''↑/'''↓ | | 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;" | | | 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;" |Present (high titer) | ||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | |||
*May present primarily with [[hyperthyroidism]] | |||
|- | |||
| 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;" |Present (high titer) | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | | align="left" style="padding: 5px 5px; background: #F5F5F5;" | | ||
* May present primarily with [[hyperthyroidism]] | *May present primarily with [[hyperthyroidism]] | ||
|- | |- | ||
| rowspan="3" style="background:#DCDCDC;" |[[Primary hypothyroidism]] | | rowspan="3" style="background:#DCDCDC;" |[[Primary hypothyroidism]] | ||
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| 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;" |'''↑'''<small>* | ||
| 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;" | | | 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;" |Present (high titer) | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer) | ||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | | align="left" style="padding: 5px 5px; background: #F5F5F5;" | | ||
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| 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;" |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;" | | | 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;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Usually present | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Usually present | ||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | | align="left" style="padding: 5px 5px; background: #F5F5F5;" | | ||
*[[Riedel's thyroiditis]] usually presents with hard and fixed | *[[Riedel's thyroiditis]] usually presents with hard and fixed thyroid mass | ||
|- | |- | ||
| align="center" style="background:#DCDCDC;" |[[ | | align="center" style="background:#DCDCDC;" |[[Suppurative thyroiditis]] (Infectious 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;" | | | 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;" | | | 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;" | | | 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;" |Absent | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent | ||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | | align="left" style="padding: 5px 5px; background: #F5F5F5;" | | ||
*[[Thyroiditis|Infectious thyroiditis]] associated with [[neck pain]] | *[[Thyroiditis|Infectious thyroiditis]] associated with [[neck pain]] | ||
|- | |- | ||
| rowspan=" | | rowspan="7" style="background:#DCDCDC;" |Others | ||
| align="center" style="background:#DCDCDC;" |Drug-induced | | align="center" style="background:#DCDCDC;" |Drug-induced | ||
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | | rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
Line 162: | Line 201: | ||
| rowspan="5" align="center" 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;" |'''''↓'''''/↑ | | rowspan="5" align="center" 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;" |↓ | ||
| 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;" |Absent** | | rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent** | ||
| rowspan="5" align="left" style="padding: 5px 5px; background: #F5F5F5;" | | | rowspan="5" align="left" style="padding: 5px 5px; background: #F5F5F5;" | | ||
Line 172: | Line 211: | ||
*History of drug use, surgery, or radiation | *History of drug use, surgery, or radiation | ||
|- | |- | ||
| align="center" style="background:#DCDCDC;" |Radiation-induced | | align="center" style="background:#DCDCDC;" |[[Radiation therapy|Radiation]]-induced | ||
|- | |- | ||
| align="center" style="background:#DCDCDC;" |Trauma induced | | align="center" style="background:#DCDCDC;" |Trauma induced | ||
Line 178: | Line 217: | ||
| align="center" style="background:#DCDCDC;" |Radioiodine induced | | align="center" style="background:#DCDCDC;" |Radioiodine induced | ||
|- | |- | ||
| align="center" style="background:#DCDCDC;" |Thyroidectomy | | align="center" style="background:#DCDCDC;" |[[Thyroidectomy]] | ||
|- | |- | ||
| align="center" style="background:#DCDCDC;" |Subclinical hypothyroidism | | 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;" | - | ||
| 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;" | | | 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;" | | | 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="left" style="padding: 5px 5px; background: #F5F5F5;" | | | align="left" style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Asymptomatic | * Asymptomatic | ||
|} | |} | ||
<br style="clear:left" /> | <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]].'' | ||
( | |||
===Differentiating de Quervain's thyroiditis from other causes of thyrotoxicosis=== | |||
*De Quervain's thyroiditis can be differentiated from the | *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 | The BMJ |format= |work= |accessdate=}}</ref> | ||
{| class="wikitable" align="center" style="border: 0px; margin: 3px;" | |||
{| style="border: 0px | ! colspan="2" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease | ||
! colspan=" | ! 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]] | |||
|- | |||
| align="center" style="background:#DCDCDC;" |[[Postpartum 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]] | |||
|- | |- | ||
| | | 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;" | | | 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;" | | | 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]] | |||
|- | |- | ||
| | | rowspan="2" style="background:#DCDCDC;" |[[hyperthyroidism|Primary hyperthyroidism]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="background:#DCDCDC;" |[[Grave's disease]] | ||
| 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;" | ↑ | | 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 | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | |||
* Patient may have opthalmopathy and dermopathy | |||
|- | |- | ||
| | | align="center" style="background:#DCDCDC;" |[[Toxic thyroid nodule]] | ||
| 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;" | | | 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;" |↑(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;" | | |||
- | |||
|- | |- | ||
| | | rowspan="1" style="background:#DCDCDC;" |[[Hyperthyroidism|Secondary hyperthyroidism]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="background:#DCDCDC;" |[[Pituitary adenoma]] | ||
| 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;" | | | 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;" |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 | |||
|- | |- | ||
| | | rowspan="1" style="background:#DCDCDC;" |[[Tertiary hyperthyroidism]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="background:#DCDCDC;" |[[Hyperthyroidism|Tertiary hyperthyroidism]] | ||
| 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;" | | | 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;" |↑ | |||
| 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 | |||
|- | |- | ||
| | | rowspan="2" style="background:#DCDCDC;" |Drug induced | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="background:#DCDCDC;" |[[Amiodarone| Amiodarone type 1]] | ||
| 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;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓ | ||
| 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;" |↓ | |||
| 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 | |||
|- | |- | ||
| | | align="center" style="background:#DCDCDC;" |[[Amiodarone|Amiodarone type 2]] | ||
| 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;" |↓ | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑ | ||
| 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;" |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 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="background:#DCDCDC;" |[[Factitious thyrotoxicosis]] | ||
| 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;" | | | 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;" |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]] | ||
| 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;" | | | 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;" |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]] | ||
| 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;" | | | 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;" |Absent | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | |||
- | |||
|- | |- | ||
|} | |} | ||
<small>''(†)[[T3]]RU; Triiodothyronine Resin uptake. (^)[[TPO]]Ab; [[Thyroid peroxidase]] antibodies.''</small> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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[[Category:Medicine]] | |||
[[Category:Endocrinology]] | |||
[[Category:Up-To-Date]] |
Latest revision as of 21:14, 29 July 2020
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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
- De Quervain's thyroiditis must be differentiated from other causes of thyroiditis, such as Hashimoto's thyroiditis, Riedel's thyroiditis, and suppurative thyroiditis.[1]
Conditions | Causes | Age at onset | Pathological findings | Diagnostic approach |
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Painful subacute (De Quervain's) thyroiditis |
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Hashimoto's thyroiditis |
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Silent thyroiditis |
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Postpartum thyroiditis |
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Riedel's thyroiditis |
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Suppurative thyroiditis (Infectious Thyroiditis) |
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- 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 |
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Postpartum thyroiditis | +/- | +/- | ↑/↓ | ↓/↑ | Normal | ↓ | ↑ | Normal/↑ | Present (high titer) |
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Silent thyroiditis | - | - | ↑/↓ | ↓/↑ | Normal | ↓ | ↑ | Normal | Present (high titer) |
| |
Primary hypothyroidism | Autoimmune (Hashimoto's thyroiditis) | - | - | ↑* | ↓ | Normal/↓ | Normal/↓ | Normal/↑ | Normal | Present (high titer) |
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Riedel's thyroiditis | - | - | Normal/↑ | Normal/↓ | Normal/↓ | Normal/↓ | Normal | Normal | Usually present |
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Suppurative thyroiditis (Infectious Thyroiditis) | + | + | Normal | Normal | Normal | Normal | Normal | Normal | Absent |
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Others | Drug-induced | - | - | ↑/↓ | ↓/↑ | Normal | ↓ | Normal/↑ | Normal | Absent** |
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Radiation-induced | |||||||||||
Trauma induced | |||||||||||
Radioiodine induced | |||||||||||
Thyroidectomy | |||||||||||
Subclinical hypothyroidism | - | - | ↑ | Normal | Normal | Normal | Normal | Normal | Normal/↑ |
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(†)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
- De Quervain's thyroiditis can initially present with thyrotoxicosis which must be differentiated from other causes of thyrotoxicosis.[2][3][1][4][5][6][7][8][9]
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 |
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Hashimoto's thyroiditis (Hashitoxicosis) | - | - | ↑* | ↓ | Normal/↓ | Normal/↓ | Normal/↑ | Normal | Absent | Present (high titer) |
| |
Postpartum thyroiditis | +/- | +/- | ↑/↓ | ↓/↑ | Normal | ↓ | ↑ | Normal/↑ | Absent | Present (high titer) |
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Silent thyroiditis | - | - | ↑/↓ | ↓/↑ | Normal | ↓ | ↑ | Normal | Absent | Present (high titer) |
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Primary hyperthyroidism | Grave's disease | - | - | ↓ | ↑ | Normal/↑ | ↑ | ↑ | Normal | Present | Absent |
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Toxic thyroid nodule | - | - | ↓ | ↑ | Normal/↑ | ↑(hot nodule) | Normal/↑ | Normal | Absent | Absent |
- | |
Secondary hyperthyroidism | Pituitary adenoma | - | - | ↑ | ↑ | Normal/↑ | ↑ | Normal/↑ | Normal | Absent | Absent |
|
Tertiary hyperthyroidism | Tertiary hyperthyroidism | - | - | ↑ | ↑ | ↑ | ↑ | Normal/↑ | ↑ | Absent | Absent |
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Drug induced | Amiodarone type 1 | - | - | ↓ | ↑ | Normal/↑ | ↓ | Normal/↑ | Normal | Absent | Absent |
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Amiodarone type 2 | - | - | ↓ | ↑ | Normal/↑ | Absent/↓ | Normal/↑ | Normal | Absent | Absent |
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Others | Factitious thyrotoxicosis | - | - | ↓ | ↑ | Normal/↑ | ↓ | ↓ | Normal | Absent | Absent |
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Trophoblastic disease | - | - | ↓ | ↑ | Normal/↑ | ↑ | - | Normal | Absent | Absent |
- | |
Struma ovarii | - | - | ↓ | ↑ | Normal/↑ | ↓ | - | Normal | Absent | Absent |
- |
(†)T3RU; Triiodothyronine Resin uptake. (^)TPOAb; Thyroid peroxidase antibodies.
References
- ↑ 1.0 1.1 1.2 "Thyroiditis — NEJM".
- ↑ 2.0 2.1 Bindra A, Braunstein GD (2006). "Thyroiditis". Am Fam Physician. 73 (10): 1769–76. PMID 16734054.
- ↑ 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.
- ↑ 4.0 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.
- ↑ 5.0 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.
- ↑ 6.0 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.
- ↑ "Clinical Finding and Thyroid Function in Women with Struma Ovarii".
- ↑ Vaidya B, Pearce SH (2014). "Diagnosis and management of thyrotoxicosis". BMJ. 349: g5128. PMID 25146390.
- ↑ "Think thyrotoxicosis factitia - measure thyroglobulin | The BMJ".