Silent thyroiditis differential diagnosis: Difference between revisions

Latest revision as of 00:11, 30 July 2020

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

Overview

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

Differentiating Silent Thyroiditis from other Diseases

Differentiating silent thyroiditis from other causes of thyroiditis

Silent thyroiditis must be differentiated from other causes of thyroiditis, such as De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis, and suppurative thyroiditis.^[1]

Conditions	Causes	Age at onset	Pathological findings	Diagnostic approach
Silent thyroiditis	Autoimmune	All ages, peak at 30-40	Lymphocytic infiltration Lymphoid follicles	Increased TSH (hypothyroidism) and/or Decreased TSH (transient hypothyroidism) TPO antibodies present in high titer I-123 uptake usually decreased
Hashimoto's thyroiditis	Autoimmune	All ages, peak at 30-50	Lymphocytic infiltration Germinal centers Fibrosis (in some variants)	Increased TSH (hypothyroidism) TPO antibodies present in high titer I-123 uptake usually decreased
Painful subacute (De Quervain's) thyroiditis	Unknown	20-60	Giant cells Granulomas	Increased TSH (hypothyroidism) and/or Decreased TSH (Thyrotoxicosis) TPO antibodies absent or very low titer I-123 uptake decreased
Postpartum thyroiditis	Autoimmune	Childbearing age	Lymphocytic infiltration	Increased TSH (hypothyroidism) and/or Decreased TSH (transient hypothyroidism) TPO antibodies present in high titer I-123 uptake usually decreased
Riedel's thyroiditis	Unknown	30-60	Dense fibrosis	Normal TSH (euthyroidism) TPO antibodies usually present I-123 uptake decreased or normal
Suppurative thyroiditis	Infection	Children, 20-40	Abscess formation	Normal TSH (euthyroidism) TPO antibodies absent I-123 uptake normal

Differentiating silent thyroiditis from other causes of hypothyroidism

Silent thyroiditis must be differentiated from other causes of hypothyroidism on the basis of history and symptoms and laboratory findings:^[2]^[3]^[1]^[4]^[5]^[6]

Disease		History and symptoms		Laboratory findings							Additional findings
Disease		Fever	Pain	TSH	Free T4	T3	T3RU†	Thyroglobin	TRH	TPOAb^	Additional findings
Transient hypothyroidism	Silent thyroiditis	-	-	↑/↓	↓/↑	Normal	↓	↑	Normal	Present (high titer)	May present primarily with hyperthyroidism
	Postpartum thyroiditis	+/-	+/-	↑/↓	↓/↑	Normal	↓	↑	Normal/↑	Present (high titer)	May present primarily with hyperthyroidism
	Subacute (de Quervain's) thyroiditis	+/-	+/-	↑/↓	↓/↑	Normal	↓	↑	Normal	Low/absent	May present primarily with hyperthyroidism
Primary hypothyroidism	Autoimmune (Hashimoto's thyroiditis)	-	-	↑*	↓	Normal/↓	Normal/↓	Normal/↑	Normal	Present (high titer)	May be accompanied by other autoimmune diseases
	Riedel's thyroiditis	-	-	Normal/↑	Normal/↓	Normal/↓	Normal/↓	Normal	Normal	Usually present	Riedel's thyroiditis usually presents with hard and fixed thyroid mass.
	Infectious thyroiditis	+	+	Normal	Normal	Normal	Normal	Normal	Normal	Absent	Infectious thyroiditis associated with neck pain
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

Differentiating silent thyroiditis from other causes of thyrotoxicosis

Silent 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
Disease		Fever	Pain	TSH	Free T4	T3	T3RU†	Thyroglobin	TRH	TSH Receptor Antibody	TPOAb^	Additional findings
Thyroiditis	Silent thyroiditis	-	-	↑/↓	↓/↑	Normal	↓	↑	Normal	Absent	Present (high titer)	May present with hypothyroidism
	Hashimoto's thyroiditis (Hashitoxicosis)	-	-	↑*	↓	Normal/↓	Normal/↓	Normal/↑	Normal	Absent	Present (high titer)	May be accompanied by other autoimmune diseases
	Subacute (de Quervain's) thyroiditis	+/-	+/-	↑/↓	↓/↑	Normal	↓	↑	Normal	Absent	Low/absent	May present with hypothyroidism
	Postpartum thyroiditis	+/-	+/-	↑/↓	↓/↑	Normal	↓	↑	Normal/↑	Absent	Present (high titer)	May present with hypothyroidism
Primary hyperthyroidism	Grave's disease	-	-	↓	↑	Normal/↑	↑	↑	Normal	Present	Absent	Patient may have opthalmopathy and dermopathy
Primary hyperthyroidism	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
Drug induced	Amiodarone type 2	-	-	↓	↑	Normal/↑	Absent/↓	Normal/↑	Normal	Absent	Absent	High urinary iodine
Others	Factitious thyrotoxicosis	-	-	↓	↑	Normal/↑	↓	↓	Normal	Absent	Absent	Decreased thyroglobulin
	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".

Template:WikiDoc Sources

[urlThyroiditis_—_NEJM-1] 1.0 ^1.1 ^1.2 "Thyroiditis — NEJM".

[pmid16734054-2] 2.0 ^2.1 Bindra A, Braunstein GD (2006). "Thyroiditis". Am Fam Physician. 73 (10): 1769–76. PMID 16734054.

[pmid19949140-3] 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.

[pmid18177256-4] 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.

[pmid18415684-5] 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.

[pmid25905413-6] 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.

[urlClinical_Finding_and_Thyroid_Function_in_Women_with_Struma_Ovarii-7] "Clinical Finding and Thyroid Function in Women with Struma Ovarii".

[pmid25146390-8] Vaidya B, Pearce SH (2014). "Diagnosis and management of thyrotoxicosis". BMJ. 349: g5128. PMID 25146390.

[urlThink_thyrotoxicosis_factitia_-_measure_thyroglobulin_|_The_BMJ-9] "Think thyrotoxicosis factitia - measure thyroglobulin | The BMJ".

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Hashimoto's thyroiditis}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Silent_thyroiditis]]
 {{CMG}} {{AE}} {{MMF}}
 ==Overview==
-[[Silent thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis.
+[[Silent thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis. Silent thyroiditis must also be differentiated from other diseases which cause [[hypothyroidism]]. As silent thyroiditis may cause transient [[Thyrotoxicosis|thyrotoxic]] symptoms, the diseases causing [[thyrotoxicosis]] must also be considered in the differential diagnosis.
-==Differentiating silent Thyroiditis from other Diseases==
+==Differentiating Silent Thyroiditis from other Diseases==
+===Differentiating silent thyroiditis from other causes of thyroiditis===
 *Silent thyroiditis must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis.<ref name="urlThyroiditis — NEJM">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMra021194 |title=Thyroiditis — NEJM |format= |work= |accessdate=}}</ref>
 {| align="center"
@@ Line 18: / Line 20: @@
 | align="center" style="background:#DCDCDC;" |[[Silent thyroiditis]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Autoimmune
+*[[Autoimmune]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *All ages, peak at 30-40
@@ Line 25: / Line 27: @@
 *Lymphoid follicles
 | 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]] (transient hypothyroidism)
+* [[Thyroid function tests|Decreased TSH]] (transient [[hypothyroidism]])
 *[[Thyroid peroxidase|TPO antibodies]] present in high titer
 *[[I-123 thyroid imaging|I-123]] uptake usually decreased
@@ Line 32: / Line 34: @@
 | align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Autoimmune
+*[[Autoimmune]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *All ages, peak at 30-50
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *Lymphocytic infiltration
-*Germinal centers
+*[[Germinal center|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 function tests|Increased TSH]] ([[hypothyroidism]])
 *[[Thyroid peroxidase|TPO antibodies]] present in high titer
 *[[I-123 thyroid imaging|I-123]] uptake usually decreased
@@ Line 52: / Line 54: @@
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *Giant cells
-*Granulomas
+*[[Granuloma|Granulomas]]
 | 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]] ([[Thyrotoxicosis]])
 *[[Thyroid peroxidase|TPO antibodies]] absent or very low titer
 *[[I-123 thyroid imaging|I-123]] uptake decreased
@@ Line 61: / Line 63: @@
 | align="center" style="background:#DCDCDC;" |[[Postpartum thyroiditis]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Autoimmune
+*[[Autoimmune]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *Childbearing age
@@ Line 67: / Line 69: @@
 *Lymphocytic infiltration
 | 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]] (transient hypothyroidism)
 *[[Thyroid peroxidase|TPO antibodies]] present in high titer
@@ Line 78: / Line 80: @@
 *30-60
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Dense fibrosis
+*Dense [[fibrosis]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *[[Thyroid function tests|Normal TSH]] (euthyroidism)
@@ Line 86: / Line 88: @@
 | align="center" style="background:#DCDCDC;" |[[Suppurative thyroiditis]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Infection
+*[[Infection]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *Children, 20-40
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Abscess formation
+*[[Abscess]] formation
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *[[Thyroid function tests|Normal TSH]] (euthyroidism)
@@ Line 97: / Line 99: @@
 |}
+===Differentiating silent thyroiditis from other causes of hypothyroidism===
 *Silent thyroiditis must be differentiated from other causes of [[hypothyroidism]] on the basis of history and symptoms and laboratory findings:<ref name="pmid16734054">{{cite journal |vauthors=Bindra A, Braunstein GD |title=Thyroiditis |journal=Am Fam Physician |volume=73 |issue=10 |pages=1769–76 |year=2006 |pmid=16734054 |doi= |url=}}</ref><ref name="pmid19949140">{{cite journal |vauthors=McDermott MT |title=In the clinic. Hypothyroidism |journal=Ann. Intern. Med. |volume=151 |issue=11 |pages=ITC61 |year=2009 |pmid=19949140 |doi=10.7326/0003-4819-151-11-200912010-01006 |url=}}</ref><ref name="urlThyroiditis — NEJM">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMra021194 |title=Thyroiditis — NEJM |format= |work= |accessdate=}}</ref><ref name="pmid18177256">{{cite journal |vauthors=Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR |title=Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002) |journal=Thyroid |volume=17 |issue=12 |pages=1211–23 |year=2007 |pmid=18177256 |doi=10.1089/thy.2006.0235 |url=}}</ref><ref name="pmid18415684">{{cite journal |vauthors=Lania A, Persani L, Beck-Peccoz P |title=Central hypothyroidism |journal=Pituitary |volume=11 |issue=2 |pages=181–6 |year=2008 |pmid=18415684 |doi=10.1007/s11102-008-0122-6 |url=}}</ref><ref name="pmid25905413">{{cite journal |vauthors=De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Stockigt J |title=Clinical Strategies in the Testing of Thyroid Function |journal= |volume= |issue= |pages= |year= |pmid=25905413 |doi= |url=}}</ref>
@@ Line 180: / Line 183: @@
 | 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.
+*[[Riedel's thyroiditis]] usually presents with hard and fixed [[thyroid]] mass.
 |-
 | align="center" style="background:#DCDCDC;" |[[Infectious thyroiditis]]
@@ Line 209: / Line 212: @@
 | rowspan="5" align="left" style="padding: 5px 5px; background: #F5F5F5;" |
 * History of [[hyperthyroidism]]
-* History of trauma
+* History of [[trauma]]
-*History of drug use, surgery, or radiation
+*History of drug use, [[surgery]], or [[radiation]]
 |-
 | align="center" style="background:#DCDCDC;" |Radiation-induced
@@ Line 218: / Line 221: @@
 | 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
@@ Line 234: / Line 237: @@
 |-
 |}
-<br style="clear:left" />''(†)T3RU; Triiodothyronine Resin uptake. (^)TPOAb; [[Thyroid peroxidase]] antibodies. (*)[[TSH]] may be decreased transiently in the [[thyrotoxicosis]]. (**)TPOAb may be present in drug-induced [[Hypothyroidism|hypo]]/[[hyperthyroidism]] such as [[Interferon-alpha]], [[Interleukin 2|interleukin-2]], and [[lithium]].''
-Painless thyroiditis must be differentiated from other causes of hyperthyroidism such as Grave's disease and toxic nodular goiter.
+===Differentiating silent thyroiditis from other causes of thyrotoxicosis===
+*Silent thyroiditis can initially present with [[thyrotoxicosis]] which must be differentiated from other causes of [[thyrotoxicosis]].<ref name="pmid16734054">{{cite journal |vauthors=Bindra A, Braunstein GD |title=Thyroiditis |journal=Am Fam Physician |volume=73 |issue=10 |pages=1769–76 |year=2006 |pmid=16734054 |doi= |url=}}</ref><ref name="pmid19949140">{{cite journal |vauthors=McDermott MT |title=In the clinic. Hypothyroidism |journal=Ann. Intern. Med. |volume=151 |issue=11 |pages=ITC61 |year=2009 |pmid=19949140 |doi=10.7326/0003-4819-151-11-200912010-01006 |url=}}</ref><ref name="urlThyroiditis — NEJM">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMra021194 |title=Thyroiditis — NEJM |format= |work= |accessdate=}}</ref><ref name="pmid18177256">{{cite journal |vauthors=Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR |title=Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002) |journal=Thyroid |volume=17 |issue=12 |pages=1211–23 |year=2007 |pmid=18177256 |doi=10.1089/thy.2006.0235 |url=}}</ref><ref name="pmid18415684">{{cite journal |vauthors=Lania A, Persani L, Beck-Peccoz P |title=Central hypothyroidism |journal=Pituitary |volume=11 |issue=2 |pages=181–6 |year=2008 |pmid=18415684 |doi=10.1007/s11102-008-0122-6 |url=}}</ref><ref name="pmid25905413">{{cite journal |vauthors=De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Stockigt J |title=Clinical Strategies in the Testing of Thyroid Function |journal= |volume= |issue= |pages= |year= |pmid=25905413 |doi= |url=}}</ref><ref name="urlClinical Finding and Thyroid Function in Women with Struma Ovarii">{{cite web |url=https://www.hindawi.com/archive/2013/717584/ |title=Clinical Finding and Thyroid Function in Women with Struma Ovarii |format= |work= |accessdate=}}</ref><ref name="pmid25146390">{{cite journal |vauthors=Vaidya B, Pearce SH |title=Diagnosis and management of thyrotoxicosis |journal=BMJ |volume=349 |issue= |pages=g5128 |year=2014 |pmid=25146390 |doi= |url=}}</ref><ref name="urlThink thyrotoxicosis factitia - measure thyroglobulin | The BMJ">{{cite web |url=http://www.bmj.com/content/349/bmj.g5128/rr/763450 |title=Think thyrotoxicosis factitia - measure thyroglobulin &#124; The BMJ |format= |work= |accessdate=}}</ref>
-{| align="center" style="border: 0px; font-size: 90%; margin: 3px;"
+{| 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="8" 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}}
 |-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Graves' disease}}
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Fever
-| style="padding: 5px 5px; background: #F5F5F5;" | +
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Pain
-| style="padding: 5px 5px; background: #F5F5F5;" | Hypoechoic pattern
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TSH
-| style="padding: 5px 5px; background: #F5F5F5;" | ?
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Free T4
-| style="padding: 5px 5px; background: #F5F5F5;" | ?
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3
-| style="padding: 5px 5px; background: #F5F5F5;" | Ophthalmopathy, dermopathy, acropachy
+! 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^
 |-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic nodular goiter}}
+| rowspan="4" style="background:#DCDCDC;" |[[Thyroiditis]]
-| style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="background:#DCDCDC;" |[[Silent thyroiditis]]
-| 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;" |↓/'''↑'''
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer)
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+*May present with [[hypothyroidism]]
 |-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic adenoma}}
+| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis]] (Hashitoxicosis)
-| style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| 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;" |'''↑'''<small>*
-| style="padding: 5px 5px; background: #F5F5F5;" | Hot nodule
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''
-| style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |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="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Subacute thyroiditis}}
+| align="center" style="background:#DCDCDC;" |[[De Quervain's thyroiditis|Subacute (de Quervain's) thyroiditis]]
-| style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
-| style="padding: 5px 5px; background: #F5F5F5;" | Heterogeneous hypoechoic areas
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
-| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓
-| style="padding: 5px 5px; background: #F5F5F5;" | ?
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑'''
-| style="padding: 5px 5px; background: #F5F5F5;" | Neck pain, fever, and<br> elevated inflammatory index
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Low/absent
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+*May present with [[hypothyroidism]]
 |-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Painless thyroiditis}}
+| align="center" style="background:#DCDCDC;" |[[Postpartum thyroiditis]]
-| style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
-| style="padding: 5px 5px; background: #F5F5F5;" | Hypoechoic pattern
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
-| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓
-| style="padding: 5px 5px; background: #F5F5F5;" | ?
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑'''
-| style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer)
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+*May present with [[hypothyroidism]]
 |-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Amiodarone induced thyroiditis-Type 1}}
+| 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;" | Diffuse or nodular goiter
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | ?/Normal/?
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | ? but higher than in Type 2
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
-| 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;" |↑
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+* Patient may have [[Grave's opthalmopathy|opthalmopathy]] and [[dermopathy]]
 |-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Amiodarone induced thyroiditis-Type 2}}
+| 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;" | 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;" | ?/absent
+| 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;" |↑(hot [[Thyroid nodule|nodule]])
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+-
 |-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Central hyperthyroidism}}
+| 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;" | Diffuse or nodular goiter
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | Normal/?
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | ?
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-| style="padding: 5px 5px; background: #F5F5F5;" | Inappropriately normal or high TSH
+| 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="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Trophoblastic disease}}
+| rowspan="1" style="background:#DCDCDC;" |[[Hyperthyroidism|Tertiary hyperthyroidism]]
-| style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="background:#DCDCDC;" |[[Hyperthyroidism|Tertiary hyperthyroidism]]
-| style="padding: 5px 5px; background: #F5F5F5;" | Diffuse or nodular goiter
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | Normal/?
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | ?
+| 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]]
 |-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Factitious thyrotoxicosis}}
+| 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;" | 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;" |↓
-| style="padding: 5px 5px; background: #F5F5F5;" | ? Serum thyroglobulin
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+*High urinary [[iodine]]
 |-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Struma ovarii}}
+| 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;" | 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;" |↑
-| 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;" |Absent/↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
-{| align="center" style="border: 0px; font-size: 90%; margin: 3px;"
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
-! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Disease}}
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
-! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Findings}}
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+*High urinary [[iodine]]
 |-
-| colspan="1" rowspan="5" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Thyroiditis}}
+| rowspan="3" style="background:#DCDCDC;" |Others
-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Direct chemical toxicity with inflammation}}
+| align="center" style="background:#DCDCDC;" |[[Thyrotoxicosis factitia|Factitious thyrotoxicosis]]
-| 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;" |↑
+| 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]]
 |-
-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Radiation thyroiditis}}
+| align="center" style="background:#DCDCDC;" |[[Trophoblastic disease]]
-| 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;" |Absent
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+-
 |-
-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Drugs that interfere with the immune system}}
+| align="center" style="background:#DCDCDC;" |[[Struma ovarii]]
-| style="padding: 5px 5px; background: #F5F5F5;" | [[Interferon alfa-2a clinical pharmacology|Interferon-alfa]] is a well-known cause of [[thyroid]] abnormality. It mostly leads to the development of de novo [[antithyroid]] [[antibodies]].<ref name="pmid8351956">{{cite journal |vauthors=Vialettes B, Guillerand MA, Viens P, Stoppa AM, Baume D, Sauvan R, Pasquier J, San Marco M, Olive D, Maraninchi D |title=Incidence rate and risk factors for thyroid dysfunction during recombinant interleukin-2 therapy in advanced malignancies |journal=Acta Endocrinol. |volume=129 |issue=1 |pages=31–8 |year=1993 |pmid=8351956 |doi= |url=}}</ref>
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
+| 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;" |
+-
 |-
-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Lithium}}
-| style="padding: 5px 5px; background: #F5F5F5;" | Patients treated with [[lithium]] are at a high risk of developing [[Thyroiditis|painless thyroiditis]] and [[Graves' disease]].
-|-
-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Palpation thyroiditis}}
-| style="padding: 5px 5px; background: #F5F5F5;" | Manipulation of the [[thyroid gland]] during [[thyroid]] [[biopsy]] or neck [[surgery]] and vigorous palpation during the physical examination may cause transient hyperthyroidism.
-|-
-| colspan="1" rowspan="4" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Exogenous and ectopic hyperthyroidism }}
-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Factitious ingestion of thyroid hormone}}
-| 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>
-|-
-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Acute hyperthyroidism from a levothyroxine overdose}}
-| 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>
-|-
-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Struma ovarii}}
-| style="padding: 5px 5px; background: #F5F5F5;" |Functioning [[thyroid]] tissue is present in an [[ovarian neoplasm]].
-|-
-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Functional thyroid cancer metastases}}
-| style="padding: 5px 5px; background: #F5F5F5;" |Large bony [[metastases]] from widely metastatic [[follicular thyroid cancer]] cause symptomatic hyperthyroidism.
-|-
-| colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Hashitoxicosis }}
-| style="padding: 5px 5px; background: #F5F5F5;" |It is an autoimmune thyroid disease that initially presents with hyperthyroidism and a high [[radioiodine]] uptake caused by [[TSH receptor|TSH-receptor]] antibodies similar to [[Graves' disease]]. It is then followed by the development of [[hypothyroidism]] due to the infiltration of the [[thyroid gland]] with [[Lymphocyte|lymphocytes]] and the resultant autoimmune-mediated destruction of [[thyroid]] tissue, similar to chronic [[lymphocytic thyroiditis]].<ref name="pmid5171000">{{cite journal |vauthors=Fatourechi V, McConahey WM, Woolner LB |title=Hyperthyroidism associated with histologic Hashimoto's thyroiditis |journal=Mayo Clin. Proc. |volume=46 |issue=10 |pages=682–9 |year=1971 |pmid=5171000 |doi= |url=}}</ref>
-|-
-| colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic adenoma and toxic multinodular goiter}}
-| 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>
-|-
-| colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Iodine-induced hyperthyroidism  }}
-| style="padding: 5px 5px; background: #F5F5F5;" |It is uncommon but can develop after an [[iodine]] load, such as administration of contrast agents used for [[angiography]] or [[Computed tomography|computed tomography (CT)]], or [[iodine]]-rich drugs such as [[amiodarone]].
-|-
-| colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Trophoblastic disease and germ cell tumors }}
-| style="padding: 5px 5px; background: #F5F5F5;" |[[Thyroid-stimulating hormone]] and [[HCG]] have a common alpha-subunit and a beta-subunit with considerable homology. As a result, [[HCG]] has weak thyroid-stimulating activity and high [[titer]] [[HCG]] may mimic hyperthyroidism.<ref name="pmid19605510">{{cite journal |vauthors=Oosting SF, de Haas EC, Links TP, de Bruin D, Sluiter WJ, de Jong IJ, Hoekstra HJ, Sleijfer DT, Gietema JA |title=Prevalence of paraneoplastic hyperthyroidism in patients with metastatic non-seminomatous germ-cell tumors |journal=Ann. Oncol. |volume=21 |issue=1 |pages=104–8 |year=2010 |pmid=19605510 |doi=10.1093/annonc/mdp265 |url=}}</ref>
 |}
+<small>''(†)T3RU; Triiodothyronine Resin uptake. (^)TPOAb; [[Thyroid peroxidase]] antibodies.''</small>
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