Differentiating Hashimoto's thyroiditis from other diseases: Difference between revisions

Latest revision as of 21:22, 29 July 2020

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

Overview

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

Differentiating Hashimoto's Thyroiditis from other Diseases

Differentiating Hashimoto's thyroiditis from other causes of thyroiditis

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

Conditions	Causes	Age at onset	Pathological findings	Diagnostic approach
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
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
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 Hashimoto's thyroiditis from other causes of hypothyroidism

Hashimoto'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
Disease		Fever	Pain	TSH	Free T4	T3	T3RU†	Thyroglobin	TRH	TPOAb^	Additional findings
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
Transient hypothyroidism	Subacute (de Quervain's) thyroiditis	+/-	+/-	↑/↓	↓/↑	Normal	↓	↑	Normal	Low/absent	May present primarily with hyperthyroidism
	Postpartum thyroiditis	+/-	+/-	↑/↓	↓/↑	Normal	↓	↑	Normal/↑	Present (high titer)	May present primarily with hyperthyroidism
	Silent thyroiditis	-	-	↑/↓	↓/↑	Normal	↓	↑	Normal	Present (high titer)	May present primarily with hyperthyroidism
Others	Drug-induced	-	-	↑/↓	↓/↑	Normal	↓	Normal/↑	Normal	Absent**	History of hyperthyroidism History of trauma History of drug use, surgery, or radiation
	Radiation-induced
	Trauma induced
	Radioiodine induced
	Thyroidectomy
	Subclinical hypothyroidism	-	-	↑	Normal	Normal	Normal	Normal	Normal	Normal/↑	Asymptomatic

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

Differentiating Hashimoto's thyroiditis from other causes of thyrotoxicosis

Hashimoto's thyroiditis can initially present with thyrotoxicosis (hashitoxicosis) 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	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
	Silent 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:WH Template:WS

[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/Hashimoto%27s_thyroiditis]]
 {{CMG}} {{AE}} {{MMF}}
 ==Overview==
-[[Hashimoto's thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis.
+[[Hashimoto's thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis. Hashimoto's thyroiditis must also be differentiated from other diseases which cause [[hypothyroidism]]. As Hashimoto's thyroiditis may cause transient thyrotoxic symptoms, the diseases causing [[thyrotoxicosis]] must also be considered in the differential diagnosis.
 ==Differentiating Hashimoto's Thyroiditis from other Diseases==
 ===Differentiating Hashimoto's thyroiditis from other causes of thyroiditis===
@@ Line 238: / Line 239: @@
 |-
 |}
-<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]].''
+<br style="clear:left" />
+<small>''(†)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]].''</small>
 ===Differentiating Hashimoto's thyroiditis from other causes of thyrotoxicosis===
+*Hashimoto's thyroiditis can initially present with thyrotoxicosis (hashitoxicosis) 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>
 {| class="wikitable" align="center" style="border: 0px; margin: 3px;"
 ! colspan="2" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease
 ! colspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |History and symptoms
-! colspan="7" align="center" style="background: #4479BA; color: #FFFFFF; " |Laboratory findings
+! colspan="8" align="center" style="background: #4479BA; color: #FFFFFF; " |Laboratory findings
 ! rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Additional findings
 |-
@@ Line 255: / Line 258: @@
 ! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Thyroglobin
 ! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TRH
-! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TPOAb^
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TSH Receptor Antibody
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TPOAb^
 |-
-| rowspan="2" style="background:#DCDCDC;" |[[Primary hyperthyroidism]]
+| rowspan="4" style="background:#DCDCDC;" |[[Thyroiditis]]
-| align="center" style="background:#DCDCDC;" |[[Grave's disease]]
+| 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;" | -
@@ Line 267: / Line 271: @@
 | 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;" |[[Toxic thyroid nodule]]
+| 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;" |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;" |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;" |Usually present
+| 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;" |
-*[[Riedel's thyroiditis]] usually presents with hard and fixed thyroid mass.
+*May present with [[hypothyroidism]]
 |-
-| rowspan="1" style="background:#DCDCDC;" |[[Secondary hyperthyroidism]]
+| align="center" style="background:#DCDCDC;" |[[Postpartum thyroiditis]]
-| align="center" style="background:#DCDCDC;" |[[Pituitary adenoma]]
 | align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
 | align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
@@ Line 293: / Line 298: @@
 | align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
 | align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
-| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Low/absent
+| 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 primarily with [[hyperthyroidism]]
+*May present with [[hypothyroidism]]
 |-
-| rowspan="1" style="background:#DCDCDC;" |[[Tertiary hyperthyroidism]]
+| align="center" style="background:#DCDCDC;" |[[Silent thyroiditis]]
-| align="center" style="background:#DCDCDC;" |[[Tertiary hyperthyroidism]]
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| align="center" style="padding: 5px 5px; background: #F5F5F5;" |-
 | align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
 | align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓
@@ Line 308: / Line 313: @@
 | 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 primarily with [[hyperthyroidism]]
+*May present with [[hypothyroidism]]
 |-
-| rowspan="3" style="background:#DCDCDC;" |Others
+| rowspan="2" style="background:#DCDCDC;" |[[hyperthyroidism|Primary hyperthyroidism]]
-| align="center" style="background:#DCDCDC;" |Factitious thyrotoxicosis
+| align="center" style="background:#DCDCDC;" |[[Grave's disease]]
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''/↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''/↑
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''''↑'''''
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent**
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present
-| rowspan="5" align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
-* History of [[hyperthyroidism]]
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
-* History of trauma
+* Patient may have opthalmopathy and dermopathy
-*History of drug use, surgery, or radiation
 |-
-| align="center" style="background:#DCDCDC;" |Trophoblastic disease
+| align="center" style="background:#DCDCDC;" |[[Toxic thyroid nodule]]
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''/↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''/↑
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑(hot nodule)
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent**
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
-| rowspan="5" align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
-* History of [[hyperthyroidism]]
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
-* History of trauma
+-
-*History of drug use, surgery, or radiation
 |-
-| align="center" style="background:#DCDCDC;" |Struma ovari
+| rowspan="1" style="background:#DCDCDC;" |[[Hyperthyroidism|Secondary hyperthyroidism]]
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="background:#DCDCDC;" |[[Pituitary adenoma]]
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''/↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''/↑
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
-| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent**
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
-| rowspan="5" align="left" 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="1" style="background:#DCDCDC;" |[[Tertiary hyperthyroidism]]
-{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
+| align="center" style="background:#DCDCDC;" |[[Hyperthyroidism|Tertiary hyperthyroidism]]
-! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Cause of thyrotoxicosis}}
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |-
-! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|TSH receptor antibodies}}
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |-
-! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Thyroid US}}
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Color flow Doppler}}
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Radioactive iodine uptake/Scan}}
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Other features}}
+| 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|Graves' disease}}
+| 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;" | Hypoechoic pattern
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | ↑
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | ↑
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
-| style="padding: 5px 5px; background: #F5F5F5;" | Ophthalmopathy, dermopathy, acropachy
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
+| 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|Toxic nodular goiter}}
+| 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;" | Multiple nodules
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
-| style="padding: 5px 5px; background: #F5F5F5;" | Hot nodules at thyroid scan
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-| style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |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
 |-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic adenoma}}
+| 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;" | Single nodule
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | Hot nodule
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
-| style="padding: 5px 5px; background: #F5F5F5;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+*Decreased thyroglobulin
 |-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Subacute thyroiditis}}
+| 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;" | 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;" |Absent
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+-
 |-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Painless thyroiditis}}
+| 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;" | 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;" |Absent
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+-
 |-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Amiodarone induced thyroiditis-Type 1}}
-| style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | Diffuse or nodular goiter
-| style="padding: 5px 5px; background: #F5F5F5;" | ↓/Normal/↑
-| style="padding: 5px 5px; background: #F5F5F5;" | ↓ but higher than in Type 2
-| style="padding: 5px 5px; background: #F5F5F5;" | High urinary iodine
-|-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Amiodarone induced thyroiditis-Type 2}}
-| style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | Normal
-| style="padding: 5px 5px; background: #F5F5F5;" | Absent
-| style="padding: 5px 5px; background: #F5F5F5;" | ↓/absent
-| style="padding: 5px 5px; background: #F5F5F5;" | High urinary iodine
-|-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Central hyperthyroidism}}
-| style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | Diffuse or nodular goiter
-| style="padding: 5px 5px; background: #F5F5F5;" | Normal/↑
-| style="padding: 5px 5px; background: #F5F5F5;" | ↑
-| style="padding: 5px 5px; background: #F5F5F5;" | Inappropriately normal or high TSH
-|-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Trophoblastic disease}}
-| style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | Diffuse or nodular goiter
-| style="padding: 5px 5px; background: #F5F5F5;" | Normal/↑
-| style="padding: 5px 5px; background: #F5F5F5;" | ↑
-| style="padding: 5px 5px; background: #F5F5F5;" | -
-|-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Factitious thyrotoxicosis}}
-| style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | Variable
-| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
-| style="padding: 5px 5px; background: #F5F5F5;" | ↓
-| style="padding: 5px 5px; background: #F5F5F5;" | ↓ Serum thyroglobulin
-|-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Struma ovarii}}
-| style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | Variable
-| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
-| style="padding: 5px 5px; background: #F5F5F5;" | ↓
-| style="padding: 5px 5px; background: #F5F5F5;" | Abdominal RAIU
 |}
+<small>''(†)T3RU; Triiodothyronine Resin uptake. (^)TPOAb; [[Thyroid peroxidase]] antibodies.''</small>
 ==References==
@@ Line 447: / Line 458: @@
 {{WH}}
 {{WS}}
-[[Category:Needs content]]
+[[Category:Medicine]]
 [[Category:Endocrinology]]
+[[Category:Up-To-Date]]