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| | | {{familytree | | | | | | | | | A01 | | | | | |A01=Suspected Graves' disease}} |
| | | {{familytree | | | | | | | | | |!| | | | | | | | }} |
| | | {{familytree | | | | | | | | | B01 | | | | | |B01=Measure serum TSH and free T4}} |
| | | {{familytree | | |,|-|-|-|v|-|-|^|-|-|v|-|-|-|.| }} |
| {| style="border: 0px; font-size: 90%; margin: 3px;" align=center | | {{familytree | | C01 | | C02 | | | | C03 | | C04 | | | |C01=Normal TSH & free T4|C02=↓ TSH & ↑ free T4|C03=↓ TSH & Normal free T4|C04= Normal or ↑ TSH & ↑ free T4}} |
| ! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Disease}}
| | {{familytree | | |!| | | |!| | | | | |!| | | |!| }} |
| |style="background: #4479BA; padding: 5px 5px;"|{{fontcolor|#FFFFFF|Findings}} | | {{familytree | | D01 | | D02 | | | | D03 | | D04 | | | |D01= Hyperthyroidism ruled out|D02=Hyperthyrodism|D03=Measure free T3|D04=TSH secreting pituitary tumor,<br> Thyroid hormone resistance<br> or Assay interference }} |
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| | style="background: #4479BA; padding: 5px 5px;" rowspan=5 colspan=1 |{{fontcolor|#FFFFFF|Thyroiditis}} | |
| | style="padding: 5px 5px; background: #4479BA;" | Direct chemical toxicity with inflammation | |
| | style="padding: 5px 5px; background: #F5F5F5;" | Amiodarone, sunitinib, pazopanib, axitinib, and other tyrosine kinase inhibitors may also be associated with a destructive thyroiditis. | |
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| | style="padding: 5px 5px; background: #4479BA;" | Radiation thyroiditis | |
| | style="padding: 5px 5px; background: #F5F5F5;" | Patients who treated with radioiodine, may develops thyroid pain and tenderness 5 to 10 days later, due to radiation-induced injury and necrosis of thyroid follicular cells and associated inflammation. | |
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| | style="padding: 5px 5px; background: #4479BA;" | Drugs that interfere with the immune system | |
| | style="padding: 5px 5px; background: #F5F5F5;" | Interferon-alfa is well known for associated thyroid abnormality. It mostly lead to development of de novo antithyroid antibodies. | |
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| | style="padding: 5px 5px; background: #4479BA;" | Lithium | |
| | style="padding: 5px 5px; background: #F5F5F5;" | Patients treated with lithium are at high risk to develop painless thyroiditis and Graves' disease. | |
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| | style="padding: 5px 5px; background: #4479BA;" | Palpation thyroiditis | |
| | style="padding: 5px 5px; background: #F5F5F5;" | Manipulation of thyroid gland during thyroid biopsy or neck surgery and vigorous palpation during physical examination may cause transient hyperthyroidism. | |
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| | style="background: #4479BA; padding: 5px 5px;" rowspan=4 colspan=1 |{{fontcolor|#FFFFFF|Exogenous and ectopic hyperthyroidism }} | |
| | style="padding: 5px 5px; background: #4479BA;" | Factitious ingestion of thyroid hormone | |
| | style="padding: 5px 5px; background: #F5F5F5;" | | |
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| | style="padding: 5px 5px; background: #4479BA;" | Acute hyperthyroidism from a levothyroxine overdose | |
| | style="padding: 5px 5px; background: #F5F5F5;" | | |
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| | style="padding: 5px 5px; background: #4479BA;" | Struma ovarii | |
| | style="padding: 5px 5px; background: #F5F5F5;" | | |
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| | style="padding: 5px 5px; background: #4479BA;" | Functional thyroid cancer metastases | |
| | style="padding: 5px 5px; background: #F5F5F5;" | | |
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| | colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Hashitoxicosis }} | |
| |It is autoimmune thyroid disease who initially present with hyperthyroidism and a high radioiodine uptake caused by TSH-receptor antibodies similar to Graves' disease followed by the development of hypothyroidism due to infiltration of thyroid gland with lymphocytes and 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> | |
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| | colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic adenoma and toxic multinodular goiter}} | |
| |Toxic adenoma and toxic multinodular goiter are result of focal/diffuse hyperplasia of thyroid follicular cells independent to TSH regulation. Finding single or multiple nodules in 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> | |
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| | colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Iodine-induced hyperthyroidism }} | |
| |It is uncommon but, can develop after an iodine load, such as administration of contrast agents used for angiography or computed tomography (CT) or iodine-rich drugs such as amiodarone. | |
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| | colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Trophoblastic disease and germ cell tumors }} | |
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