Sandbox:ddx graves: Difference between revisions
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{{familytree | | | | | | | J01 | | J02 | | J03 | | | | | | | | |J01=Graves' disease|J02=Toxic nodular goiter|J03=Subacute thyroiditis<br>Excess thyroid hormone intake<br>HCG secreting tumor}} | {{familytree | | | | | | | J01 | | J02 | | J03 | | | | | | | | |J01=Graves' disease|J02=Toxic nodular goiter|J03=Subacute thyroiditis<br>Excess thyroid hormone intake<br>HCG secreting tumor}} | ||
{{familytree/end}} | {{familytree/end}} | ||
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center | |||
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 | {{fontcolor|#FFFFFF|Cause of thyrotoxicosis}} | |||
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 | {{fontcolor|#FFFFFF|TSH receptor Antibodies}} | |||
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 | {{fontcolor|#FFFFFF|Thyroid US}} | |||
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 | {{fontcolor|#FFFFFF|Color flow Doppler}} | |||
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 | {{fontcolor|#FFFFFF|Radioactive iodine uptake/Scan}} | |||
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 | {{fontcolor|#FFFFFF|Other features}} | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Graves' disease}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Present | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Hypoechoic pattern | |||
| style="padding: 5px 5px; background: #F5F5F5;" | ↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" | ↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Ophthalmopathy, dermopathy, acropachy | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Toxic nodular goiter}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Multiple nodules | |||
| style="padding: 5px 5px; background: #F5F5F5;" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Hot nodules at thyroid scan | |||
| style="padding: 5px 5px; background: #F5F5F5;" | - | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Toxic adenoma}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Single nodule | |||
| style="padding: 5px 5px; background: #F5F5F5;" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Hot nodule | |||
| style="padding: 5px 5px; background: #F5F5F5;" | - | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Subacute thyroiditis}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Heterogeneous hypoechoic areas | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow | |||
| style="padding: 5px 5px; background: #F5F5F5;" | ↓ | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Neck pain-fever and<br> elevated inflammatory index | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Painless thyroiditis}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Hypoechoic pattern | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow | |||
| style="padding: 5px 5px; background: #F5F5F5;" | ↓ | |||
| style="padding: 5px 5px; background: #F5F5F5;" | - | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Amiodarone induced thyroiditis-Type 1}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Absent | |||
| 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 | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Amiodarone induced thyroiditis-Type 2}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Absent | |||
| 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 | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Central hyperthyroidism}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Absent | |||
| 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 | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Trophoblastic disease}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Absent | |||
| 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;" | - | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Factitious thyrotoxicosis}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Absent | |||
| 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 | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Struma ovarii}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Absent | |||
| 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 | |||
|} |
Revision as of 14:14, 20 December 2016
Suspected Graves' disease | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Measure serum TSH and free T4 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Normal TSH & free T4 | ↓ TSH & ↑ free T4 | ↓ TSH & Normal free T4 | Normal or ↑ TSH & ↑ free T4 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Hyperthyroidism ruled out | Hyperthyrodism | Measure free T3 | TSH secreting pituitary tumor, Thyroid hormone resistance or Assay interference | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Measure TSH receptor antibodies | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
↑ free T3 | Normal free T3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Present | Absent | T3 Toxicosis | Sub-clinical Hyperthyrodism | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Graves' Disease | Assess radioiodine uptake obtain radionuclide scan or both | Evolving Graves' disease Evolving toxic nodular goiter Excess thyroid hormone intake Non thyroidal illness | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Homogeneous increased uptake | Patchy uptake or single nodule | Low or no uptake | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Graves' disease | Toxic nodular goiter | Subacute thyroiditis Excess thyroid hormone intake HCG secreting tumor | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Cause of thyrotoxicosis | TSH receptor Antibodies | Thyroid US | Color flow Doppler | Radioactive iodine uptake/Scan | Other features |
---|---|---|---|---|---|
Graves' disease | Present | Hypoechoic pattern | ↑ | ↑ | Ophthalmopathy, dermopathy, acropachy |
Toxic nodular goiter | Absent | Multiple nodules | - | Hot nodules at thyroid scan | - |
Toxic adenoma | Absent | Single nodule | - | Hot nodule | - |
Subacute thyroiditis | Absent | Heterogeneous hypoechoic areas | Reduced/absent flow | ↓ | Neck pain-fever and elevated inflammatory index |
Painless thyroiditis | Absent | Hypoechoic pattern | Reduced/absent flow | ↓ | - |
Amiodarone induced thyroiditis-Type 1 | Absent | Diffuse or nodular goiter | ↓/Normal/↑ | ↓ but higher than in Type 2 | High urinary iodine |
Amiodarone induced thyroiditis-Type 2 | Absent | Normal | Absent | ↓/absent | High urinary iodine |
Central hyperthyroidism | Absent | Diffuse or nodular goiter | Normal/↑ | ↑ | Inappropriately normal or high TSH |
Trophoblastic disease | Absent | Diffuse or nodular goiter | Normal/↑ | ↑ | - |
Factitious thyrotoxicosis | Absent | Variable | Reduced/absent flow | ↓ | ↓ serum thyroglobulin |
Struma ovarii | Absent | Variable | Reduced/absent flow | ↓ | Abdominal RAIU |