Differentiating Hashimoto's thyroiditis from other diseases

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

Overview

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

Differentiating Hashimoto's Thyroiditis from other Diseases

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

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
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 different causes of hypothyroidism

Hashimoto's thyroiditis must be differentiated from other causes of hypothyroidism can be differentiated from each other on the basis of history and symptoms and laboratory findings:

Disease		History and symptoms			Laboratory findings							Additional findings
		Fever	Goiter	Pain	TSH	Free T4	T3	T3RU	Thyroglobin	TRH	TPOAb
Primary hypothyroidism	Autoimmune	+	+/- Diffuse	-	↑	↓	N/↓	N	N/↑	N	Present	May be accompanied by other autoimmune diseases
	Riedel's thyroiditis	-	+/-	-	N/↑	N/↓	N/↓	N	N	N	Present or absent	Riedel's thyroiditis usually presents with hard and fixed thyroid mass.
	Infectious thyroiditis	+	+/-	+	↑	↓	N	N	N/↑	N	N	Infectious thyroiditis associated with neck pain
Exogenous	Drug/radiation/trauma induced, radioiodine, thyroidectomy	-	+/-	-	↑	↓	N	N	N/↑	Normal	N	History of hyperthyroidism Drug history
	Transient hypothyroidism (Subacute (de Quervain's) thyroiditis, post partum thyroiditis)	+/-	-	+/-	↑	↑	N	N	↑	N	N	May present primarily with hyperthyroidism
	Subclinical hypothyroidism	-	-	-	↑	N	N	N	↑	N	N/↑	Asymptomatic