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

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Revision as of 18:14, 5 September 2017

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.^[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
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

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:^[2]^[3]^[1]^[4]^[5]

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)	-	-	↑	↓	N/↓	N/↓	N/↑	N	Present (high titer)	May be accompanied by other autoimmune diseases
	Riedel's thyroiditis	-	-	N/↑	N/↓	N/↓	N/↓	N	N	Usually present	Riedel's thyroiditis usually presents with hard and fixed thyroid mass.
	Infectious thyroiditis	+	+	N	N	N	N	N	N	Absent	Infectious thyroiditis associated with neck pain
Transient hypothyroidism	Subacute (de Quervain's) thyroiditis	+/-	+/-	↑/↓	↓/↑	N	↓	N	N	Absent	May present primarily with hyperthyroidism
Transient hypothyroidism	Post-partum thyroiditis	+/-	+/-	↑/↓	↓/↑	N	↓	N	N	Absent	May present primarily with hyperthyroidism
Others	Drug-induced	-	-	↑/↓	↓/↑	N	↓	N/↑	N	Absent*	History of hyperthyroidism Drug history
	Radiation-induced
	Trauma induced
	Radioiodine induced
	Thyroidectomy
	Subclinical hypothyroidism	-	-	↑	N	N	N	N	N	N/↑	Asymptomatic

References

↑ ^1.0 ^1.1 "Thyroiditis — NEJM".
↑ Bindra A, Braunstein GD (2006). "Thyroiditis". Am Fam Physician. 73 (10): 1769–76. PMID 16734054.
↑ McDermott MT (2009). "In the clinic. Hypothyroidism". Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.
↑ 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.
↑ Lania A, Persani L, Beck-Peccoz P (2008). "Central hypothyroidism". Pituitary. 11 (2): 181–6. doi:10.1007/s11102-008-0122-6. PMID 18415684.

Template:WH Template:WS

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

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

[pmid19949140-3] 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] 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] Lania A, Persani L, Beck-Peccoz P (2008). "Central hypothyroidism". Pituitary. 11 (2): 181–6. doi:10.1007/s11102-008-0122-6. PMID 18415684.

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@@ Line 92: / Line 92: @@
 ! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TPOAb
 |-
-| rowspan="3" style="background:#DCDCDC;" |Primary hypothyroidism
+| rowspan="3" style="background:#DCDCDC;" |[[Primary hypothyroidism]]
-| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis|Autoimmune]]
+| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis|Autoimmune]] ([[Hashimoto's thyroiditis]])
 | align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
 | align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
@@ Line 131: / Line 131: @@
 | align="left" style="padding: 5px 5px; background: #F5F5F5;" |
 *[[Thyroiditis|Infectious thyroiditis]] associated with [[neck pain]]
+|-
+| rowspan="2" style="background:#DCDCDC;" |[[Hypothyroidism|Transient hypothyroidism]]
+| 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;" |N
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+* May present primarily with [[hyperthyroidism]]
+|-
+| align="center" style="background:#DCDCDC;" |Post-partum 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;" |N
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+* May present primarily with [[hyperthyroidism]]
 |-
 | rowspan="8" style="background:#DCDCDC;" |Others
@@ Line 154: / Line 181: @@
 |-
 | align="center" style="background:#DCDCDC;" |Thyroidectomy
-|-
-| align="center" style="background:#DCDCDC;" |Transient hypothyroidism (Subacute (de Quervain's) thyroiditis, post partum 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;" |N
-| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
-| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N
-| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N
-| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
-| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
-* May present primarily with [[hyperthyroidism]]
 |-
 | align="center" style="background:#DCDCDC;" |Subclinical hypothyroidism

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

Revision as of 18:14, 5 September 2017

Overview

Differentiating Hashimoto's Thyroiditis from other Diseases

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