Postpartum thyroiditis differential diagnosis: Difference between revisions

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Revision as of 21:01, 27 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
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

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.

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.
↑ 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.

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.

[pmid25905413-6] 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.

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[2]

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[5]

[6]

@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Postpartum thyroiditis}}
+{{Hashimoto's thyroiditis}}
-{{CMG}}; {{AE}}
+{{CMG}} {{AE}} {{MMF}}
 ==Overview==
-PPT must be differentiated from other diseases that cause postpartum fatigue, postpartum mood changes, and postpartum palpitation, such as Hashimoto's thyroiditis, Postpartum thyroid dysfunction syndrome, and Postpartum depression.
+[[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.<ref name="urlThyroiditis — NEJM">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMra021194 |title=Thyroiditis — NEJM |format= |work= |accessdate=}}</ref>
+{| align="center"
+|-
+|}
+{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
+! style="background:#4479BA; color: #FFFFFF;" | Conditions
+! style="background:#4479BA; color: #FFFFFF;" |Causes
+! style="background:#4479BA; color: #FFFFFF;" |Age at onset
+! style="background:#4479BA; color: #FFFFFF;" |Pathological findings
+! style="background:#4479BA; color: #FFFFFF;" |Diagnostic approach
-==Differentiating Postpartum Thyroiditis from other Diseases==
+|-
-*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
+| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis]]
-*[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Autoimmune
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*All ages, peak at 30-50
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Lymphocytic infiltration
+*Germinal centers
+*Fibrosis (in some variants)
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Thyroid function tests|Increased TSH]] (hypothyroidism)
+*[[Thyroid peroxidase|TPO antibodies]] present in high titer
+*[[I-123 thyroid imaging|I-123]] uptake usually decreased
+|-
+|-
+| align="center" style="background:#DCDCDC;" |[[De Quervain's thyroiditis|Painful subacute (De Quervain's) thyroiditis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Unknown
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*20-60
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Giant cells
+*Granulomas
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Thyroid function tests|Increased TSH]] (hypothyroidism) and/or
+* [[Thyroid function tests|Decreased TSH]] (Thyrotoxicosis)
+*[[Thyroid peroxidase|TPO antibodies]] absent or very low titer
+*[[I-123 thyroid imaging|I-123]] uptake decreased
+|-
+| align="center" style="background:#DCDCDC;" |[[Silent thyroiditis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Autoimmune
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*All ages, peak at 30-40
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Lymphocytic infiltration
+*Lymphoid follicles
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Thyroid function tests|Increased TSH]] (hypothyroidism) and/or
+* [[Thyroid function tests|Decreased TSH]] (transient hypothyroidism)
+*[[Thyroid peroxidase|TPO antibodies]] present in high titer
+*[[I-123 thyroid imaging|I-123]] uptake usually decreased
+|-
+| align="center" style="background:#DCDCDC;" |[[Postpartum thyroiditis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Autoimmune
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Childbearing age
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Lymphocytic infiltration
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Thyroid function tests|Increased TSH]] (hypothyroidism) and/or
+* [[Thyroid function tests|Decreased TSH]] (transient hypothyroidism)
+*[[Thyroid peroxidase|TPO antibodies]] present in high titer
+*[[I-123 thyroid imaging|I-123]] uptake usually decreased
+|-
+| align="center" style="background:#DCDCDC;" |[[Riedel's thyroiditis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Unknown
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*30-60
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Dense fibrosis
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Thyroid function tests|Normal TSH]] (euthyroidism)
+*[[Thyroid peroxidase|TPO antibodies]] usually present
+*[[I-123 thyroid imaging|I-123]] uptake decreased or normal
+|-
+| align="center" style="background:#DCDCDC;" |[[Suppurative thyroiditis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Infection
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Children, 20-40
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Abscess formation
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Thyroid function tests|Normal TSH]] (euthyroidism)
+*[[Thyroid peroxidase|TPO antibodies]] absent
+*[[I-123 thyroid imaging|I-123]] uptake normal
+|}
-*As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
+*Hashimoto's thyroiditis must be differentiated from other causes of [[hypothyroidism]] on the basis of history and symptoms and laboratory findings:<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>
-===Preferred Table===
+{| class="wikitable" align="center" style="border: 0px; margin: 3px;"
-{|
+! colspan="2" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+! colspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |History and symptoms
-! rowspan="2" |Diseases
+! colspan="7" align="center" style="background: #4479BA; color: #FFFFFF; " |Laboratory findings
-! colspan="4" |Laboratory Findings
+! rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Additional findings
-! colspan="4" |Physical Examination
+|-
-! colspan="4" |History and Symptoms
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Fever
-! rowspan="2" |Other Findings
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Pain
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TSH
-!Lab Test 1
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Free T4
-!Lab Test 2
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3
-!Lab Test 3
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3RU<small>†
-!Lab Test 4
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Thyroglobin
-!Physical Finding 1
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TRH
-!Physical Finding 2
+! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TPOAb^
-!Physical Finding 3
+|-
-!Physical Finding 4
+| rowspan="3" style="background:#DCDCDC;" |[[Primary hypothyroidism]]
-!Finding 1
+| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis|Autoimmune]] ([[Hashimoto's thyroiditis]])
-!Finding 2
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-!Finding 3
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-!Finding 4
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''<small>*
+| 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;" |Normal
+| 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;" |[[Riedel'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;" |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;" |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;" |Usually present
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Riedel's thyroiditis]] usually presents with hard and fixed thyroid mass.
+|-
+| align="center" style="background:#DCDCDC;" |[[Infectious 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;" |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;" |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;" |Absent
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Thyroiditis|Infectious thyroiditis]] associated with [[neck pain]]
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
+| rowspan="3" style="background:#DCDCDC;" |[[Hypothyroidism|Transient hypothyroidism]]
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="background:#DCDCDC;" |[[De Quervain's thyroiditis|Subacute (de Quervain's) thyroiditis]]
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
-| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑'''
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Low/absent
-| style="background: #F5F5F5; padding: 5px;" |
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
-| style="background: #F5F5F5; padding: 5px;" |
+*May present primarily with [[hyperthyroidism]]
-| style="background: #F5F5F5; padding: 5px;" |
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
+| align="center" style="background:#DCDCDC;" |[[Postpartum thyroiditis]]
-| style="background: #F5F5F5; padding: 5px;" |'''↑'''
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓
-| style="background: #F5F5F5; padding: 5px;" | -
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑'''
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer)
-| style="background: #F5F5F5; padding: 5px;" |
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
-| style="background: #F5F5F5; padding: 5px;" |
+*May present primarily with [[hyperthyroidism]]
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
+| align="center" style="background:#DCDCDC;" |[[Silent thyroiditis]]
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="background: #F5F5F5; padding: 5px;" |↓
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑'''
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer)
-| style="background: #F5F5F5; padding: 5px;" |
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
-| style="background: #F5F5F5; padding: 5px;" |
+*May present primarily with [[hyperthyroidism]]
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
+| rowspan="8" style="background:#DCDCDC;" |Others
-| style="background: #F5F5F5; padding: 5px;" |
+| align="center" style="background:#DCDCDC;" |Drug-induced
-| style="background: #F5F5F5; padding: 5px;" |
+| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="background: #F5F5F5; padding: 5px;" |
+| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="background: #F5F5F5; padding: 5px;" |
+| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''/↓
-| style="background: #F5F5F5; padding: 5px;" |
+| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''/↑
-| style="background: #F5F5F5; padding: 5px;" |
+| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
-| style="background: #F5F5F5; padding: 5px;" |
+| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
-| style="background: #F5F5F5; padding: 5px;" |
+| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
-| style="background: #F5F5F5; padding: 5px;" |
+| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
-| style="background: #F5F5F5; padding: 5px;" |
+| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent**
-| style="background: #F5F5F5; padding: 5px;" |
+| rowspan="5" align="left" style="padding: 5px 5px; background: #F5F5F5;" |
-| style="background: #F5F5F5; padding: 5px;" |
+* History of [[hyperthyroidism]]
-| style="background: #F5F5F5; padding: 5px;" |
+* History of trauma
+*History of drug use, surgery, or radiation
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
+| align="center" style="background:#DCDCDC;" |Radiation-induced
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-|}
-===Use if the above table can not be made===
-{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
-| valign="top" |
-|+
-! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
-! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
-! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 1
+| align="center" style="background:#DCDCDC;" |Trauma induced
-| style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
-| style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 2
+| align="center" style="background:#DCDCDC;" |Radioiodine induced
-| style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
-| style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 3
+| align="center" style="background:#DCDCDC;" |Thyroidectomy
-| style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
-| style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 4
+| align="center" style="background:#DCDCDC;" |Subclinical hypothyroidism
-| style="padding: 5px 5px; background: #F5F5F5;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" |
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
+| 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;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
+| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
+| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
+* Asymptomatic
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 5
-| style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
-| style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
 |}
+<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]].''
 ==References==
 {{Reflist|2}}
 {{WH}}
 {{WS}}
-[[Category: (name of the system)]]
+[[Category:Needs content]]
+[[Category:Endocrinology]]

Postpartum thyroiditis differential diagnosis: Difference between revisions

Revision as of 21:01, 27 September 2017

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Differentiating Hashimoto's Thyroiditis from other Diseases

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