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

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 240: Line 240:
<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]].''
<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]].''


===Differentiating Hashimoto's thyroiditis from other causes of thyrotoxicosis===
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Cause of thyrotoxicosis}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|TSH receptor antibodies}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Thyroid US}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Color flow Doppler}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Radioactive iodine uptake/Scan}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Other features}}
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Graves' disease}}
| style="padding: 5px 5px; background: #F5F5F5;" | +
| 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
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic nodular goiter}}
| style="padding: 5px 5px; background: #F5F5F5;" | -
| 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;" | -
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic adenoma}}
| style="padding: 5px 5px; background: #F5F5F5;" | -
| 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;" | -
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Subacute thyroiditis}}
| style="padding: 5px 5px; background: #F5F5F5;" | -
| 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
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Painless thyroiditis}}
| style="padding: 5px 5px; background: #F5F5F5;" | -
| 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;" | -
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Amiodarone induced thyroiditis-Type 1}}
| style="padding: 5px 5px; background: #F5F5F5;" | -
| 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
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Amiodarone induced thyroiditis-Type 2}}
| style="padding: 5px 5px; background: #F5F5F5;" | -
| 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
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Central hyperthyroidism}}
| style="padding: 5px 5px; background: #F5F5F5;" | -
| 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
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Trophoblastic disease}}
| style="padding: 5px 5px; background: #F5F5F5;" | -
| 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;" | -
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Factitious thyrotoxicosis}}
| style="padding: 5px 5px; background: #F5F5F5;" | -
| 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
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Struma ovarii}}
| style="padding: 5px 5px; background: #F5F5F5;" | -
| 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
|}
==References==
==References==


Revision as of 13:01, 5 October 2017

Hashimoto's thyroiditis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hashimoto's Thyroiditis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary prevention

Secondary prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Differentiating Hashimoto's thyroiditis from other diseases On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Differentiating Hashimoto's thyroiditis from other diseases

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Differentiating Hashimoto's thyroiditis from other diseases

CDC on Differentiating Hashimoto's thyroiditis from other diseases

Differentiating Hashimoto's thyroiditis from other diseases in the news

Blogs on Differentiating Hashimoto's thyroiditis from other diseases

Directions to Hospitals Treating Hashimoto's thyroiditis

Risk calculators and risk factors for Differentiating Hashimoto's thyroiditis from other diseases

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

Differentiating Hashimoto's thyroiditis from other causes of 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)
Painful subacute (De Quervain's) thyroiditis
  • Unknown
  • 20-60
  • Giant cells
  • Granulomas
Silent thyroiditis
  • Autoimmune
  • All ages, peak at 30-40
  • Lymphocytic infiltration
  • Lymphoid follicles
Postpartum thyroiditis
  • Autoimmune
  • Childbearing age
  • Lymphocytic infiltration
Riedel's thyroiditis
  • Unknown
  • 30-60
  • Dense fibrosis
Suppurative thyroiditis
  • Infection
  • Children, 20-40
  • Abscess formation

Differentiating Hashimoto's thyroiditis from other causes of hypothyroidism

  • 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
Fever Pain TSH Free T4 T3 T3RU† Thyroglobin TRH TPOAb^
Primary hypothyroidism Autoimmune (Hashimoto's thyroiditis) - - ↑* ↓ Normal/↓ Normal/↓ Normal/↑ Normal Present (high titer)
Riedel's thyroiditis - - Normal/↑ Normal/↓ Normal/↓ Normal/↓ Normal Normal Usually present
Infectious thyroiditis + + Normal Normal Normal Normal Normal Normal Absent
Transient hypothyroidism Subacute (de Quervain's) thyroiditis +/- +/- ↑/↓ ↓/↑ Normal ↓ ↑ Normal Low/absent
Postpartum thyroiditis +/- +/- ↑/↓ ↓/↑ Normal ↓ ↑ Normal/↑ Present (high titer)
Silent thyroiditis - - ↑/↓ ↓/↑ Normal ↓ ↑ Normal Present (high titer)
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.

Differentiating Hashimoto's thyroiditis from other causes of thyrotoxicosis

Cause of thyrotoxicosis TSH receptor antibodies Thyroid US Color flow Doppler Radioactive iodine uptake/Scan Other features
Graves' disease + Hypoechoic pattern ↑ ↑ Ophthalmopathy, dermopathy, acropachy
Toxic nodular goiter - Multiple nodules - Hot nodules at thyroid scan -
Toxic adenoma - Single nodule - Hot nodule -
Subacute thyroiditis - Heterogeneous hypoechoic areas Reduced/absent flow ↓ Neck pain, fever, and
elevated inflammatory index
Painless thyroiditis - Hypoechoic pattern Reduced/absent flow ↓ -
Amiodarone induced thyroiditis-Type 1 - Diffuse or nodular goiter ↓/Normal/↑ ↓ but higher than in Type 2 High urinary iodine
Amiodarone induced thyroiditis-Type 2 - Normal Absent ↓/absent High urinary iodine
Central hyperthyroidism - Diffuse or nodular goiter Normal/↑ ↑ Inappropriately normal or high TSH
Trophoblastic disease - Diffuse or nodular goiter Normal/↑ ↑ -
Factitious thyrotoxicosis - Variable Reduced/absent flow ↓ ↓ Serum thyroglobulin
Struma ovarii - Variable Reduced/absent flow ↓ Abdominal RAIU

References

  1. ↑ 1.0 1.1 "Thyroiditis — NEJM".
  2. ↑ Bindra A, Braunstein GD (2006). "Thyroiditis". Am Fam Physician. 73 (10): 1769–76. PMID 16734054.
  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.
  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.
  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.
  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.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Differentiating_Hashimoto%27s_thyroiditis_from_other_diseases&oldid=1370482"