Silent thyroiditis differential diagnosis: Difference between revisions
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[[Silent thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis. | [[Silent thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis. | ||
==Differentiating Silent Thyroiditis from other Diseases== | ==Differentiating Silent Thyroiditis from other Diseases== | ||
===Differentiating silent thyroiditis from other causes of thyroiditis=== | |||
*Silent thyroiditis must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Hashimoto'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> | *Silent thyroiditis must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Hashimoto'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" | {| align="center" | ||
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*[[I-123 thyroid imaging|I-123]] uptake normal | *[[I-123 thyroid imaging|I-123]] uptake normal | ||
|} | |} | ||
===Differentiating silent thyroiditis from other causes of hypothyroidism=== | |||
*Silent 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> | *Silent 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> | ||
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|- | |- | ||
|} | |} | ||
===Differentiating silent thyroiditis from other causes of thyrotoxicosis=== | |||
*Silent thyroiditis can initially present with thyrotoxicosis which must be differentiated from other causes of thyrotoxicosis.<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><ref name="urlClinical Finding and Thyroid Function in Women with Struma Ovarii">{{cite web |url=https://www.hindawi.com/archive/2013/717584/ |title=Clinical Finding and Thyroid Function in Women with Struma Ovarii |format= |work= |accessdate=}}</ref><ref name="pmid25146390">{{cite journal |vauthors=Vaidya B, Pearce SH |title=Diagnosis and management of thyrotoxicosis |journal=BMJ |volume=349 |issue= |pages=g5128 |year=2014 |pmid=25146390 |doi= |url=}}</ref><ref name="urlThink thyrotoxicosis factitia - measure thyroglobulin | The BMJ">{{cite web |url=http://www.bmj.com/content/349/bmj.g5128/rr/763450 |title=Think thyrotoxicosis factitia - measure thyroglobulin | The BMJ |format= |work= |accessdate=}}</ref> | |||
{| | {| class="wikitable" align="center" style="border: 0px; margin: 3px;" | ||
! colspan="2" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease | |||
! colspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |History and symptoms | |||
! colspan=" | ! colspan="8" align="center" style="background: #4479BA; color: #FFFFFF; " |Laboratory findings | ||
! colspan=" | ! rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Additional findings | ||
! colspan=" | |||
! | |||
|- | |- | ||
| | ! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Fever | ||
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Pain | |||
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TSH | |||
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Free T4 | |||
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3 | |||
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3RU<small>† | |||
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Thyroglobin | |||
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TRH | |||
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TSH Receptor Antibody | |||
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TPOAb^ | |||
|- | |- | ||
| | | rowspan="4" style="background:#DCDCDC;" |[[Thyroiditis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="background:#DCDCDC;" |[[Silent thyroiditis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓ | ||
| 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;" |↓ | |||
| 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;" |Absent | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer) | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | |||
*May present with [[hypothyroidism]] | |||
|- | |- | ||
| | | align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis]] (Hashitoxicosis) | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''<small>* | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓''''' | ||
| 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;" |Absent | |||
| 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;" |[[De Quervain's thyroiditis|Subacute (de Quervain's) thyroiditis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/- | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/- | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓ | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| 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;" |Absent | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Low/absent | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | |||
*May present with [[hypothyroidism]] | |||
|- | |- | ||
| | | align="center" style="background:#DCDCDC;" |[[Postpartum thyroiditis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/- | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/- | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓ | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| 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;" |Absent | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer) | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | |||
*May present with [[hypothyroidism]] | |||
|- | |- | ||
| | | rowspan="2" style="background:#DCDCDC;" |[[hyperthyroidism|Primary hyperthyroidism]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="background:#DCDCDC;" |[[Grave's disease]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓ | ||
| 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;" |↑ | |||
| 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;" |Present | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | |||
* Patient may have opthalmopathy and dermopathy | |||
|- | |- | ||
| | | align="center" style="background:#DCDCDC;" |[[Toxic thyroid nodule]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Absent | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓ | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑ | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑(hot nodule) | |||
| 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="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | |||
- | |||
|- | |- | ||
| | | rowspan="1" style="background:#DCDCDC;" |[[Hyperthyroidism|Secondary hyperthyroidism]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="background:#DCDCDC;" |[[Pituitary adenoma]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Normal/ | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Inappropriately normal or | | 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;" |↑ | |||
| 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="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Inappropriately normal or increased TSH | |||
|- | |- | ||
| | | rowspan="1" style="background:#DCDCDC;" |[[Tertiary hyperthyroidism]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="background:#DCDCDC;" |[[Hyperthyroidism|Tertiary hyperthyroidism]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Normal/ | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑ | ||
| 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;" |Normal/'''↑''' | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑ | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Inappropriately normal or increased TSH | |||
|- | |- | ||
| | | rowspan="2" style="background:#DCDCDC;" |Drug induced | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="background:#DCDCDC;" |[[Amiodarone| Amiodarone type 1]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓ | ||
| 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;" |↓ | |||
| 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="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | |||
*High urinary iodine | |||
|- | |- | ||
| | | align="center" style="background:#DCDCDC;" |[[Amiodarone|Amiodarone type 2]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | - | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓ | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑ | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent/↓ | |||
| 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="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | |||
*High urinary iodine | |||
|- | |- | ||
| | | rowspan="3" style="background:#DCDCDC;" |Others | ||
| style="padding: 5px 5px; background: # | | align="center" style="background:#DCDCDC;" |[[Factitious thyrotoxicosis]] | ||
| 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;" |↑ | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑ | |||
| 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;" |Absent | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Decreased thyroglobulin | |||
|- | |- | ||
| style="padding: 5px 5px; background: # | | align="center" style="background:#DCDCDC;" |[[Trophoblastic disease]] | ||
| 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;" |↑ | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑ | |||
| 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;" |Absent | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | | |||
- | |||
|- | |- | ||
| | | align="center" style="background:#DCDCDC;" |[[Struma ovarii]] | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓ | |||
| 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;" |↓ | ||
| 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;" |Absent | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | align="left" style="padding: 5px 5px; background: #F5F5F5;" | | ||
| | - | ||
| | |||
|- | |||
| | |||
| | |||
| | |||
| | |||
|- | |- | ||
|} | |} | ||
<small>''(†)T3RU; Triiodothyronine Resin uptake. (^)TPOAb; [[Thyroid peroxidase]] antibodies.''</small> | |||
==References== | ==References== |
Revision as of 17:17, 5 October 2017
Hashimoto's thyroiditis Microchapters |
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Silent thyroiditis differential diagnosis On the Web |
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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
Silent thyroiditis must be differentiated from other causes of thyroiditis, such as De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis, and suppurative thyroiditis.
Differentiating Silent Thyroiditis from other Diseases
Differentiating silent thyroiditis from other causes of thyroiditis
- Silent thyroiditis must be differentiated from other causes of thyroiditis, such as De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis, and suppurative thyroiditis.[1]
Conditions | Causes | Age at onset | Pathological findings | Diagnostic approach |
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Silent thyroiditis |
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Hashimoto's thyroiditis |
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Painful subacute (De Quervain's) thyroiditis |
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Postpartum thyroiditis |
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Riedel's thyroiditis |
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Suppurative thyroiditis |
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Differentiating silent thyroiditis from other causes of hypothyroidism
- Silent 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^ | |||
Transient hypothyroidism | Silent thyroiditis | - | - | ↑/↓ | ↓/↑ | Normal | ↓ | ↑ | Normal | Present (high titer) |
|
Postpartum thyroiditis | +/- | +/- | ↑/↓ | ↓/↑ | Normal | ↓ | ↑ | Normal/↑ | Present (high titer) |
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Subacute (de Quervain's) thyroiditis | +/- | +/- | ↑/↓ | ↓/↑ | Normal | ↓ | ↑ | Normal | Low/absent |
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Primary hypothyroidism | Autoimmune (Hashimoto's thyroiditis) | - | - | ↑* | ↓ | Normal/↓ | Normal/↓ | Normal/↑ | Normal | Present (high titer) |
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Riedel's thyroiditis | - | - | Normal/↑ | Normal/↓ | Normal/↓ | Normal/↓ | Normal | Normal | Usually present |
| |
Infectious thyroiditis | + | + | Normal | Normal | Normal | Normal | Normal | Normal | Absent |
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Others | Drug-induced | - | - | ↑/↓ | ↓/↑ | Normal | ↓ | Normal/↑ | Normal | Absent** |
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Radiation-induced | |||||||||||
Trauma induced | |||||||||||
Radioiodine induced | |||||||||||
Thyroidectomy | |||||||||||
Subclinical hypothyroidism | - | - | ↑ | Normal | Normal | Normal | Normal | Normal | Normal/↑ |
|
Differentiating silent thyroiditis from other causes of thyrotoxicosis
- Silent thyroiditis can initially present with thyrotoxicosis which must be differentiated from other causes of thyrotoxicosis.[2][3][1][4][5][6][7][8][9]
Disease | History and symptoms | Laboratory findings | Additional findings | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Fever | Pain | TSH | Free T4 | T3 | T3RU† | Thyroglobin | TRH | TSH Receptor Antibody | TPOAb^ | |||
Thyroiditis | Silent thyroiditis | - | - | ↑/↓ | ↓/↑ | Normal | ↓ | ↑ | Normal | Absent | Present (high titer) |
|
Hashimoto's thyroiditis (Hashitoxicosis) | - | - | ↑* | ↓ | Normal/↓ | Normal/↓ | Normal/↑ | Normal | Absent | Present (high titer) |
| |
Subacute (de Quervain's) thyroiditis | +/- | +/- | ↑/↓ | ↓/↑ | Normal | ↓ | ↑ | Normal | Absent | Low/absent |
| |
Postpartum thyroiditis | +/- | +/- | ↑/↓ | ↓/↑ | Normal | ↓ | ↑ | Normal/↑ | Absent | Present (high titer) |
| |
Primary hyperthyroidism | Grave's disease | - | - | ↓ | ↑ | Normal/↑ | ↑ | ↑ | Normal | Present | Absent |
|
Toxic thyroid nodule | - | - | ↓ | ↑ | Normal/↑ | ↑(hot nodule) | Normal/↑ | Normal | Absent | Absent |
- | |
Secondary hyperthyroidism | Pituitary adenoma | - | - | ↑ | ↑ | Normal/↑ | ↑ | Normal/↑ | Normal | Absent | Absent |
|
Tertiary hyperthyroidism | Tertiary hyperthyroidism | - | - | ↑ | ↑ | ↑ | ↑ | Normal/↑ | ↑ | Absent | Absent |
|
Drug induced | Amiodarone type 1 | - | - | ↓ | ↑ | Normal/↑ | ↓ | Normal/↑ | Normal | Absent | Absent |
|
Amiodarone type 2 | - | - | ↓ | ↑ | Normal/↑ | Absent/↓ | Normal/↑ | Normal | Absent | Absent |
| |
Others | Factitious thyrotoxicosis | - | - | ↓ | ↑ | Normal/↑ | ↓ | ↓ | Normal | Absent | Absent |
|
Trophoblastic disease | - | - | ↓ | ↑ | Normal/↑ | ↑ | - | Normal | Absent | Absent |
- | |
Struma ovarii | - | - | ↓ | ↑ | Normal/↑ | ↓ | - | Normal | Absent | Absent |
- |
(†)T3RU; Triiodothyronine Resin uptake. (^)TPOAb; Thyroid peroxidase antibodies.
References
- ↑ 1.0 1.1 1.2 "Thyroiditis — NEJM".
- ↑ 2.0 2.1 Bindra A, Braunstein GD (2006). "Thyroiditis". Am Fam Physician. 73 (10): 1769–76. PMID 16734054.
- ↑ 3.0 3.1 McDermott MT (2009). "In the clinic. Hypothyroidism". Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.
- ↑ 4.0 4.1 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.
- ↑ 5.0 5.1 Lania A, Persani L, Beck-Peccoz P (2008). "Central hypothyroidism". Pituitary. 11 (2): 181–6. doi:10.1007/s11102-008-0122-6. PMID 18415684.
- ↑ 6.0 6.1 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.
- ↑ "Clinical Finding and Thyroid Function in Women with Struma Ovarii".
- ↑ Vaidya B, Pearce SH (2014). "Diagnosis and management of thyrotoxicosis". BMJ. 349: g5128. PMID 25146390.
- ↑ "Think thyrotoxicosis factitia - measure thyroglobulin | The BMJ".