Graves' disease diagnostic approach
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
A diagnostic approach to evaluate a suspect patient with clinical symptoms of hyperthyrodism must be done in order to make an accurate diagnosis.
Diagnostic approach
- In the presence of relative clinical symptoms and signs for hyperthyroidism, a diagnostic approach must be taken to address accurate diagnosis and start the management.[1][2][3]
- Following algorithm summarizes the diagnostic approach to a suspected hyperthyroid patient.
| Suspected Graves' disease | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Measure serum TSH and free T4 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Normal TSH & free T4 | ↓ TSH & ↑ free T4 | ↓ TSH & Normal free T4 | Normal or ↑ TSH & ↑ free T4 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hyperthyroidism ruled out | Hyperthyrodism | Measure free T3 | TSH secreting pituitary tumor, Thyroid hormone resistance or Assay interference | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Measure TSH receptor antibodies | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ↑ free T3 | Normal free T3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Present | Absent | T3 Toxicosis | Sub-clinical Hyperthyrodism | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Graves' Disease | Assess radioiodine uptake obtain radionuclide scan or both | Evolving Graves' disease Evolving toxic nodular goiter Excess thyroid hormone intake Non thyroidal illness | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Homogeneous increased uptake | Patchy uptake or single nodule | Low or no uptake | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Graves' Disease | Toxic nodular goiter | Subacute thyroiditis Excess thyroid hormone intake HCG secreting tumor | |||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Tozzoli R, Bagnasco M, Giavarina D, Bizzaro N (2012). "TSH receptor autoantibody immunoassay in patients with Graves' disease: improvement of diagnostic accuracy over different generations of methods. Systematic review and meta-analysis". Autoimmun Rev. 12 (2): 107–13. doi:10.1016/j.autrev.2012.07.003. PMID 22776786.
- ↑ Pedersen IB, Knudsen N, Perrild H, Ovesen L, Laurberg P (2001). "TSH-receptor antibody measurement for differentiation of hyperthyroidism into Graves' disease and multinodular toxic goitre: a comparison of two competitive binding assays". Clin. Endocrinol. (Oxf). 55 (3): 381–90.
- ↑ Terry J. Smith & Laszlo Hegedus (2016). "Graves' Disease". The New England journal of medicine. 375 (16): 1552–1565. doi:10.1056/NEJMra1510030. PMID 27797318. Unknown parameter
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