Differentiating Euthyroid sick syndrome from other diseases: Difference between revisions

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==Differentiating Euthyroid sick syndrome from other Diseases==
==Differentiating Euthyroid sick syndrome 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].
== Differentiating different causes of hypothyroidism ==
*[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
Various kinds of hypothyroidism can be differentiated from each other on the basis of history and symptoms and laboratory findings:<ref name="pmid19949140" /><ref name="pmid18177256" /><ref name="pmid18415684" />


*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].
{| class="wikitable" align="center" style="border: 0px; margin: 3px;"
 
! colspan="2" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease
===Preferred Table===
! colspan="3" align="center" style="background: #4479BA; color: #FFFFFF; " |History and symptoms
{|
! colspan="7" align="center" style="background: #4479BA; color: #FFFFFF; " |Laboratory findings
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Additional findings
! rowspan="2" |Diseases
! colspan="4" |Laboratory Findings
! colspan="4" |Physical Examination
! colspan="4" |History and Symptoms
! rowspan="2" |Other Findings
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Lab Test 1
!Lab Test 2
!Lab Test 3
!Lab Test 4
!Physical Finding 1
!Physical Finding 2
!Physical Finding 3
!Physical Finding 4
!Finding 1
!Finding 2
!Finding 3
!Finding 4
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Fever
|style="background: #F5F5F5; padding: 5px;" |
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Goiter
|style="background: #F5F5F5; padding: 5px;" |
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Pain
|style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TSH
|style="background: #F5F5F5; padding: 5px;" |
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Free T4
|style="background: #F5F5F5; padding: 5px;" |
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3
|style="background: #F5F5F5; padding: 5px;" |
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3RU
|style="background: #F5F5F5; padding: 5px;" |
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Thyroglobin
|style="background: #F5F5F5; padding: 5px;" |
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TRH
| style="background: #F5F5F5; padding: 5px;" |
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TPOAb
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
| rowspan="3" style="background:#DCDCDC;" |Primary hypothyroidism
|style="background: #F5F5F5; padding: 5px;" |'''↑'''
| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis|Autoimmune]]
|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;" |-
Diffuse
|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;" |N/'''''↓'''''
|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;" |N/'''↑'''
|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="left" style="padding: 5px 5px; background: #F5F5F5;" |
* May be accompanied by other [[autoimmune diseases]]
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
| align="center" style="background:#DCDCDC;" |[[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;" |'''''↓'''''
|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;" |Normal
|style="background: #F5F5F5; padding: 5px;" |
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑'''
|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;" |Normal
|style="background: #F5F5F5; padding: 5px;" |
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
|style="background: #F5F5F5; padding: 5px;" |
*[[Thyroiditis|Infectious thyroiditis]] associated with neck pain
|style="background: #F5F5F5; padding: 5px;" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
| align="center" style="background:#DCDCDC;" |Others
|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;" |'''''↓'''''
|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;" |Normal
|style="background: #F5F5F5; padding: 5px;" |
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑'''
|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;" |Normal
|style="background: #F5F5F5; padding: 5px;" |
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
|style="background: #F5F5F5; padding: 5px;" |
* History of [[hyperthyroidism]]
|style="background: #F5F5F5; padding: 5px;" |
* Drug history
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
|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
| colspan="2" style="background:#DCDCDC;" |Transient 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;" |'''↑'''
| 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;" |'''↑'''
| 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;" |
* May present primarily with [[hyperthyroidism]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 2
| colspan="2" 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;" |'''↑'''
| 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;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑'''
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* Asymptomatic
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 3
| rowspan="2" align="center" style="background:#DCDCDC;" |Central Hypothyroidism
| style="padding: 5px 5px; background: #F5F5F5;"|
| align="center" style="padding: 5px 5px; background: #DCDCDC;" |Pituitary
* 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;" | -
| rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓'''''
| rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓'''''
| rowspan="2" 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;" |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;" |
* Other [[Pituitary hormone|pituitary hormone deficiencies]] signs
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 4
| align="center" style="padding: 5px 5px; background: #DCDCDC;" |Hypothalamus
| 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;" |'''↑'''
| 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="left" style="padding: 5px 5px; background: #F5F5F5;" |
* Other [[Pituitary hormone|pituitary hormone deficiencies]] signs
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 5
| colspan="2" style="background:#DCDCDC;" |Resistance to TSH/TRH
| 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;" |'''↑'''
| 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;" |Normal
| 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="left" style="padding: 5px 5px; background: #F5F5F5;" |
* Rare
|}
|}


Revision as of 16:45, 7 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief:

Overview

Fasting, starvation, sepsis, trauma, cardiopulmonary bypass, malignancy, heart failure, hypothermia, myocardial infarction, chronic renal failure, cirrhosis, and diabetic ketoacidosis.



  • [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].
  • [Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Differentiating Euthyroid sick syndrome from other Diseases

Differentiating different causes of hypothyroidism

Various kinds of hypothyroidism can be differentiated from each other on the basis of history and symptoms and laboratory findings:[1][2][3]

Disease History and symptoms Laboratory findings Additional findings
Fever Goiter Pain TSH Free T4 T3 T3RU Thyroglobin TRH TPOAb
Primary hypothyroidism Autoimmune + +/-

Diffuse

- ↑ ↓ N/↓ Normal N/↑ Normal ↑
Thyroiditis + +/- + ↑ ↓ Normal Normal N/↑ Normal Normal
Others - +/- - ↑ ↓ Normal Normal N/↑ Normal Normal
Transient hypothyroidism +/- - +/- ↑ ↑ Normal Normal ↑ Normal Normal
Subclinical hypothyroidism - - - ↑ Normal Normal Normal ↑ Normal N/↑
  • Asymptomatic
Central Hypothyroidism Pituitary + - - N/↓ N/↓ N/↓ ↓ Normal Normal Normal
Hypothalamus + - - ↑ Normal ↓ Normal
Resistance to TSH/TRH - - - ↑ N/↓ N/↓ Normal Normal ↑/↓ Normal
  • Rare

References

  1. ↑
  2. ↑
  3. ↑

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