Graves' disease differential diagnosis: Difference between revisions

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! style="background: #4479BA; width: 340px;" | {{fontcolor|#000|Disease}}
! colspan="2" style="background: #4479BA; width: 340px;" | {{fontcolor|#000|Disease}}
! style="background: #4479BA; width: 1050px;" | {{fontcolor|#000|Findings}}
! style="background: #4479BA; width: 1050px;" | {{fontcolor|#000|Findings}}
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| style="padding: 7px 7px; background: #DCDCDC;" | '''Hashitoxicosis'''
| colspan="2" style="padding: 7px 7px; background: #DCDCDC;" | '''Hashitoxicosis'''
| style="padding: 7px 7px; background: #F5F5F5;" | It is autoimmune thyroid disease who initially present with hyperthyroidism and a high radioiodine uptake caused by TSH-receptor antibodies similar to Graves' disease followed by the development of hypothyroidism due to infiltration of thyroid gland with lymphocytes and resultant autoimmune-mediated destruction of thyroid tissue similar to chronic lymphocytic thyroiditis.<ref name="pmid5171000">{{cite journal |vauthors=Fatourechi V, McConahey WM, Woolner LB |title=Hyperthyroidism associated with histologic Hashimoto's thyroiditis |journal=Mayo Clin. Proc. |volume=46 |issue=10 |pages=682–9 |year=1971 |pmid=5171000 |doi= |url=}}</ref>
| style="padding: 7px 7px; background: #F5F5F5;" | It is autoimmune thyroid disease who initially present with hyperthyroidism and a high radioiodine uptake caused by TSH-receptor antibodies similar to Graves' disease followed by the development of hypothyroidism due to infiltration of thyroid gland with lymphocytes and resultant autoimmune-mediated destruction of thyroid tissue similar to chronic lymphocytic thyroiditis.<ref name="pmid5171000">{{cite journal |vauthors=Fatourechi V, McConahey WM, Woolner LB |title=Hyperthyroidism associated with histologic Hashimoto's thyroiditis |journal=Mayo Clin. Proc. |volume=46 |issue=10 |pages=682–9 |year=1971 |pmid=5171000 |doi= |url=}}</ref>
|-
|-
| style="padding: 7px 7px; background: #DCDCDC;" |'''Toxic adenoma and [[toxic multinodular goiter]]'''
| colspan="2" style="padding: 7px 7px; background: #DCDCDC;" |'''Toxic adenoma and [[toxic multinodular goiter]]'''
| style="padding: 7px 7px; background: #F5F5F5;" |Toxic adenoma and toxic multinodular goiter are result of focal/diffuse hyperplasia of thyroid follicular cells independent to TSH regulation. Finding single or multiple nodules in physical examination or thyroid scan.<ref name="pmid2040867">{{cite journal |vauthors=Laurberg P, Pedersen KM, Vestergaard H, Sigurdsson G |title=High incidence of multinodular toxic goitre in the elderly population in a low iodine intake area vs. high incidence of Graves' disease in the young in a high iodine intake area: comparative surveys of thyrotoxicosis epidemiology in East-Jutland Denmark and Iceland |journal=J. Intern. Med. |volume=229 |issue=5 |pages=415–20 |year=1991 |pmid=2040867 |doi= |url=}}</ref>
| style="padding: 7px 7px; background: #F5F5F5;" |Toxic adenoma and toxic multinodular goiter are result of focal/diffuse hyperplasia of thyroid follicular cells independent to TSH regulation. Finding single or multiple nodules in physical examination or thyroid scan.<ref name="pmid2040867">{{cite journal |vauthors=Laurberg P, Pedersen KM, Vestergaard H, Sigurdsson G |title=High incidence of multinodular toxic goitre in the elderly population in a low iodine intake area vs. high incidence of Graves' disease in the young in a high iodine intake area: comparative surveys of thyrotoxicosis epidemiology in East-Jutland Denmark and Iceland |journal=J. Intern. Med. |volume=229 |issue=5 |pages=415–20 |year=1991 |pmid=2040867 |doi= |url=}}</ref>
|-
|-
| style="padding: 7px 7px; background: #DCDCDC;" | '''Iodine-induced hyperthyroidism'''
| colspan="2" style="padding: 7px 7px; background: #DCDCDC;" | '''Iodine-induced hyperthyroidism'''
| style="padding: 7px 7px; background: #F5F5F5;" |It is uncommon but, can develop after an iodine load, such as administration of contrast agents used for angiography or computed tomography (CT) or iodine-rich drugs such as amiodarone.
| style="padding: 7px 7px; background: #F5F5F5;" |It is uncommon but, can develop after an iodine load, such as administration of contrast agents used for angiography or computed tomography (CT) or iodine-rich drugs such as amiodarone.
|-
|-
| style="padding: 7px 7px; background: #DCDCDC;" | '''Trophoblastic disease and germ cell tumors'''
| colspan="2" style="padding: 7px 7px; background: #DCDCDC;" | '''Trophoblastic disease and germ cell tumors'''
| style="padding: 7px 7px; background: #F5F5F5;" |Present with acute severe unilateral lower quadrant abdominal pain, nausea and vomiting, tender adnexal mass palpated in 90%, ultrasound is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
| style="padding: 7px 7px; background: #F5F5F5;" |Present with acute severe unilateral lower quadrant abdominal pain, nausea and vomiting, tender adnexal mass palpated in 90%, ultrasound is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
|-
|-
| style="padding: 7px 7px; background: #DCDCDC;" | '''Thyroiditis'''
| style="padding: 7px 7px; background: #DCDCDC;" | '''Thyroiditis'''
|
* Direct chemical toxicity with inflammation
* Radiation thyroiditis
* Drugs that interfere with the immune system
* Lithium
* Palpation thyroiditis
| style="padding: 7px 7px; background: #F5F5F5;" |Presents with localized abdominal pain, nausea, and vomiting. Hypovolemic shock may be present; abdominal tenderness and guarding are physical exam findings, ultrasound is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
| style="padding: 7px 7px; background: #F5F5F5;" |Presents with localized abdominal pain, nausea, and vomiting. Hypovolemic shock may be present; abdominal tenderness and guarding are physical exam findings, ultrasound is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
|-
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| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Endometriosis]]'''
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Endometriosis]]'''
|
| style="padding: 7px 7px; background: #F5F5F5;" |Present with cyclic pain that is exacerbated by onset of menses and during the luteal phase; dyspareuni, transvaginal ultrasound is suggestive, laparascopic exploration is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
| style="padding: 7px 7px; background: #F5F5F5;" |Present with cyclic pain that is exacerbated by onset of menses and during the luteal phase; dyspareuni, transvaginal ultrasound is suggestive, laparascopic exploration is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
|-
|-
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Diverticulitis]]'''
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Diverticulitis]]'''
|
| style="padding: 7px 7px; background: #F5F5F5;" |Present with bowel symptoms in older women
| style="padding: 7px 7px; background: #F5F5F5;" |Present with bowel symptoms in older women
|-
|-
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Acute cystitis]]'''
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Acute cystitis]]'''
|
| style="padding: 7px 7px; background: #F5F5F5;" |Features with increased frequency and urgency, [[dysuria]], and suprapubic pain.<ref>{{Cite journal
| style="padding: 7px 7px; background: #F5F5F5;" |Features with increased frequency and urgency, [[dysuria]], and suprapubic pain.<ref>{{Cite journal
  | author = [[W. E. Stamm]]
  | author = [[W. E. Stamm]]

Revision as of 18:12, 13 December 2016

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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

Differentiating Graves' disease from other Diseases

Disease Findings
Hashitoxicosis It is autoimmune thyroid disease who initially present with hyperthyroidism and a high radioiodine uptake caused by TSH-receptor antibodies similar to Graves' disease followed by the development of hypothyroidism due to infiltration of thyroid gland with lymphocytes and resultant autoimmune-mediated destruction of thyroid tissue similar to chronic lymphocytic thyroiditis.[1]
Toxic adenoma and toxic multinodular goiter Toxic adenoma and toxic multinodular goiter are result of focal/diffuse hyperplasia of thyroid follicular cells independent to TSH regulation. Finding single or multiple nodules in physical examination or thyroid scan.[2]
Iodine-induced hyperthyroidism It is uncommon but, can develop after an iodine load, such as administration of contrast agents used for angiography or computed tomography (CT) or iodine-rich drugs such as amiodarone.
Trophoblastic disease and germ cell tumors Present with acute severe unilateral lower quadrant abdominal pain, nausea and vomiting, tender adnexal mass palpated in 90%, ultrasound is diagnostic.[3]
Thyroiditis
  • Direct chemical toxicity with inflammation
  • Radiation thyroiditis
  • Drugs that interfere with the immune system
  • Lithium
  • Palpation thyroiditis
 Presents with localized abdominal pain, nausea, and vomiting. Hypovolemic shock may be present; abdominal tenderness and guarding are physical exam findings, ultrasound is diagnostic.[3]
Endometriosis Present with cyclic pain that is exacerbated by onset of menses and during the luteal phase; dyspareuni, transvaginal ultrasound is suggestive, laparascopic exploration is diagnostic.[3]
Diverticulitis Present with bowel symptoms in older women
Acute cystitis Features with increased frequency and urgency, dysuria, and suprapubic pain.[4][5]

References

  1. ↑ Fatourechi V, McConahey WM, Woolner LB (1971). "Hyperthyroidism associated with histologic Hashimoto's thyroiditis". Mayo Clin. Proc. 46 (10): 682–9. PMID 5171000.
  2. ↑ Laurberg P, Pedersen KM, Vestergaard H, Sigurdsson G (1991). "High incidence of multinodular toxic goitre in the elderly population in a low iodine intake area vs. high incidence of Graves' disease in the young in a high iodine intake area: comparative surveys of thyrotoxicosis epidemiology in East-Jutland Denmark and Iceland". J. Intern. Med. 229 (5): 415–20. PMID 2040867.
  3. ↑ 3.0 3.1 3.2 Bhavsar AK, Gelner EJ, Shorma T (2016). "Common Questions About the Evaluation of Acute Pelvic Pain". Am Fam Physician. 93 (1): 41–8. PMID 26760839.
  4. ↑ W. E. Stamm (1981). "Etiology and management of the acute urethral syndrome". Sexually transmitted diseases. 8 (3): 235–238. PMID 7292216. Unknown parameter |month= ignored (help)
  5. ↑ W. E. Stamm, K. F. Wagner, R. Amsel, E. R. Alexander, M. Turck, G. W. Counts & K. K. Holmes (1980). "Causes of the acute urethral syndrome in women". The New England journal of medicine. 303 (8): 409–415. doi:10.1056/NEJM198008213030801. PMID 6993946. Unknown parameter |month= ignored (help)

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