Postpartum thyroiditis differential diagnosis: Difference between revisions
Sunny Kumar (talk | contribs) |
Sunny Kumar (talk | contribs) |
||
(2 intermediate revisions by the same user not shown) | |||
Line 8: | Line 8: | ||
==Differentiating Postpartum Thyroiditis from other Diseases== | ==Differentiating Postpartum Thyroiditis from other Diseases== | ||
===Differentiating postpartum thyroiditis from other causes of thyroiditis=== | ===Differentiating postpartum thyroiditis from other causes of thyroiditis=== | ||
*Postpartum 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> | *Postpartum 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><ref name="pmid28781832">{{cite journal| author=Akuzawa N, Yokota T, Suzuki T, Kurabayashi M| title=Acute suppurative thyroiditis caused by Streptococcus agalactiae infection: a case report. | journal=Clin Case Rep | year= 2017 | volume= 5 | issue= 8 | pages= 1238-1242 | pmid=28781832 | doi=10.1002/ccr3.1048 | pmc=5538065 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28781832 }}</ref><ref name="pmid287818323">{{cite journal| author=Akuzawa N, Yokota T, Suzuki T, Kurabayashi M| title=Acute suppurative thyroiditis caused by Streptococcus agalactiae infection: a case report. | journal=Clin Case Rep | year= 2017 | volume= 5 | issue= 8 | pages= 1238-1242 | pmid=28781832 | doi=10.1002/ccr3.1048 | pmc=5538065 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28781832 }}</ref> | ||
{| align="center" | {| align="center" | ||
|- | |- | ||
Line 453: | Line 453: | ||
! | ! | ||
! colspan="4" |Symptoms and Signs | ! colspan="4" |Symptoms and Signs | ||
! colspan=" | ! colspan="7" |Labs | ||
! | !Mechanisum | ||
|- | |- | ||
! | ! | ||
Line 471: | Line 470: | ||
!RAI | !RAI | ||
U | |||
!Thyroid U/S | !Thyroid U/S | ||
! | !Microscopic | ||
! | |||
Picture | |||
!aetology | |||
|- | |- | ||
!Persistent | !Persistent | ||
hyperthyroidism | hyperthyroidism | ||
![[Grave's disease]] | ![[Grave's disease]] | ||
! | !+ | ||
!Small painful | !Small | ||
painful | |||
mass | mass | ||
!Present | !Present | ||
Line 488: | Line 490: | ||
!High | !High | ||
!Absent | !Absent | ||
! | !↑ | ||
! | !↑ | ||
!diffusely enlarged | !diffusely | ||
enlarged | |||
hypervascular | hypervascular | ||
heterogeneous echotexture | heterogeneous | ||
echotexture | |||
! | ! | ||
hyperplastic | |||
follicles due to | |||
eosinophilic | |||
cytoplasm | |||
scalloping | |||
! | ! | ||
|- | |- | ||
Line 501: | Line 515: | ||
hyperthyroidism | hyperthyroidism | ||
![[Silent thyroiditis]] | ![[Silent thyroiditis]] | ||
! | !+ | ||
!Small painless | !Small | ||
painless | |||
goiter | goiter | ||
!Present | !Present | ||
Line 513: | Line 528: | ||
!High | !High | ||
!50% | !50% | ||
! | !NL | ||
! | !↓ | ||
!markedly decreased vascularity | !markedly | ||
decreased | |||
vascularity | |||
variable | |||
heterogeneous | |||
texture | |||
!Lymphocytic | |||
infiltration | |||
Lymphoid | |||
follicles | |||
! | ! | ||
|- | |- | ||
![[Postpartum thyroiditis]] | ![[Postpartum thyroiditis]] | ||
! | !+ | ||
!Small painless | !Small | ||
painless | |||
goiter | goiter | ||
!Present | !Present | ||
Line 535: | Line 565: | ||
!High | !High | ||
!>80% | !>80% | ||
! | !↑ | ||
! | !↓ | ||
!hypoechoic diffusely enlarged with normal or decreased vasclarity | !hypoechoic | ||
! | diffusely | ||
enlarged | |||
with | |||
normal | |||
or decreased | |||
vasclarity | |||
!variable | |||
heterogeneous | |||
texture | |||
hypoechogenic | |||
! | ! | ||
|- | |- | ||
![[De Quervain's thyroiditis|Subacute (de Quervain's)]] | ![[De Quervain's thyroiditis|Subacute (de Quervain's)]] | ||
[[De Quervain's thyroiditis|granulomatous thyroiditis]] | [[De Quervain's thyroiditis|granulomatous thyroiditis]] | ||
! | !+ | ||
!Small painful | !Small | ||
painful | |||
mass | mass | ||
!Present | !Present | ||
Line 555: | Line 603: | ||
!High | !High | ||
!Absent | !Absent | ||
! | !↑ | ||
! | !↓ | ||
!diffusely enlarged | !diffusely | ||
! | enlarged & | ||
normal or | |||
decreased | |||
vasclarity | |||
!Giant cells | |||
Granulomas | |||
! | ! | ||
|- | |- | ||
![[Factitious thyrotoxicosis|Factitious]] | ![[Factitious thyrotoxicosis|Factitious]] | ||
[[Factitious thyrotoxicosis|thyrotoxicosis]] | [[Factitious thyrotoxicosis|thyrotoxicosis]] | ||
! | !+ | ||
!Normal | !Normal | ||
!Absent | !Absent | ||
Line 573: | Line 631: | ||
!High | !High | ||
!Absent | !Absent | ||
!NL | |||
!↓ | |||
!Normal | !Normal | ||
! | !Normal | ||
histology | |||
! | ! | ||
|- | |- | ||
!acute suppurative | !acute suppurative | ||
thyroiditis | thyroiditis | ||
! | !+ | ||
!Small painful | !Small | ||
painful | |||
mass | mass | ||
!Present | !Present | ||
Line 593: | Line 654: | ||
!High | !High | ||
!Absent | !Absent | ||
! | !↑ | ||
! | !↓ | ||
!variable heterogeneous texture | !variable | ||
! | heterogeneous | ||
texture | |||
perithyroidal | |||
hypoechoic | |||
space due to | |||
abcess | |||
!polymorphonuclear leukocytes | |||
lymphocytes | |||
exudates | |||
! | ! | ||
|- | |- | ||
Line 603: | Line 679: | ||
![[De Quervain's thyroiditis|Subacute (de Quervain's)]] | ![[De Quervain's thyroiditis|Subacute (de Quervain's)]] | ||
[[De Quervain's thyroiditis|granulomatous thyroiditis]] | [[De Quervain's thyroiditis|granulomatous thyroiditis]] | ||
! | !+ | ||
!Small painful | !Small | ||
painful | |||
mass | mass | ||
!Present | !Present | ||
Line 615: | Line 692: | ||
!High | !High | ||
!Absent | !Absent | ||
! | !↑ | ||
! | !↓ | ||
!diffusely enlarged | !diffusely | ||
! | enlarged | ||
&normal or | |||
decreased | |||
vasclarity | |||
!Giant cells | |||
Granulomas | |||
! | ! | ||
|- | |- | ||
![[Postpartum thyroiditis|Postpartum]] | ![[Postpartum thyroiditis|Postpartum]] | ||
[[Postpartum thyroiditis|thyroiditis]] | [[Postpartum thyroiditis|thyroiditis]] | ||
! | !+ | ||
!Small painless | !Small | ||
painless | |||
goiter | goiter | ||
!Present | !Present | ||
Line 635: | Line 723: | ||
!High | !High | ||
!>80% | !>80% | ||
! | !↑ | ||
! | !↓ | ||
!hypoechoic diffusely enlarged | !hypoechoic | ||
! | diffusely | ||
enlarged& | |||
normal or | |||
decreased | |||
vasclarity | |||
!variable | |||
heterogeneous | |||
texture | |||
hypoechogenic | |||
! | ! | ||
|- | |- | ||
!acute suppurative | !acute suppurative | ||
thyroiditis | thyroiditis | ||
! | !+ | ||
!Small painful | !Small | ||
painful | |||
mass | mass | ||
!Present | !Present | ||
Line 655: | Line 759: | ||
!High | !High | ||
!Absent | !Absent | ||
! | !↑ | ||
! | !↓ | ||
!variable heterogeneous texture | !variable | ||
! | heterogeneous | ||
texture | |||
perithyroidal | |||
hypoechoic | |||
space due to | |||
abcess | |||
!polymorphonuclear leukocytes | |||
lymphocytes | |||
exudates | |||
! | ! | ||
|- | |- | ||
Line 665: | Line 785: | ||
|[[Postpartum thyroiditis|Postpartum]] | |[[Postpartum thyroiditis|Postpartum]] | ||
[[Postpartum thyroiditis|thyroiditis]] | [[Postpartum thyroiditis|thyroiditis]] | ||
| | | + | ||
|Small painless | |Small | ||
painless | |||
goiter | goiter | ||
|Present | |Present | ||
Line 677: | Line 798: | ||
|Low | |Low | ||
|>80% | |>80% | ||
| | |↑ | ||
| | |↓ | ||
| hypoechoic diffusely enlarged | | hypoechoic | ||
| | diffusely | ||
enlarged | |||
& normal or | |||
decreased | |||
vasclarity | |||
|variable | |||
heterogeneous | |||
texture | |||
, hypoechogenic | |||
| | | | ||
|- | |- | ||
|[[Silent thyroiditis|Silent]] | |[[Silent thyroiditis|Silent]] | ||
[[Silent thyroiditis|thyroiditis]] | [[Silent thyroiditis|thyroiditis]] | ||
| | | + | ||
|Small painless | |Small | ||
painless | |||
goiter | goiter | ||
|Present | |Present | ||
Line 697: | Line 834: | ||
|Low | |Low | ||
|Present | |Present | ||
| | |NL | ||
| | |↓ | ||
|markedly decreased vascularity | |markedly | ||
decreased | |||
vascularity | |||
variable | |||
heterogeneous | |||
texture | |||
|Lymphocytic infiltration | |||
Lymphoid follicles | |||
| | | | ||
|- | |- | ||
|[[De Quervain's thyroiditis|Subacute (de Quervain's)]] | |[[De Quervain's thyroiditis|Subacute (de Quervain's)]] | ||
[[De Quervain's thyroiditis|granulomatous thyroiditis]] | [[De Quervain's thyroiditis|granulomatous thyroiditis]] | ||
| | | + | ||
|Small painful | |Small | ||
painful | |||
mass | mass | ||
|Present | |Present | ||
Line 720: | Line 868: | ||
|Low | |Low | ||
|Absent | |Absent | ||
| | |↑ | ||
| | |↓ | ||
|diffusely enlarged | |diffusely | ||
| | enlarged | ||
normal or | |||
decreased | |||
vasclarity | |||
|Giant cells | |||
Granulomas | |||
| | | | ||
|- | |- | ||
|[[Infectious thyroiditis|acute suppurative]] | |[[Infectious thyroiditis|acute suppurative]] | ||
[[Infectious thyroiditis|thyroiditis]] | [[Infectious thyroiditis|thyroiditis]] | ||
| | | + | ||
|Small painful | |Small | ||
painful | |||
mass | mass | ||
|Present | |Present | ||
Line 740: | Line 899: | ||
|Low | |Low | ||
|Absent | |Absent | ||
| | |↑ | ||
| | |↓ | ||
|variable heterogeneous texture | |variable | ||
heterogeneous | |||
texture | |||
perithyroidal | |||
hypoechoic | |||
space due to | |||
abcess | |||
|polymorphonuclear leukocytes | |||
lymphocytes | |||
exudates | |||
| | | | ||
|- | |- | ||
Line 752: | Line 924: | ||
|[[Riedel's thyroiditis|Riedel's]] | |[[Riedel's thyroiditis|Riedel's]] | ||
[[Riedel's thyroiditis|thyroiditis]] | [[Riedel's thyroiditis|thyroiditis]] | ||
| | | + | ||
|Small painful | |Small | ||
painful | |||
mass | mass | ||
|Present | |Present | ||
Line 762: | Line 935: | ||
|Low | |Low | ||
|75% | |75% | ||
| | |↑ | ||
| | |↓ | ||
|homogeneously hypoechoic | |homogeneously | ||
hypoechoic | |||
fibrotic | |||
invasion of the | |||
adjacent | |||
structures | |||
| | | lymphocytes, plasma cells, and eosinophils in a dense matrix of hyalinized connective tissue | ||
| | | | ||
|- | |- | ||
|[[Postpartum thyroiditis|Postpartum]] | |[[Postpartum thyroiditis|Postpartum]] | ||
[[Postpartum thyroiditis|thyroiditis]] | [[Postpartum thyroiditis|thyroiditis]] | ||
| | | + | ||
|Small painless | |Small | ||
painless | |||
goiter | goiter | ||
|Present | |Present | ||
Line 784: | Line 963: | ||
|Low | |Low | ||
|>80% | |>80% | ||
| | |↑ | ||
| | |↓ | ||
|hypoechoic diffusely enlarged | |hypoechoic | ||
| | diffusely | ||
enlarged& | |||
normal | |||
or decreased | |||
vasclarity | |||
|variable | |||
heterogeneous | |||
texture, | |||
hypoechogenic | |||
| | | | ||
|- | |- | ||
|[[Hashimoto's thyroiditis|Hashimoto's]] | |[[Hashimoto's thyroiditis|Hashimoto's]] | ||
[[Hashimoto's thyroiditis|thyroiditis]] | [[Hashimoto's thyroiditis|thyroiditis]] | ||
| | | + | ||
|Painful | |Painful | ||
mass | mass | ||
Line 802: | Line 996: | ||
|Low | |Low | ||
|95% | |95% | ||
| | |↑ | ||
| | |↓ | ||
|heterogeneous echotexture | |heterogeneous | ||
echotexture | |||
decreased | |||
vasclarity | |||
hypoechoic | |||
micronodules | |||
|lymphoid | |||
follicles | |||
Germinal centers | |||
| | | | ||
|- | |- | ||
|Acute suppurative | |Acute suppurative | ||
thyroiditis | thyroiditis | ||
| | | + | ||
|Small painful | |Small | ||
painful | |||
mass | mass | ||
|Present | |Present | ||
Line 824: | Line 1,029: | ||
|Low | |Low | ||
|Absent | |Absent | ||
| | |↑ | ||
| | |↓ | ||
|variable heterogeneous texture | |variable | ||
heterogeneous | |||
texture | |||
perithyroidal | |||
hypoechoic | |||
space due to | |||
abcess | |||
|polymorphonuclear leukocytes | |||
lymphocytes | |||
exudates | |||
| | | | ||
|} | |} |
Revision as of 21:28, 20 October 2017
Postpartum thyroiditis Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Postpartum thyroiditis differential diagnosis On the Web |
American Roentgen Ray Society Images of Postpartum thyroiditis differential diagnosis |
Risk calculators and risk factors for Postpartum thyroiditis differential diagnosis |
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
Postpartum thyroiditis must be differentiated from other causes of thyroiditis, such as De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis, and suppurative thyroiditis. Postpartum thyroiditis must be differentiated from other causes of thyroiditis, such as De Quervain's thyroiditis, Riedel's thyroiditis, and suppurative thyroiditis. Postpartum thyroiditis must also be differentiated from other diseases which cause hypothyroidism. As Postpartum thyroiditis may cause transient thyrotoxic symptoms, the diseases causing thyrotoxicosis must also be considered in the differential diagnosis.
Differentiating Postpartum Thyroiditis from other Diseases
Differentiating postpartum thyroiditis from other causes of thyroiditis
- Postpartum 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][2][3]
Conditions | Causes | Age at onset | Pathological findings | Diagnostic approach |
---|---|---|---|---|
Hashimoto's thyroiditis |
|
|
|
|
Painful subacute (De Quervain's) thyroiditis |
|
|
|
|
Silent thyroiditis |
|
|
|
|
Postpartum thyroiditis |
|
|
|
|
Riedel's thyroiditis |
|
|
|
|
Suppurative thyroiditis |
|
|
|
|
Differentiating postpartum thyroiditis from other causes of hypothyroidism
- Postpartum thyroiditis must be differentiated from other causes of hypothyroidism on the basis of history and symptoms and laboratory findings:[4][5][1][6][7][8]
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** |
|
Radiation-induced | |||||||||||
Trauma induced | |||||||||||
Radioiodine induced | |||||||||||
Thyroidectomy | |||||||||||
Subclinical hypothyroidism | - | - | ↑ | Normal | Normal | Normal | Normal | Normal | Normal/↑ |
|
(†)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 postpartum thyroiditis from other causes of thyrotoxicosis
- Postpartum thyroiditis can initially present with thyrotoxicosis which must be differentiated from other causes of thyrotoxicosis.[4][5][1][6][7][8][9][10][11]
Disease | History and symptoms | Laboratory findings | Additional findings | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Fever | Pain | TSH | Free T4 | T3 | T3RU† | Thyroglobin | TRH | TSH Receptor Antibody | TPOAb^ | |||
Thyroiditis | Postpartum 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 |
| |
Silent 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.
Symptoms and Signs | Labs | Mechanisum | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Fatiuge | Neck
swelling |
Low
mood |
Irritability | TSH | FT4 | TPO ab | ESR | RAI
U |
Thyroid U/S | Microscopic
Picture |
aetology | ||
Persistent
hyperthyroidism |
Grave's disease | + | Small
painful mass |
Present | Present
early |
Low | High | Absent | ↑ | ↑ | diffusely
enlarged hypervascular heterogeneous echotexture |
hyperplastic follicles due to eosinophilic cytoplasm scalloping |
|
Transient
hyperthyroidism |
Silent thyroiditis | + | Small
painless goiter |
Present
late |
Present
early |
Normal
or Low |
High | 50% | NL | ↓ | markedly
decreased vascularity variable heterogeneous texture |
Lymphocytic
infiltration Lymphoid follicles |
|
Postpartum thyroiditis | + | Small
painless goiter |
Present
late |
Present
early |
Normal
or Low |
High | >80% | ↑ | ↓ | hypoechoic
diffusely enlarged with normal or decreased vasclarity |
variable
heterogeneous texture hypoechogenic |
||
Subacute (de Quervain's) | + | Small
painful mass |
Present
late |
Present
early |
Normal
or Low |
High | Absent | ↑ | ↓ | diffusely
enlarged & normal or decreased vasclarity |
Giant cells
Granulomas |
||
Factitious | + | Normal | Absent | Present
early |
Normal
or Low |
High | Absent | NL | ↓ | Normal | Normal
histology |
||
acute suppurative
thyroiditis |
+ | Small
painful mass |
Present
late |
Present
early |
Normal
or Low |
High | Absent | ↑ | ↓ | variable
heterogeneous texture perithyroidal hypoechoic space due to abcess |
polymorphonuclear leukocytes
lymphocytes exudates |
||
Destructive
hyperthyroidism |
Subacute (de Quervain's) | + | Small
painful mass |
Present
late |
Present
early |
Normal
or Low |
High | Absent | ↑ | ↓ | diffusely
enlarged &normal or decreased vasclarity |
Giant cells
Granulomas |
|
Postpartum | + | Small
painless goiter |
Present
late |
Present
early |
Normal
or Low |
High | >80% | ↑ | ↓ | hypoechoic
diffusely enlarged& normal or decreased vasclarity |
variable
heterogeneous texture hypoechogenic |
||
acute suppurative
thyroiditis |
+ | Small
painful mass |
Present
late |
Present
early |
Normal
or Low |
High | Absent | ↑ | ↓ | variable
heterogeneous texture perithyroidal hypoechoic space due to abcess |
polymorphonuclear leukocytes
lymphocytes exudates |
||
Transient
hypothyroidism |
Postpartum | + | Small
painless goiter |
Present
late |
Present
early |
Normal
or High |
Low | >80% | ↑ | ↓ | hypoechoic
diffusely enlarged & normal or decreased vasclarity |
variable
heterogeneous texture , hypoechogenic |
|
Silent | + | Small
painless goiter |
Present
late |
Present
early |
Normal
or High |
Low | Present | NL | ↓ | markedly
decreased vascularity variable heterogeneous texture |
Lymphocytic infiltration
Lymphoid follicles |
||
Subacute (de Quervain's) | + | Small
painful mass |
Present
late |
Present
early |
Normal
or High |
Low | Absent | ↑ | ↓ | diffusely
enlarged normal or decreased vasclarity |
Giant cells
Granulomas |
||
acute suppurative | + | Small
painful mass |
Present
late |
Present
early |
Normal
or High |
Low | Absent | ↑ | ↓ | variable
heterogeneous texture perithyroidal hypoechoic space due to abcess |
polymorphonuclear leukocytes
lymphocytes exudates |
||
Persistent
hypothyroidism |
Riedel's | + | Small
painful mass |
Present
late |
Present
early |
High | Low | 75% | ↑ | ↓ | homogeneously
hypoechoic fibrotic invasion of the adjacent structures |
lymphocytes, plasma cells, and eosinophils in a dense matrix of hyalinized connective tissue | |
Postpartum | + | Small
painless goiter |
Present
late |
Present
early |
High | Low | >80% | ↑ | ↓ | hypoechoic
diffusely enlarged& normal or decreased vasclarity |
variable
heterogeneous texture, hypoechogenic |
||
Hashimoto's | + | Painful
mass |
Present
late |
Present
early |
High | Low | 95% | ↑ | ↓ | heterogeneous
echotexture decreased vasclarity hypoechoic micronodules |
lymphoid
follicles Germinal centers |
||
Acute suppurative
thyroiditis |
+ | Small
painful mass |
Present
late |
Present
early |
High | Low | Absent | ↑ | ↓ | variable
heterogeneous texture perithyroidal hypoechoic space due to abcess |
polymorphonuclear leukocytes
lymphocytes exudates |
References
- ↑ 1.0 1.1 1.2 "Thyroiditis — NEJM".
- ↑ Akuzawa N, Yokota T, Suzuki T, Kurabayashi M (2017). "Acute suppurative thyroiditis caused by Streptococcus agalactiae infection: a case report". Clin Case Rep. 5 (8): 1238–1242. doi:10.1002/ccr3.1048. PMC 5538065. PMID 28781832.
- ↑ Akuzawa N, Yokota T, Suzuki T, Kurabayashi M (2017). "Acute suppurative thyroiditis caused by Streptococcus agalactiae infection: a case report". Clin Case Rep. 5 (8): 1238–1242. doi:10.1002/ccr3.1048. PMC 5538065. PMID 28781832.
- ↑ 4.0 4.1 Bindra A, Braunstein GD (2006). "Thyroiditis". Am Fam Physician. 73 (10): 1769–76. PMID 16734054.
- ↑ 5.0 5.1 McDermott MT (2009). "In the clinic. Hypothyroidism". Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.
- ↑ 6.0 6.1 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.
- ↑ 7.0 7.1 Lania A, Persani L, Beck-Peccoz P (2008). "Central hypothyroidism". Pituitary. 11 (2): 181–6. doi:10.1007/s11102-008-0122-6. PMID 18415684.
- ↑ 8.0 8.1 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".