Postpartum thyroiditis differential diagnosis: Difference between revisions

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!Low mood
!Low mood
!Irritability
!Irritability
!early late
!
!
!
!
!
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![[Grave's disease]]
![[Grave's disease]]
!Present
!Present
!
!Small painful mass
!
!Present
!Present early
!Present early
!
!
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![[Silent thyroiditis]]
![[Silent thyroiditis]]
!Present
!Present
!
!Small painless goiter
!
!Present late
!Present early
!Present early
!
!
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![[Postpartum thyroiditis]]
![[Postpartum thyroiditis]]
!Present
!Present
!Present
!Small painless goiter
!Present late
!Present late
!Present early
!Present early
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![[De Quervain's thyroiditis|Subacute (de Quervain's) thyroiditis]]
![[De Quervain's thyroiditis|Subacute (de Quervain's) thyroiditis]]
!Present
!Present
!
!Small painful mass
!Present late
!Present late
!Present early
!Present early
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![[Factitious thyrotoxicosis]]
![[Factitious thyrotoxicosis]]
!Present
!Present
!
!Normal
!
!Absent
!Present early
!Present early
!
!
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!acute suppurative thyroiditis
!acute suppurative thyroiditis
!Present
!Present
!
!Small painful mass
!Present late
!Present late
!Present early
!Present early
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![[De Quervain's thyroiditis|Subacute (de Quervain's) thyroiditis]]
![[De Quervain's thyroiditis|Subacute (de Quervain's) thyroiditis]]
!Present
!Present
!
!Small painful mass
!Present late
!Present late
!Present early
!Present early
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![[Postpartum thyroiditis]]
![[Postpartum thyroiditis]]
!Present
!Present
!
!Small painless goiter
!Present late
!Present late
!Present early
!Present early
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!acute suppurative thyroiditis
!acute suppurative thyroiditis
!Present
!Present
!
!Small painful mass
!Present late
!Present late
!Present early
!Present early
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|[[Postpartum thyroiditis]]
|[[Postpartum thyroiditis]]
|Present
|Present
|Present
|Small painless goiter
|Present late
|Present late
|Present early
|Present early
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|[[Silent thyroiditis]]
|[[Silent thyroiditis]]
|Present
|Present
|
|Small painless goiter
|Present late
|Present late
|Present early
|Present early
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|[[De Quervain's thyroiditis|Subacute (de Quervain's) thyroiditis]]
|[[De Quervain's thyroiditis|Subacute (de Quervain's) thyroiditis]]
|Present
|Present
|
|Small painful mass
|Present late
|Present late
|Present early
|Present early
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|[[Infectious thyroiditis|acute suppurative thyroiditis]]
|[[Infectious thyroiditis|acute suppurative thyroiditis]]
|Present
|Present
|
|Small painful mass
|Present late
|Present late
|Present early
|Present early
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|[[Riedel's thyroiditis]]
|[[Riedel's thyroiditis]]
|Present
|Present
|
|Small painful mass
|Present late
|Present late
|Present early
|Present early
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|[[Postpartum thyroiditis]]
|[[Postpartum thyroiditis]]
|Present
|Present
|Present
|Small painless goiter
|Present late
|Present late
|Present early
|Present early
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|[[Hashimoto's thyroiditis]]
|[[Hashimoto's thyroiditis]]
|Present
|Present
|
|Painful mass
|Present late
|Present late
|Present early
|Present early
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|Acute suppurative thyroiditis
|Acute suppurative thyroiditis
|Present
|Present
|
|Small painful mass
|Present late
|Present late
|Present early
|Present early

Revision as of 17:33, 20 October 2017

Postpartum thyroiditis Microchapters

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Epidemiology and Demographics

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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

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

Conditions Causes Age at onset Pathological findings Diagnostic approach
Hashimoto's thyroiditis
  • Autoimmune
  • All ages, peak at 30-50
  • Lymphocytic infiltration
  • Germinal centers
  • Fibrosis (in some variants)
Painful subacute (De Quervain's) thyroiditis
  • Unknown
  • 20-60
  • Giant cells
  • Granulomas
Silent thyroiditis
  • Autoimmune
  • All ages, peak at 30-40
  • Lymphocytic infiltration
  • Lymphoid follicles
Postpartum thyroiditis
  • Autoimmune
  • Childbearing age
  • Lymphocytic infiltration
Riedel's thyroiditis
  • Unknown
  • 30-60
  • Dense fibrosis
Suppurative thyroiditis
  • Infection
  • Children, 20-40
  • Abscess formation

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:[2][3][1][4][5][6]
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**
  • History of hyperthyroidism
  • History of trauma
  • History of drug use, surgery, or radiation
Radiation-induced
Trauma induced
Radioiodine induced
Thyroidectomy
Subclinical hypothyroidism - - ↑ Normal Normal Normal Normal Normal Normal/↑
  • Asymptomatic


(†)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.[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 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
  • Patient may have opthalmopathy and dermopathy
Toxic thyroid nodule - - ↓ ↑ Normal/↑ ↑(hot nodule) Normal/↑ Normal Absent Absent

-

Secondary hyperthyroidism Pituitary adenoma - - ↑ ↑ Normal/↑ ↑ Normal/↑ Normal Absent Absent
  • Inappropriately normal or increased TSH
Tertiary hyperthyroidism Tertiary hyperthyroidism - - ↑ ↑ ↑ ↑ Normal/↑ ↑ Absent Absent
  • Inappropriately normal or increased TSH
Drug induced Amiodarone type 1 - - ↓ ↑ Normal/↑ ↓ Normal/↑ Normal Absent Absent
  • High urinary iodine
Amiodarone type 2 - - ↓ ↑ Normal/↑ Absent/↓ Normal/↑ Normal Absent Absent
  • High urinary iodine
Others Factitious thyrotoxicosis - - ↓ ↑ Normal/↑ ↓ ↓ Normal Absent Absent
  • Decreased thyroglobulin
Trophoblastic disease - - ↓ ↑ Normal/↑ ↑ - Normal Absent Absent

-

Struma ovarii - - ↓ ↑ Normal/↑ ↓ - Normal Absent Absent

-

(†)T3RU; Triiodothyronine Resin uptake. (^)TPOAb; Thyroid peroxidase antibodies.

Fatiuge Neck swelling Low mood Irritability
Persistent hyperthyroidism Grave's disease Present Small painful mass Present Present early
Transient hyperthyroidism Silent thyroiditis Present Small painless goiter Present late Present early
Postpartum thyroiditis Present Small painless goiter Present late Present early
Subacute (de Quervain's) thyroiditis Present Small painful mass Present late Present early
Factitious thyrotoxicosis Present Normal Absent Present early
acute suppurative thyroiditis Present Small painful mass Present late Present early
Destructive hyperthyroidism Subacute (de Quervain's) thyroiditis Present Small painful mass Present late Present early
Postpartum thyroiditis Present Small painless goiter Present late Present early
acute suppurative thyroiditis Present Small painful mass Present late Present early
Transient hypothyroidism Postpartum thyroiditis Present Small painless goiter Present late Present early
Silent thyroiditis Present Small painless goiter Present late Present early
Subacute (de Quervain's) thyroiditis Present Small painful mass Present late Present early
acute suppurative thyroiditis Present Small painful mass Present late Present early
Persistent hypothyroidism Riedel's thyroiditis Present Small painful mass Present late Present early
Postpartum thyroiditis Present Small painless goiter Present late Present early
Hashimoto's thyroiditis Present Painful mass Present late Present early
Acute suppurative thyroiditis Present Small painful mass Present late Present early

References

  1. ↑ 1.0 1.1 1.2 "Thyroiditis — NEJM".
  2. ↑ 2.0 2.1 Bindra A, Braunstein GD (2006). "Thyroiditis". Am Fam Physician. 73 (10): 1769–76. PMID 16734054.
  3. ↑ 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. ↑ 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. ↑ 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. ↑ 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.
  7. ↑ "Clinical Finding and Thyroid Function in Women with Struma Ovarii".
  8. ↑ Vaidya B, Pearce SH (2014). "Diagnosis and management of thyrotoxicosis". BMJ. 349: g5128. PMID 25146390.
  9. ↑ "Think thyrotoxicosis factitia - measure thyroglobulin | The BMJ".

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