Silent thyroiditis differential diagnosis: Difference between revisions

Jump to navigation Jump to search
m (Bot: Removing from Primary care)
 
(7 intermediate revisions by 3 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Silent thyroiditis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Silent_thyroiditis]]
{{CMG}} {{AE}} {{MMF}}
{{CMG}} {{AE}} {{MMF}}
==Overview==
==Overview==
[[Silent thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis. Silent thyroiditis must also be differentiated from other diseases which cause [[hypothyroidism]]. As silent thyroiditis may cause transient thyrotoxic symptoms, the diseases causing [[thyrotoxicosis]] must also be considered in the differential diagnosis.
[[Silent thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis. Silent thyroiditis must also be differentiated from other diseases which cause [[hypothyroidism]]. As silent thyroiditis may cause transient [[Thyrotoxicosis|thyrotoxic]] symptoms, the diseases causing [[thyrotoxicosis]] must also be considered in the differential diagnosis.


==Differentiating Silent Thyroiditis from other Diseases==
==Differentiating Silent Thyroiditis from other Diseases==
Line 28: Line 28:
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Increased TSH]] ([[hypothyroidism]]) and/or
*[[Thyroid function tests|Increased TSH]] ([[hypothyroidism]]) and/or
* [[Thyroid function tests|Decreased TSH]] (transient hypothyroidism)
* [[Thyroid function tests|Decreased TSH]] (transient [[hypothyroidism]])
*[[Thyroid peroxidase|TPO antibodies]] present in high titer
*[[Thyroid peroxidase|TPO antibodies]] present in high titer
*[[I-123 thyroid imaging|I-123]] uptake usually decreased
*[[I-123 thyroid imaging|I-123]] uptake usually decreased
Line 212: Line 212:
| rowspan="5" align="left" style="padding: 5px 5px; background: #F5F5F5;" |
| rowspan="5" align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* History of [[hyperthyroidism]]
* History of [[hyperthyroidism]]
* History of trauma
* History of [[trauma]]
*History of drug use, surgery, or radiation
*History of drug use, [[surgery]], or [[radiation]]
|-
|-
| align="center" style="background:#DCDCDC;" |Radiation-induced
| align="center" style="background:#DCDCDC;" |Radiation-induced
Line 239: Line 239:


===Differentiating silent thyroiditis from other causes of thyrotoxicosis===
===Differentiating silent thyroiditis from other causes of thyrotoxicosis===
*Silent thyroiditis can initially present with thyrotoxicosis which must be differentiated from other causes of thyrotoxicosis.<ref name="pmid16734054">{{cite journal |vauthors=Bindra A, Braunstein GD |title=Thyroiditis |journal=Am Fam Physician |volume=73 |issue=10 |pages=1769–76 |year=2006 |pmid=16734054 |doi= |url=}}</ref><ref name="pmid19949140">{{cite journal |vauthors=McDermott MT |title=In the clinic. Hypothyroidism |journal=Ann. Intern. Med. |volume=151 |issue=11 |pages=ITC61 |year=2009 |pmid=19949140 |doi=10.7326/0003-4819-151-11-200912010-01006 |url=}}</ref><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="pmid18177256">{{cite journal |vauthors=Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR |title=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) |journal=Thyroid |volume=17 |issue=12 |pages=1211–23 |year=2007 |pmid=18177256 |doi=10.1089/thy.2006.0235 |url=}}</ref><ref name="pmid18415684">{{cite journal |vauthors=Lania A, Persani L, Beck-Peccoz P |title=Central hypothyroidism |journal=Pituitary |volume=11 |issue=2 |pages=181–6 |year=2008 |pmid=18415684 |doi=10.1007/s11102-008-0122-6 |url=}}</ref><ref name="pmid25905413">{{cite journal |vauthors=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 |title=Clinical Strategies in the Testing of Thyroid Function |journal= |volume= |issue= |pages= |year= |pmid=25905413 |doi= |url=}}</ref><ref name="urlClinical Finding and Thyroid Function in Women with Struma Ovarii">{{cite web |url=https://www.hindawi.com/archive/2013/717584/ |title=Clinical Finding and Thyroid Function in Women with Struma Ovarii |format= |work= |accessdate=}}</ref><ref name="pmid25146390">{{cite journal |vauthors=Vaidya B, Pearce SH |title=Diagnosis and management of thyrotoxicosis |journal=BMJ |volume=349 |issue= |pages=g5128 |year=2014 |pmid=25146390 |doi= |url=}}</ref><ref name="urlThink thyrotoxicosis factitia - measure thyroglobulin | The BMJ">{{cite web |url=http://www.bmj.com/content/349/bmj.g5128/rr/763450 |title=Think thyrotoxicosis factitia - measure thyroglobulin &#124; The BMJ |format= |work= |accessdate=}}</ref>
*Silent thyroiditis can initially present with [[thyrotoxicosis]] which must be differentiated from other causes of [[thyrotoxicosis]].<ref name="pmid16734054">{{cite journal |vauthors=Bindra A, Braunstein GD |title=Thyroiditis |journal=Am Fam Physician |volume=73 |issue=10 |pages=1769–76 |year=2006 |pmid=16734054 |doi= |url=}}</ref><ref name="pmid19949140">{{cite journal |vauthors=McDermott MT |title=In the clinic. Hypothyroidism |journal=Ann. Intern. Med. |volume=151 |issue=11 |pages=ITC61 |year=2009 |pmid=19949140 |doi=10.7326/0003-4819-151-11-200912010-01006 |url=}}</ref><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="pmid18177256">{{cite journal |vauthors=Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR |title=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) |journal=Thyroid |volume=17 |issue=12 |pages=1211–23 |year=2007 |pmid=18177256 |doi=10.1089/thy.2006.0235 |url=}}</ref><ref name="pmid18415684">{{cite journal |vauthors=Lania A, Persani L, Beck-Peccoz P |title=Central hypothyroidism |journal=Pituitary |volume=11 |issue=2 |pages=181–6 |year=2008 |pmid=18415684 |doi=10.1007/s11102-008-0122-6 |url=}}</ref><ref name="pmid25905413">{{cite journal |vauthors=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 |title=Clinical Strategies in the Testing of Thyroid Function |journal= |volume= |issue= |pages= |year= |pmid=25905413 |doi= |url=}}</ref><ref name="urlClinical Finding and Thyroid Function in Women with Struma Ovarii">{{cite web |url=https://www.hindawi.com/archive/2013/717584/ |title=Clinical Finding and Thyroid Function in Women with Struma Ovarii |format= |work= |accessdate=}}</ref><ref name="pmid25146390">{{cite journal |vauthors=Vaidya B, Pearce SH |title=Diagnosis and management of thyrotoxicosis |journal=BMJ |volume=349 |issue= |pages=g5128 |year=2014 |pmid=25146390 |doi= |url=}}</ref><ref name="urlThink thyrotoxicosis factitia - measure thyroglobulin | The BMJ">{{cite web |url=http://www.bmj.com/content/349/bmj.g5128/rr/763450 |title=Think thyrotoxicosis factitia - measure thyroglobulin &#124; The BMJ |format= |work= |accessdate=}}</ref>
{| class="wikitable" align="center" style="border: 0px; margin: 3px;"
{| class="wikitable" align="center" style="border: 0px; margin: 3px;"
! colspan="2" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease
! colspan="2" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease
Line 327: Line 327:
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* Patient may have opthalmopathy and dermopathy
* Patient may have [[Grave's opthalmopathy|opthalmopathy]] and [[dermopathy]]
|-
|-
| align="center" style="background:#DCDCDC;" |[[Toxic thyroid nodule]]
| align="center" style="background:#DCDCDC;" |[[Toxic thyroid nodule]]
Line 335: Line 335:
| 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;" |↑(hot nodule)
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑(hot [[Thyroid nodule|nodule]])
| 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;" |Normal
Line 356: Line 356:
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*Inappropriately normal or increased TSH
*Inappropriately normal or increased [[TSH]]
|-
|-
| rowspan="1" style="background:#DCDCDC;" |[[Tertiary hyperthyroidism]]  
| rowspan="1" style="background:#DCDCDC;" |[[Hyperthyroidism|Tertiary hyperthyroidism]]  
| align="center" style="background:#DCDCDC;" |[[Hyperthyroidism|Tertiary hyperthyroidism]]
| align="center" style="background:#DCDCDC;" |[[Hyperthyroidism|Tertiary hyperthyroidism]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
Line 371: Line 371:
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*Inappropriately normal or increased TSH
*Inappropriately normal or increased [[TSH]]
|-
|-
| rowspan="2" style="background:#DCDCDC;" |Drug induced
| rowspan="2" style="background:#DCDCDC;" |Drug induced
Line 386: Line 386:
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*High urinary iodine
*High urinary [[iodine]]
|-
|-
| align="center" style="background:#DCDCDC;" |[[Amiodarone|Amiodarone type 2]]
| align="center" style="background:#DCDCDC;" |[[Amiodarone|Amiodarone type 2]]
Line 400: Line 400:
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*High urinary iodine
*High urinary [[iodine]]
|-
|-
| rowspan="3" style="background:#DCDCDC;" |Others
| rowspan="3" style="background:#DCDCDC;" |Others
| align="center" style="background:#DCDCDC;" |[[Factitious thyrotoxicosis]]
| align="center" style="background:#DCDCDC;" |[[Thyrotoxicosis factitia|Factitious thyrotoxicosis]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
Line 415: Line 415:
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*Decreased thyroglobulin
*Decreased [[thyroglobulin]]
|-
|-
| align="center" style="background:#DCDCDC;" |[[Trophoblastic disease]]
| align="center" style="background:#DCDCDC;" |[[Trophoblastic disease]]
Line 424: Line 424:
| 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;" |↑
| 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;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
Line 438: Line 438:
| 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;" |↓
| 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;" |Absent
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
Line 450: Line 450:
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Needs content]]
[[Category:Disease]]
[[Category:Endocrinology]]


{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}
[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Up-To-Date]]

Latest revision as of 00:11, 30 July 2020

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

Silent thyroiditis must be differentiated from other causes of thyroiditis, such as De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis, and suppurative thyroiditis. Silent thyroiditis must also be differentiated from other diseases which cause hypothyroidism. As silent thyroiditis may cause transient thyrotoxic symptoms, the diseases causing thyrotoxicosis must also be considered in the differential diagnosis.

Differentiating Silent Thyroiditis from other Diseases

Differentiating silent thyroiditis from other causes of thyroiditis

Conditions Causes Age at onset Pathological findings Diagnostic approach
Silent thyroiditis
  • All ages, peak at 30-40
  • Lymphocytic infiltration
  • Lymphoid follicles
Hashimoto's thyroiditis
  • All ages, peak at 30-50
Painful subacute (De Quervain's) thyroiditis
  • Unknown
  • 20-60
Postpartum thyroiditis
  • Childbearing age
  • Lymphocytic infiltration
Riedel's thyroiditis
  • Unknown
  • 30-60
Suppurative thyroiditis
  • Children, 20-40

Differentiating silent thyroiditis from other causes of hypothyroidism

Disease History and symptoms Laboratory findings Additional findings
Fever Pain TSH Free T4 T3 T3RU Thyroglobin TRH TPOAb^
Transient hypothyroidism Silent thyroiditis - - ↑/ ↓/ Normal Normal Present (high titer)
Postpartum thyroiditis +/- +/- ↑/ ↓/ Normal Normal/↑ Present (high titer)
Subacute (de Quervain's) thyroiditis +/- +/- ↑/ ↓/ Normal Normal Low/absent
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
Others Drug-induced - - /↓ /↑ Normal Normal/ Normal Absent**
Radiation-induced
Trauma induced
Radioiodine induced
Thyroidectomy
Subclinical hypothyroidism - - Normal Normal Normal Normal Normal Normal/
  • Asymptomatic

Differentiating silent thyroiditis from other causes of thyrotoxicosis

Disease History and symptoms Laboratory findings Additional findings
Fever Pain TSH Free T4 T3 T3RU Thyroglobin TRH TSH Receptor Antibody TPOAb^
Thyroiditis Silent 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
Postpartum 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
  • 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
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.

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".

Template:WikiDoc Sources