Riedel's thyroiditis differential diagnosis

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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

Riedel's thyroiditis must be differentiated from other causes of thyroiditis, such as De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis, and suppurative thyroiditis.

Differentiating Riedel's Thyroiditis from other Diseases

Conditions Causes Age at onset Pathological findings Diagnostic findings
Riedel's thyroiditis
  • Unknown
  • 30-60
  • Dense fibrosis
Hashimoto's thyroiditis
  • All ages, peak at 30-50
Painful subacute (De Quervain's) thyroiditis
  • Unknown
  • 20-60
Silent thyroiditis
  • All ages, peak at 30-40
  • Lymphocytic infiltration
  • Lymphoid follicles
Postpartum thyroiditis
  • Childbearing age
  • Lymphocytic infiltration
Suppurative thyroiditis
  • Infection
  • Children, 20-40
Disease History and symptoms Laboratory findings Additional findings
Fever Pain TSH Free T4 T3 T3RU Thyroglobin TRH TPOAb^
Primary hypothyroidism Riedel's thyroiditis - - Normal/↑ Normal/↓ Normal/↓ Normal/↓ Normal Normal Usually present
Autoimmune (Hashimoto's thyroiditis) - - * Normal/ Normal/↓ Normal/ Normal Present (high titer)
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.


References

  1. 1.0 1.1 "Thyroiditis — NEJM".
  2. Bindra A, Braunstein GD (2006). "Thyroiditis". Am Fam Physician. 73 (10): 1769–76. PMID 16734054.
  3. 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. 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. 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. 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.



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