Graves' disease differential diagnosis: Difference between revisions
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==Differentiating Graves' disease from other Diseases== | ==Differentiating Graves' disease from other Diseases== | ||
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center | |||
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 | {{fontcolor|#FFFFFF|Disease}} | |||
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 | {{fontcolor|#FFFFFF|Findings}} | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=5 colspan=1 |{{fontcolor|#FFFFFF|Thyroiditis}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Direct chemical toxicity with inflammation | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Amiodarone, sunitinib, pazopanib, axitinib, and other tyrosine kinase inhibitors may also be associated with a destructive thyroiditis. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Radiation thyroiditis | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Patients who treated with radioiodine, may develops thyroid pain and tenderness 5 to 10 days later, due to radiation-induced injury and necrosis of thyroid follicular cells and associated inflammation. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Drugs that interfere with the immune system | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Interferon-alfa is well known for associated thyroid abnormality. It mostly lead to development of de novo antithyroid antibodies. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Lithium | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Patients treated with lithium are at high risk to develop painless thyroiditis and Graves' disease. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Palpation thyroiditis | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Manipulation of thyroid gland during thyroid biopsy or neck surgery and vigorous palpation during physical examination may cause transient hyperthyroidism. | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=4 colspan=1 |{{fontcolor|#FFFFFF|Exogenous and ectopic hyperthyroidism }} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Factitious ingestion of thyroid hormone | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Acute hyperthyroidism from a levothyroxine overdose | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Struma ovarii | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Functional thyroid cancer metastases | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Hashitoxicosis }} | |||
| style="padding: 5px 5px; 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="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Toxic adenoma and toxic multinodular goiter}} | |||
| style="padding: 5px 5px; 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="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Iodine-induced hyperthyroidism }} | |||
| style="padding: 5px 5px; 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="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Trophoblastic disease and germ cell tumors }} | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
|} | |||
{| class="wikitable" | {| class="wikitable" | ||
! colspan="2" |Disease | ! colspan="2" |Disease |
Revision as of 16:53, 14 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 | |
---|---|---|
Thyroiditis | Direct chemical toxicity with inflammation | Amiodarone, sunitinib, pazopanib, axitinib, and other tyrosine kinase inhibitors may also be associated with a destructive thyroiditis. |
Radiation thyroiditis | Patients who treated with radioiodine, may develops thyroid pain and tenderness 5 to 10 days later, due to radiation-induced injury and necrosis of thyroid follicular cells and associated inflammation. | |
Drugs that interfere with the immune system | Interferon-alfa is well known for associated thyroid abnormality. It mostly lead to development of de novo antithyroid antibodies. | |
Lithium | Patients treated with lithium are at high risk to develop painless thyroiditis and Graves' disease. | |
Palpation thyroiditis | Manipulation of thyroid gland during thyroid biopsy or neck surgery and vigorous palpation during physical examination may cause transient hyperthyroidism. | |
Exogenous and ectopic hyperthyroidism | Factitious ingestion of thyroid hormone | |
Acute hyperthyroidism from a levothyroxine overdose | ||
Struma ovarii | ||
Functional thyroid cancer metastases | ||
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 |
Disease | Findings | |
---|---|---|
Thyroiditis |
|
|
Exogenous and ectopic hyperthyroidism |
|
|
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 |
References
- ↑ 1.0 1.1 Fatourechi V, McConahey WM, Woolner LB (1971). "Hyperthyroidism associated with histologic Hashimoto's thyroiditis". Mayo Clin. Proc. 46 (10): 682–9. PMID 5171000.
- ↑ 2.0 2.1 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.
- ↑ Espiritu RP, Dean DS (2010). "Parathyroidectomy-induced thyroiditis". Endocr Pract. 16 (4): 656–9. doi:10.4158/EP09367.CR. PMID 20350919.