Graves' disease differential diagnosis
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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 | The diagnosis is based upon the clinical features, laboratory findings, and 24-hour radioiodine uptake. |
| Acute hyperthyroidism from a levothyroxine overdose | The diagnosis is based upon the clinical features, laboratory findings, and 24-hour radioiodine uptake. | |
| Struma ovarii | Functioning thyroid tissue is present in an ovarian neoplasm. | |
| Functional thyroid cancer metastases | Large bony metastases from widely metastatic follicular thyroid cancer cause symptomatic 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
- ↑ Fatourechi V, McConahey WM, Woolner LB (1971). "Hyperthyroidism associated with histologic Hashimoto's thyroiditis". Mayo Clin. Proc. 46 (10): 682–9. PMID 5171000.
- ↑ 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.