De Quervain's thyroiditis from other diseases: Difference between revisions

	De Quervain's thyroiditis Microchapters
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Differentiating De Quervain's thyroiditis from other Diseases
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Revision as of 16:09, 3 October 2017

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

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

Differentiating De Quervain's thyroiditis from other diseases

De Quervain's thyroiditis must be differentiated from other causes of thyroiditis, such as Hashimoto's thyroiditis, Riedel's thyroiditis, and suppurative thyroiditis.^[1]

Conditions	Causes	Age at onset	Pathological findings	Diagnostic approach
Painful subacute (De Quervain's) thyroiditis	Unknown	20-60	Giant cells Granulomas	Increased TSH (hypothyroidism) and/or Decreased TSH (Thyrotoxicosis) TPO antibodies absent or very low titer I-123 uptake decreased
Hashimoto's thyroiditis	Autoimmune	All ages, peak at 30-50	Lymphocytic infiltration Germinal centers Fibrosis (in some variants)	Increased TSH (hypothyroidism) TPO antibodies present in high titer I-123 uptake usually decreased
Silent thyroiditis	Autoimmune	All ages, peak at 30-40	Lymphocytic infiltration Lymphoid follicles	Increased TSH (hypothyroidism) and/or Decreased TSH (transient hypothyroidism) TPO antibodies present in high titer I-123 uptake usually decreased
Postpartum thyroiditis	Autoimmune	Childbearing age	Lymphocytic infiltration	Increased TSH (hypothyroidism) and/or Decreased TSH (transient hypothyroidism) TPO antibodies present in high titer I-123 uptake usually decreased
Riedel's thyroiditis	Unknown	30-60	Dense fibrosis	Normal TSH (euthyroidism) TPO antibodies usually present I-123 uptake decreased or normal
Suppurative thyroiditis (Infectious Thyroiditis)	Infection	Children, 20-40	Abscess formation	Normal TSH (euthyroidism) TPO antibodies absent I-123 uptake normal

De Quervain's 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
Disease		Fever	Pain	TSH	Free T4	T3	T3RU†	Thyroglobin	TRH	TPOAb^	Additional findings
Transient hypothyroidism	Subacute (de Quervain's) thyroiditis	+/-	+/-	↑/↓	↓/↑	Normal	↓	↑	Normal	Low/absent	May present primarily with hyperthyroidism
	Postpartum thyroiditis	+/-	+/-	↑/↓	↓/↑	Normal	↓	↑	Normal/↑	Present (high titer)	May present primarily with hyperthyroidism
	Silent thyroiditis	-	-	↑/↓	↓/↑	Normal	↓	↑	Normal	Present (high titer)	May present primarily with hyperthyroidism
Primary hypothyroidism	Autoimmune (Hashimoto's thyroiditis)	-	-	↑*	↓	Normal/↓	Normal/↓	Normal/↑	Normal	Present (high titer)	May be accompanied by other autoimmune diseases
	Riedel's thyroiditis	-	-	Normal/↑	Normal/↓	Normal/↓	Normal/↓	Normal	Normal	Usually present	Riedel's thyroiditis usually presents with hard and fixed thyroid mass
	Suppurative thyroiditis (Infectious Thyroiditis)	+	+	Normal	Normal	Normal	Normal	Normal	Normal	Absent	Infectious thyroiditis associated with neck pain
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

↑ ^1.0 ^1.1 "Thyroiditis — NEJM".
↑ Bindra A, Braunstein GD (2006). "Thyroiditis". Am Fam Physician. 73 (10): 1769–76. PMID 16734054.
↑ McDermott MT (2009). "In the clinic. Hypothyroidism". Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.
↑ 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.
↑ Lania A, Persani L, Beck-Peccoz P (2008). "Central hypothyroidism". Pituitary. 11 (2): 181–6. doi:10.1007/s11102-008-0122-6. PMID 18415684.
↑ 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.

[urlThyroiditis_—_NEJM-1] 1.0 ^1.1 "Thyroiditis — NEJM".

[pmid16734054-2] Bindra A, Braunstein GD (2006). "Thyroiditis". Am Fam Physician. 73 (10): 1769–76. PMID 16734054.

[pmid19949140-3] McDermott MT (2009). "In the clinic. Hypothyroidism". Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.

[pmid18177256-4] 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.

[pmid18415684-5] Lania A, Persani L, Beck-Peccoz P (2008). "Central hypothyroidism". Pituitary. 11 (2): 181–6. doi:10.1007/s11102-008-0122-6. PMID 18415684.

[pmid25905413-6] 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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@@ Line 3: / Line 3: @@
 {{CMG}} {{AE}} {{MMF}}
 ==Overview==
-[[De Quervain's thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis.
+[[De Quervain's thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and [[suppurative]] thyroiditis.
 ==Differentiating De Quervain's thyroiditis from other diseases==
 *[[De Quervain's thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis.<ref name="urlThyroiditis — NEJM">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMra021194 |title=Thyroiditis — NEJM |format= |work= |accessdate=}}</ref>
@@ Line 22: / Line 22: @@
 *20-60
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Giant cells
+*[[Giant cells]]
-*Granulomas
+*[[Granulomas]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *[[Thyroid function tests|Increased TSH]] (hypothyroidism) and/or
@@ Line 36: / Line 36: @@
 *All ages, peak at 30-50
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Lymphocytic infiltration
+*[[Lymphocytic]] infiltration
-*Germinal centers
+*[[Germinal centers]]
 *Fibrosis (in some variants)
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
@@ Line 64: / Line 64: @@
 *Childbearing age
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Lymphocytic infiltration
+*[[Lymphocyte|Lymphocytic]] infiltration
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *[[Thyroid function tests|Increased TSH]] (hypothyroidism) and/or
@@ Line 77: / Line 77: @@
 *30-60
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Dense fibrosis
+*Dense [[fibrosis]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *[[Thyroid function tests|Normal TSH]] (euthyroidism)
@@ Line 89: / Line 89: @@
 *Children, 20-40
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Abscess formation
+*[[Abscess]] formation
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *[[Thyroid function tests|Normal TSH]] (euthyroidism)
@@ Line 194: / Line 194: @@
 *[[Thyroiditis|Infectious thyroiditis]] associated with [[neck pain]]
 |-
-| rowspan="8" style="background:#DCDCDC;" |Others
+| rowspan="7" style="background:#DCDCDC;" |Others
 | align="center" style="background:#DCDCDC;" |Drug-induced
 | rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
@@ Line 210: / Line 210: @@
 *History of drug use, surgery, or radiation
 |-
-| align="center" style="background:#DCDCDC;" |Radiation-induced
+| align="center" style="background:#DCDCDC;" |[[Radiation therapy|Radiation]]-induced
 |-
 | align="center" style="background:#DCDCDC;" |Trauma induced
@@ Line 216: / Line 216: @@
 | align="center" style="background:#DCDCDC;" |Radioiodine induced
 |-
-| align="center" style="background:#DCDCDC;" |Thyroidectomy
+| align="center" style="background:#DCDCDC;" |[[Thyroidectomy]]
 |-
 | align="center" style="background:#DCDCDC;" |Subclinical hypothyroidism
@@ Line 230: / Line 230: @@
 | align="left" style="padding: 5px 5px; background: #F5F5F5;" |
 * Asymptomatic
-|-
 |}
 <br style="clear:left" />''(†)T3RU; Triiodothyronine Resin uptake. (^)TPOAb; [[Thyroid peroxidase]] antibodies. (*)[[TSH]] may be decreased transiently in the [[thyrotoxicosis]]. (**)TPOAb may be present in drug-induced [[Hypothyroidism|hypo]]/[[hyperthyroidism]] such as [[Interferon-alpha]], [[Interleukin 2|interleukin-2]], and [[lithium]].''

De Quervain's thyroiditis from other diseases: Difference between revisions

Revision as of 16:09, 3 October 2017

Overview

Differentiating De Quervain's thyroiditis from other diseases

References

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