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

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==References==
==References==
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Latest revision as of 21:14, 29 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

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

Differentiating De Quervain's thyroiditis from other diseases

Conditions Causes Age at onset Pathological findings Diagnostic approach
Painful subacute (De Quervain's) thyroiditis
  • Unknown
  • 20-60
Hashimoto's thyroiditis
  • Autoimmune
  • All ages, peak at 30-50
Silent thyroiditis
  • Autoimmune
  • All ages, peak at 30-40
Postpartum thyroiditis
  • Autoimmune
  • Childbearing age
Riedel's thyroiditis
  • Unknown
  • 30-60
Suppurative thyroiditis (Infectious Thyroiditis)
  • Infection
  • Children, 20-40
  • 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
Fever Pain TSH Free T4 T3 T3RU Thyroglobin TRH TPOAb^
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)
Primary hypothyroidism Autoimmune (Hashimoto's thyroiditis) - - * Normal/ Normal/↓ Normal/ Normal Present (high titer)
Riedel's thyroiditis - - Normal/↑ Normal/↓ Normal/↓ Normal/↓ Normal Normal Usually present
Suppurative thyroiditis (Infectious Thyroiditis) + + Normal Normal Normal Normal Normal Normal Absent
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.

Differentiating de Quervain's 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 Subacute (de Quervain's) thyroiditis +/- +/- ↑/ ↓/ Normal Normal Absent Low/absent
Hashimoto's thyroiditis (Hashitoxicosis) - - * Normal/ Normal/↓ Normal/ Normal Absent Present (high titer)
Postpartum thyroiditis +/- +/- ↑/ ↓/ Normal Normal/↑ Absent Present (high titer)
Silent thyroiditis - - ↑/ ↓/ Normal Normal Absent Present (high titer)
Primary hyperthyroidism Grave's disease - - Normal/ Normal Present Absent
  • Patient may have opthalmopathy and dermopathy
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
  • High urinary iodine
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".