De Quervain's thyroiditis from other diseases

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De Quervain's thyroiditis Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating De Quervain's thyroiditis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary prevention

Secondary prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

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

Conditions Causes Age at onset Pathological findings Diagnostic approach
Painful subacute (De Quervain's) thyroiditis
  • Unknown
  • 20-60
  • Giant cells
  • Granulomas
Hashimoto's thyroiditis
  • Autoimmune
  • All ages, peak at 30-50
  • Lymphocytic infiltration
  • Germinal centers
  • Fibrosis (in some variants)
Riedel's thyroiditis
  • Unknown
  • 30-60
  • Dense fibrosis
Suppurative thyroiditis
  • Infection
  • Children, 20-40
  • Abscess formation

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]

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 +/- +/- ↑/ ↓/ N N N Absent
Post-partum thyroiditis +/- +/- ↑/ ↓/ N N N Absent
Primary hypothyroidism Autoimmune (Hashimoto's thyroiditis) - - N/ N/↓ N/ N Present (high titer)
Riedel's thyroiditis - - N/↑ N/↓ N/↓ N/↓ N N Usually present
Infectious thyroiditis + + N N N N N N Absent
Others Drug-induced - - /↓ /↑ N N/ N Absent**
Radiation-induced
Trauma induced
Radioiodine induced
Thyroidectomy
Subclinical hypothyroidism - - N N N N N N/
  • Asymptomatic



De Quervain's thyroiditis can be differentiated from the conditions causing thyrotoxicosis on the basis of following features:

Cause of thyrotoxicosis TSH receptor Antibodies Thyroid US Color flow Doppler Radioactive iodine uptake/Scan Other features
Subacute thyroiditis - Heterogeneous hypoechoic areas Reduced/absent flow Neck pain, fever, and
elevated inflammatory index
Graves' disease + Hypoechoic pattern Ophthalmopathy, dermopathy, acropachy
Toxic nodular goiter - Multiple nodules - Hot nodules at thyroid scan -
Toxic adenoma - Single nodule - Hot nodule -
Painless thyroiditis - Hypoechoic pattern Reduced/absent flow -
Amiodarone induced thyroiditis-Type 1 - Diffuse or nodular goiter ↓/Normal/↑ ↓ but higher than in Type 2 High urinary iodine
Amiodarone induced thyroiditis-Type 2 - Normal Absent ↓/absent High urinary iodine
Central hyperthyroidism - Diffuse or nodular goiter Normal/↑ Inappropriately normal or high TSH
Trophoblastic disease - Diffuse or nodular goiter Normal/↑ -
Factitious thyrotoxicosis - Variable Reduced/absent flow ↓ serum thyroglobulin
Struma ovarii - Variable Reduced/absent flow Abdominal RAIU

(*)T3RU; Triiodothyronine Resin uptake. (^)TPOAb; Thyroid peroxidase antibodies. (**)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.