Hashimoto's thyroiditis diagnostic criteria: Difference between revisions

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Latest revision as of 21:58, 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

There are no established criteria for the diagnosis of Hashimoto's thyroiditis. The diagnosis of Hashimoto's thyroiditis is made on laboratory and pathological findings after the clinical suspicion. It includes the presence of TPO antibodies, hypothyroidism, reduced echogenicity on the ultrasound, the presence of germinal centers and lymphocytic infiltration of the thyroid gland.

Diagnostic Criteria

There are no established criteria for the diagnosis of Hashimoto's thyroiditis. The diagnosis of Hashimoto's thyroiditis is made based on laboratory, ultrasound, and pathological findings after the clinical suspicion:^[1]^[2]^[3]^[4]

Laboratory findings
- Presence of TPO antibodies
- Low T3 and T4
- High TSH
Ultrasound findings
- Reduced echogenicity
Pathological findings
- Germinal centers
- Lymphocytic infiltration

Stepwise clinical diagnosis of Hashimoto's thyroiditis

The following flowchart describes the clinical approach to the diagnosis of Hashimoto's thyroiditis.

Neck pain

Yes

No

RAIU*

Presenting symptoms and TFTs‡

Increased

Decreased

Suppurative thyroiditis

De Quervain's thyroiditis

Increased

Decreased

Hashimoto's thyroiditis

Riedel's thyroiditis††

Grave's disease†

Silent thyroiditis

Postpartum thyroiditis

‡TFT; Thyroid function tests(TSH, T4, and T3), †Grave's disease is not a thyroiditis, *RAIU; Radioiodine uptake.††One third of Riedel's thyroiditis presents with hypothyroidism.
Table modified from ^[5]

References

↑ Dong YH, Fu DG (2014). "Autoimmune thyroid disease: mechanism, genetics and current knowledge". Eur Rev Med Pharmacol Sci. 18 (23): 3611–8. PMID 25535130.
↑ Caturegli P, De Remigis A, Rose NR (2014). "Hashimoto thyroiditis: clinical and diagnostic criteria". Autoimmun Rev. 13 (4–5): 391–7. doi:10.1016/j.autrev.2014.01.007. PMID 24434360.
↑ Giannini, AJ (1986). The Biological Foundations of Clinical Psychiatry. New Hyde Park, NY: Medical Examination Publishing Company. pp. 193–198. ISBN 0-87488-449-7.
↑ Simmons, PJ (1998). "Antigen-presenting dendritic cells as regulators of the growth of thyrocytes: a role of interleukin-1beta and interleukin-6". Endocrinology. 139 (7): 3158–3186. doi:10.1210/en.139.7.3148. PMID 9645688.
↑ "Thyroiditis: Differential Diagnosis and Management - American Family Physician".

Template:WH Template:WS

[pmid25535130-1] Dong YH, Fu DG (2014). "Autoimmune thyroid disease: mechanism, genetics and current knowledge". Eur Rev Med Pharmacol Sci. 18 (23): 3611–8. PMID 25535130.

[pmid24434360-2] Caturegli P, De Remigis A, Rose NR (2014). "Hashimoto thyroiditis: clinical and diagnostic criteria". Autoimmun Rev. 13 (4–5): 391–7. doi:10.1016/j.autrev.2014.01.007. PMID 24434360.

[3] Giannini, AJ (1986). The Biological Foundations of Clinical Psychiatry. New Hyde Park, NY: Medical Examination Publishing Company. pp. 193–198. ISBN 0-87488-449-7.

[4] Simmons, PJ (1998). "Antigen-presenting dendritic cells as regulators of the growth of thyrocytes: a role of interleukin-1beta and interleukin-6". Endocrinology. 139 (7): 3158–3186. doi:10.1210/en.139.7.3148. PMID 9645688.

[urlThyroiditis:_Differential_Diagnosis_and_Management_-_American_Family_Physician-5] "Thyroiditis: Differential Diagnosis and Management - American Family Physician".

[1]

[2]

[3]

[4]

[5]

@@ Line 2: / Line 2: @@
 {{Hashimoto's thyroiditis}}
-{{CMG}}; {{AE}}
+{{CMG}}; {{AE}} {{MMF}}
 ==Overview==
-The diagnosis of Hashimoto's thyroiditis is made on laboratory and pathological findings after the clinical suspicion. It includes the [[Thyroid peroxidase|TPO]] antibodies, [[hypothyroidism]], the presence of [[Germinal center|germinal centers]] and [[lymphocytic]] infiltration of the thyroid gland.
+There are no established criteria for the diagnosis of Hashimoto's thyroiditis. The diagnosis of Hashimoto's thyroiditis is made on laboratory and pathological findings after the clinical suspicion. It includes the presence of [[Thyroid peroxidase|TPO]] antibodies, [[hypothyroidism]], reduced echogenicity on the [[ultrasound]], the presence of [[Germinal center|germinal centers]] and [[lymphocytic]] infiltration of the thyroid gland.
 ==Diagnostic Criteria==
-*The diagnosis of Hashimoto's thyroiditis is made on laboratory and pathological findings after the clinical suspicion:
+There are no established criteria for the diagnosis of Hashimoto's thyroiditis. The diagnosis of Hashimoto's thyroiditis is made based on [[laboratory]], [[ultrasound]], and [[pathological]] findings after the clinical suspicion:<ref name="pmid25535130">{{cite journal |vauthors=Dong YH, Fu DG |title=Autoimmune thyroid disease: mechanism, genetics and current knowledge |journal=Eur Rev Med Pharmacol Sci |volume=18 |issue=23 |pages=3611–8 |year=2014 |pmid=25535130 |doi= |url=}}</ref><ref name="pmid24434360">{{cite journal |vauthors=Caturegli P, De Remigis A, Rose NR |title=Hashimoto thyroiditis: clinical and diagnostic criteria |journal=Autoimmun Rev |volume=13 |issue=4-5 |pages=391–7 |year=2014 |pmid=24434360 |doi=10.1016/j.autrev.2014.01.007 |url=}}</ref><ref>{{cite book |last1= Giannini |first1= AJ |authorlink1= |title= The Biological Foundations of Clinical Psychiatry |url=  |year= 1986 |publisher= Medical Examination Publishing Company |location= New Hyde Park, NY |language= |isbn= 0-87488-449-7 |oclc= |doi= |id= |page= |pages= 193–198 |quote= |ref= |bibcode= }}</ref><ref>{{cite journal|last=Simmons|first=PJ|title=Antigen-presenting dendritic cells as regulators of the growth of thyrocytes: a role of interleukin-1beta and interleukin-6|journal=Endocrinology|year=1998|volume=139|issue=7|pages=3158–3186|pmid=9645688|doi=10.1210/en.139.7.3148}}</ref>
-**Laboratory findings
+*Laboratory findings
-***Presence of [[Thyroid peroxidase|TPO]] antibodies
+**Presence of [[Thyroid peroxidase|TPO antibodies]]
-***Low [[T3]] and [[T4]]
+**Low [[T3]] and [[T4]]
-***High [[TSH]]
+**High [[TSH]]
-**Pathological findings
+*[[Ultrasound]] findings
-***[[Germinal center|Germinal centers]]
+**Reduced [[echogenicity]]
-***[[Lymphocytic]] infiltration
+*Pathological findings
+**[[Germinal center|Germinal centers]]
+**[[Lymphocytic]] infiltration
+===Stepwise clinical diagnosis of Hashimoto's thyroiditis===
+The following flowchart describes the clinical approach to the diagnosis of Hashimoto's thyroiditis.
+{{familytree/start |summary=Sample 1}}
+{{familytree | | | | | | | | | | | | A01 | | |A01=Neck pain}}
+{{familytree | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|-|.| | | | }}
+{{familytree | | | | | | B01 | | | | | | | | | | | B02 | | |B01=Yes|B02=No}}
+{{familytree | | | | | | |!| | | | | | | | | | | | |!| }}
+{{familytree | | | | | | C01 | | | | | | | | | | | C02 |C01=[[RAIU]]*|C02=Presenting symptoms and [[TFTs]]‡}}
+{{familytree | | | | |,|-|^|-|-|.| | | | | | | |,|-|^|-|-|-|v|-|-|-|.| }}
+{{familytree | | | | D01 | | | D02 | | | | | | D03 | | | | D04 | |D05|D01=Increased|D02=Decreased|D03=[[Hyperthyroid]]|D04=[[Hypothyroid]]|D05=[[Euthyroid]]}}
+{{familytree | | | | |!| | | | |!| | | | | | | |!| | | | | |!| | | |!|}}
+{{familytree | | | | |!| | | | |!| | | | | | | H01 | | | | |!| | | |!|H01=[[RAIU]]*}}
+{{familytree | | | | |!| | | | |!| | | | | |,|-|^|-|.| | | |!| | | |!|}}
+{{familytree | | | | E01 | | | E04 | | | | E02 | | E03 | | E05 | | |E06 |E01=[[Suppurative thyroiditis]]|E02=Increased|E03=Decreased|E04=[[De Quervain's thyroiditis]]|E05='''Hashimoto's thyroiditis'''|E06=[[Riedel's thyroiditis]]††}}
+{{familytree | | | | | | | | | | | | | | | |!| | | |!| }}
+{{familytree | | | | | | | | | | | | | | | F01 | | F02 |F01=[[Grave's disease]]†|F02=
+[[Silent thyroiditis]]
+[[Postpartum thyroiditis]]}}
+{{familytree/end}}
+<small>‡TFT; Thyroid function tests(TSH, T4, and T3), †[[Grave's disease]] is not a thyroiditis, *RAIU; Radioiodine uptake.††One third of [[Riedel's thyroiditis]] presents with [[hypothyroidism]].</small>
+<small>
+<br>
+Table modified from <ref name="urlThyroiditis: Differential Diagnosis and Management - American Family Physician">{{cite web |url=http://www.aafp.org/afp/2000/0215/p1047.html#afp20000215p1047-b7 |title=Thyroiditis: Differential Diagnosis and Management - American Family Physician |format= |work= |accessdate=}}</ref></small>
 ==References==
 {{Reflist|2}}
 {{WH}}
 {{WS}}
+[[Category:Medicine]]
+[[Category:Endocrinology]]
+[[Category:Up-To-Date]]