Differentiating Struma ovarii from other diseases: Difference between revisions

Latest revision as of 19:09, 25 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S [2]

Overview

Struma ovarii is a potentially malignant tumor, that should be differentiated from an ovarian mass with cystic, solid, or mixed cystic and solid structure. Struma ovarii must be differentiated from other diseases like benign and malignant ovarian neoplasm, ovarian cyst, endometrioma and tubo-ovarian abscess.

Differentiating Struma ovarii from other Diseases

Struma ovarii is a potentially malignant tumor, that should be differentiated from an ovarian mass with cystic, solid, or mixed cystic and solid structure such as: ^[1]^[2]^[3]^[4]^[5]^[6]^[7] ^[8]^[9]

Various benign and malignant ovarian neoplasms
Endometrioma
Ectopic Pregnancy
Metastatic thyroid cancer to the ovary
Ovarian cyst(Physiological)
Tubo-ovarian abscess
Hydrosalpinx
Hyperthyroidism

Struma ovarii must be differentiated from other causes of hyperthyroidism such as Grave's disease and toxic nodular goiter:

Cause of thyrotoxicosis	TSH receptor antibodies	Thyroid US	Color flow Doppler	Radioactive iodine uptake/Scan	Other features
Struma ovarii	-	Variable	Reduced/absent flow	↓	Abdominal RAIU
Toxic nodular goiter	-	Multiple nodules	-	Hot nodules at thyroid scan	-
Graves' disease	+	Hypoechoic pattern	↑	↑	Ophthalmopathy, dermopathy, acropachy
Toxic adenoma	-	Single nodule	-	Hot nodule	-
Subacute thyroiditis	-	Heterogeneous hypoechoic areas	Reduced/absent flow	↓	Neck pain, fever, and elevated inflammatory index
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

References

↑ Kraemer B, Grischke EM, Staebler A, Hirides P, Rothmund R (2011). "Laparoscopic excision of malignant struma ovarii and 1 year follow-up without further treatment". Fertil Steril. 95 (6): 2124.e9–12. doi:10.1016/j.fertnstert.2010.12.047. PMID 21269611.
↑ Yoo SC, Chang KH, Lyu MO, Chang SJ, Ryu HS, Kim HS (2008). "Clinical characteristics of struma ovarii". J Gynecol Oncol. 19 (2): 135–8. doi:10.3802/jgo.2008.19.2.135. PMC 2676458.
↑ Park CH, Jung MH, Ji YI (2015). "Risk factors for malignant transformation of mature cystic teratoma". Obstet Gynecol Sci. 58 (6): 475–80. doi:10.5468/ogs.2015.58.6.475. PMC 4663225. PMID 26623411.
↑ Wee JY, Li X, Chern BS, Chua IS (2015). "Struma ovarii: management and follow-up of a rare ovarian tumour". Singapore Med J. 56 (1): 35–9. PMC 4325564. PMID 25640097.
↑ Dujardin MI, Sekhri P, Turnbull LW (2014). "Struma ovarii: role of imaging?". Insights Imaging. 5 (1): 41–51. doi:10.1007/s13244-013-0303-3. PMC 3948908. PMID 24357453.
↑ Mostaghel N, Enzevaei A, Zare K, Fallahian M (2012). "Struma ovarii associated with Pseudo-Meig's syndrome and high serum level of CA 125; a case report". J Ovarian Res. 5: 10. doi:10.1186/1757-2215-5-10. PMC 3350392. PMID 22436494.
↑ Tanimanidis P, Chatzistamatiou K, Nikolaidou A, Kaplanis K (2014). "Struma ovarii. A case report". Hippokratia. 18 (4): 357–8. PMC 4453812. PMID 26052205.
↑ Yücesoy G, Cakiroglu Y, Muezzinoglu B, Besnili B, Yucesoy I (2010). "Malignant struma ovarii: a case report". J. Korean Med. Sci. 25 (2): 327–9. doi:10.3346/jkms.2010.25.2.327. PMID 20119594.
↑ Rosenblum, NG; LiVolsi, VA; Edmonds, PR; Mikuta, JJ (1989). "Malignant struma ovarli". International Journal of Gynecology & Obstetrics. 30 (1): 80–81. doi:10.1016/0020-7292(89)90235-X. ISSN 0020-7292.

Template:WH Template:WS

[pmid21269611-1] Kraemer B, Grischke EM, Staebler A, Hirides P, Rothmund R (2011). "Laparoscopic excision of malignant struma ovarii and 1 year follow-up without further treatment". Fertil Steril. 95 (6): 2124.e9–12. doi:10.1016/j.fertnstert.2010.12.047. PMID 21269611.

[pmid-2] Yoo SC, Chang KH, Lyu MO, Chang SJ, Ryu HS, Kim HS (2008). "Clinical characteristics of struma ovarii". J Gynecol Oncol. 19 (2): 135–8. doi:10.3802/jgo.2008.19.2.135. PMC 2676458.

[pmid26623411-3] Park CH, Jung MH, Ji YI (2015). "Risk factors for malignant transformation of mature cystic teratoma". Obstet Gynecol Sci. 58 (6): 475–80. doi:10.5468/ogs.2015.58.6.475. PMC 4663225. PMID 26623411.

[pmid25640097-4] Wee JY, Li X, Chern BS, Chua IS (2015). "Struma ovarii: management and follow-up of a rare ovarian tumour". Singapore Med J. 56 (1): 35–9. PMC 4325564. PMID 25640097.

[pmid24357453-5] Dujardin MI, Sekhri P, Turnbull LW (2014). "Struma ovarii: role of imaging?". Insights Imaging. 5 (1): 41–51. doi:10.1007/s13244-013-0303-3. PMC 3948908. PMID 24357453.

[pmid22436494-6] Mostaghel N, Enzevaei A, Zare K, Fallahian M (2012). "Struma ovarii associated with Pseudo-Meig's syndrome and high serum level of CA 125; a case report". J Ovarian Res. 5: 10. doi:10.1186/1757-2215-5-10. PMC 3350392. PMID 22436494.

[pmid26052205-7] Tanimanidis P, Chatzistamatiou K, Nikolaidou A, Kaplanis K (2014). "Struma ovarii. A case report". Hippokratia. 18 (4): 357–8. PMC 4453812. PMID 26052205.

[pmid20119594-8] Yücesoy G, Cakiroglu Y, Muezzinoglu B, Besnili B, Yucesoy I (2010). "Malignant struma ovarii: a case report". J. Korean Med. Sci. 25 (2): 327–9. doi:10.3346/jkms.2010.25.2.327. PMID 20119594.

[RosenblumLiVolsi1989-9] Rosenblum, NG; LiVolsi, VA; Edmonds, PR; Mikuta, JJ (1989). "Malignant struma ovarli". International Journal of Gynecology & Obstetrics. 30 (1): 80–81. doi:10.1016/0020-7292(89)90235-X. ISSN 0020-7292.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Stroma of ovary}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Struma_ovarii]]
-{{CMG}}; {{AE}}
+{{CMG}}; {{AE}} {{ARK}}
 ==Overview==
-*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
+Struma ovarii is a potentially [[malignant]] tumor, that should be differentiated from an ovarian mass with [[cystic]], solid, or mixed cystic and solid structure. Struma ovarii must be differentiated from other diseases like benign and [[malignant]] [[ovarian neoplasm]], [[ovarian cyst]], [[endometrioma]] and [[tubo-ovarian abscess]].
-*[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
-==Differentiating X from other Diseases==
+==Differentiating Struma ovarii from other Diseases==
-*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
-*[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
-*As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
+*Struma ovarii is a potentially [[malignant]] tumor, that should be differentiated from an [[ovarian mass]] with cystic, solid, or mixed cystic and solid structure such as: <ref name="pmid21269611">{{cite journal| author=Kraemer B, Grischke EM, Staebler A, Hirides P, Rothmund R| title=Laparoscopic excision of malignant struma ovarii and 1 year follow-up without further treatment. | journal=Fertil Steril | year= 2011 | volume= 95 | issue= 6 | pages= 2124.e9-12 | pmid=21269611 | doi=10.1016/j.fertnstert.2010.12.047 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21269611  }} </ref><ref name="pmid">{{cite journal |vauthors=Yoo SC, Chang KH, Lyu MO, Chang SJ, Ryu HS, Kim HS |title=Clinical characteristics of struma ovarii |journal=J Gynecol Oncol |volume=19 |issue=2 |pages=135–8 |year=2008 |pmid= |pmc=2676458 |doi=10.3802/jgo.2008.19.2.135 |url=}}</ref><ref name="pmid26623411">{{cite journal |vauthors=Park CH, Jung MH, Ji YI |title=Risk factors for malignant transformation of mature cystic teratoma |journal=Obstet Gynecol Sci |volume=58 |issue=6 |pages=475–80 |year=2015 |pmid=26623411 |pmc=4663225 |doi=10.5468/ogs.2015.58.6.475 |url=}}</ref><ref name="pmid25640097">{{cite journal |vauthors=Wee JY, Li X, Chern BS, Chua IS |title=Struma ovarii: management and follow-up of a rare ovarian tumour |journal=Singapore Med J |volume=56 |issue=1 |pages=35–9 |year=2015 |pmid=25640097 |pmc=4325564 |doi= |url=}}</ref><ref name="pmid24357453">{{cite journal |vauthors=Dujardin MI, Sekhri P, Turnbull LW |title=Struma ovarii: role of imaging? |journal=Insights Imaging |volume=5 |issue=1 |pages=41–51 |year=2014 |pmid=24357453 |pmc=3948908 |doi=10.1007/s13244-013-0303-3 |url=}}</ref><ref name="pmid22436494">{{cite journal |vauthors=Mostaghel N, Enzevaei A, Zare K, Fallahian M |title=Struma ovarii associated with Pseudo-Meig's syndrome and high serum level of CA 125; a case report |journal=J Ovarian Res |volume=5 |issue= |pages=10 |year=2012 |pmid=22436494 |pmc=3350392 |doi=10.1186/1757-2215-5-10 |url=}}</ref><ref name="pmid26052205">{{cite journal |vauthors=Tanimanidis P, Chatzistamatiou K, Nikolaidou A, Kaplanis K |title=Struma ovarii. A case report |journal=Hippokratia |volume=18 |issue=4 |pages=357–8 |year=2014 |pmid=26052205 |pmc=4453812 |doi= |url=}}</ref> <ref name="pmid20119594">{{cite journal |vauthors=Yücesoy G, Cakiroglu Y, Muezzinoglu B, Besnili B, Yucesoy I |title=Malignant struma ovarii: a case report |journal=J. Korean Med. Sci. |volume=25 |issue=2 |pages=327–9 |year=2010 |pmid=20119594 |doi=10.3346/jkms.2010.25.2.327 |url=}}</ref><ref name="RosenblumLiVolsi1989">{{cite journal|last1=Rosenblum|first1=NG|last2=LiVolsi|first2=VA|last3=Edmonds|first3=PR|last4=Mikuta|first4=JJ|title=Malignant struma ovarli|journal=International Journal of Gynecology & Obstetrics|volume=30|issue=1|year=1989|pages=80–81|issn=00207292|doi=10.1016/0020-7292(89)90235-X}}</ref>
-===Preferred Table===
+:*Various [[benign]] and [[malignant]] ovarian neoplasms
-{|
+:*[[Endometrioma]]
-|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
+:*[[Ectopic pregnancy|Ectopic Pregnancy]]
-! rowspan="2" |Diseases
+:*[[Metastatic]] [[thyroid cancer]] to the ovary
-! colspan="4" |Laboratory Findings
+:*[[Ovarian cyst]](Physiological)
-! colspan="4" |Physical Examination
+:*[[Tubo-ovarian abscess]]
-! colspan="4" |History and Symptoms
+:*[[Hydrosalpinx]]
-! rowspan="2" |Other Findings
+:*[[Hyperthyroidism]]
-|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
-!Lab Test 1
+==== Struma ovarii must be differentiated from other causes of [[hyperthyroidism]] such as [[Graves' disease|Grave's disease]] and [[Toxic multinodular goiter|toxic nodular goiter]]: ====
-!Lab Test 2
-!Lab Test 3
+{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
-!Lab Test 4
+! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Cause of thyrotoxicosis}}
-!Physical Finding 1
+! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|TSH receptor antibodies}}
-!Physical Finding 2
+! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Thyroid US}}
-!Physical Finding 3
+! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Color flow Doppler}}
-!Physical Finding 4
+! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Radioactive iodine uptake/Scan}}
-!Finding 1
+! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Other features}}
-!Finding 2
-!Finding 3
-!Finding 4
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
+| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Struma ovarii}}
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | Variable
-|style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | Abdominal RAIU
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
+| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic nodular goiter}}
-|style="background: #F5F5F5; padding: 5px;" |'''↑'''
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | Multiple nodules
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-|style="background: #F5F5F5; padding: 5px;" |-
+| style="padding: 5px 5px; background: #F5F5F5;" | Hot nodules at thyroid scan
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
+| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Graves' disease}}
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | +
-|style="background: #F5F5F5; padding: 5px;" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" | Hypoechoic pattern
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | ↑
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | ↑
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | Ophthalmopathy, dermopathy, acropachy
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
+| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic adenoma}}
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | Single nodule
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | Hot nodule
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
+| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Subacute thyroiditis}}
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | Heterogeneous hypoechoic areas
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | Neck pain, fever, and<br> elevated inflammatory index
-|style="background: #F5F5F5; padding: 5px;" |
+|-
-|style="background: #F5F5F5; padding: 5px;" |
+| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Painless thyroiditis}}
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | Hypoechoic pattern
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓
-|style="background: #F5F5F5; padding: 5px;" |
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-|style="background: #F5F5F5; padding: 5px;" |
+|-
-|}
+| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Amiodarone induced thyroiditis-Type 1}}
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-===Use if the above table can not be made===
+| style="padding: 5px 5px; background: #F5F5F5;" | Diffuse or nodular goiter
-{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align=center
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓/Normal/↑
-|valign=top|
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓ but higher than in Type 2
-|+
+| style="padding: 5px 5px; background: #F5F5F5;" | High urinary iodine
-! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
-! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
-! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 1
+| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Amiodarone induced thyroiditis-Type 2}}
-| style="padding: 5px 5px; background: #F5F5F5;"|
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
+| style="padding: 5px 5px; background: #F5F5F5;" | Normal
-| style="padding: 5px 5px; background: #F5F5F5;"|
+| style="padding: 5px 5px; background: #F5F5F5;" | Absent
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓/absent
+| style="padding: 5px 5px; background: #F5F5F5;" | High urinary iodine
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 2
+| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Central hyperthyroidism}}
-| style="padding: 5px 5px; background: #F5F5F5;"|
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
+| style="padding: 5px 5px; background: #F5F5F5;" | Diffuse or nodular goiter
-| style="padding: 5px 5px; background: #F5F5F5;"|
+| style="padding: 5px 5px; background: #F5F5F5;" | Normal/↑
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
+| style="padding: 5px 5px; background: #F5F5F5;" | ↑
+| style="padding: 5px 5px; background: #F5F5F5;" | Inappropriately normal or high TSH
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 3
+| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Trophoblastic disease}}
-| style="padding: 5px 5px; background: #F5F5F5;"|
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
+| style="padding: 5px 5px; background: #F5F5F5;" | Diffuse or nodular goiter
-| style="padding: 5px 5px; background: #F5F5F5;"|
+| style="padding: 5px 5px; background: #F5F5F5;" | Normal/↑
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
+| style="padding: 5px 5px; background: #F5F5F5;" | ↑
+| style="padding: 5px 5px; background: #F5F5F5;" | -
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 4
+| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Factitious thyrotoxicosis}}
-| style="padding: 5px 5px; background: #F5F5F5;"|
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
+| style="padding: 5px 5px; background: #F5F5F5;" | Variable
-| style="padding: 5px 5px; background: #F5F5F5;"|
+| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓ Serum thyroglobulin
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 5
-| style="padding: 5px 5px; background: #F5F5F5;"|
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
-| style="padding: 5px 5px; background: #F5F5F5;"|
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
 |}