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__
-{{Struma ovarii}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Struma_ovarii]]
 {{CMG}}; {{AE}} {{ARK}}
 ==Overview==
-Struma ovarii which is potentially [[malignant]] 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]].
+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 which is potentially malignant should be differentiated from an [[ovarian mass]] with cystic, solid, or mixed cystic and solid structure. <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>
+*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>
-*Struma ovarii must be differentiated from other diseases that cause: <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>
 :*Various [[benign]] and [[malignant]] ovarian neoplasms
 :*[[Endometrioma]]
-:*Ectopic Pregnancy
+:*[[Ectopic pregnancy|Ectopic Pregnancy]]
 :*[[Metastatic]] [[thyroid cancer]] to the ovary
 :*[[Ovarian cyst]](Physiological)
@@ Line 21: / Line 19: @@
 :*[[Hyperthyroidism]]
-*Struma ovarii must be differentiated from other causes of hyperthyroidism such as Grave's disease and toxic nodular goiter.
+==== Struma ovarii must be differentiated from other causes of [[hyperthyroidism]] such as [[Graves' disease|Grave's disease]] and [[Toxic multinodular goiter|toxic nodular goiter]]: ====
-{| align="center" style="border: 0px; font-size: 90%; margin: 3px;"
+{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
 ! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Cause of thyrotoxicosis}}
 ! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|TSH receptor antibodies}}
@@ Line 31: / Line 29: @@
 ! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Other features}}
 |-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Graves' disease}}
+| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Struma ovarii}}
-| style="padding: 5px 5px; background: #F5F5F5;" | +
+| style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | Hypoechoic pattern
+| style="padding: 5px 5px; background: #F5F5F5;" | Variable
-| style="padding: 5px 5px; background: #F5F5F5;" | ?
+| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
-| style="padding: 5px 5px; background: #F5F5F5;" | ?
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓
-| style="padding: 5px 5px; background: #F5F5F5;" | Ophthalmopathy, dermopathy, acropachy
+| style="padding: 5px 5px; background: #F5F5F5;" | Abdominal RAIU
 |-
 | colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic nodular goiter}}
@@ Line 44: / Line 42: @@
 | style="padding: 5px 5px; background: #F5F5F5;" | Hot nodules at thyroid scan
 | style="padding: 5px 5px; background: #F5F5F5;" | -
+|-
+| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Graves' disease}}
+| style="padding: 5px 5px; background: #F5F5F5;" | +
+| style="padding: 5px 5px; background: #F5F5F5;" | Hypoechoic pattern
+| style="padding: 5px 5px; background: #F5F5F5;" | ↑
+| style="padding: 5px 5px; background: #F5F5F5;" | ↑
+| style="padding: 5px 5px; background: #F5F5F5;" | Ophthalmopathy, dermopathy, acropachy
 |-
 | colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic adenoma}}
@@ Line 56: / Line 61: @@
 | style="padding: 5px 5px; background: #F5F5F5;" | Heterogeneous hypoechoic areas
 | style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
-| style="padding: 5px 5px; background: #F5F5F5;" | ?
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓
 | style="padding: 5px 5px; background: #F5F5F5;" | Neck pain, fever, and<br> elevated inflammatory index
 |-
@@ Line 63: / Line 68: @@
 | style="padding: 5px 5px; background: #F5F5F5;" | Hypoechoic pattern
 | style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
-| style="padding: 5px 5px; background: #F5F5F5;" | ?
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓
 | style="padding: 5px 5px; background: #F5F5F5;" | -
 |-
@@ Line 69: / Line 74: @@
 | style="padding: 5px 5px; background: #F5F5F5;" | -
 | style="padding: 5px 5px; background: #F5F5F5;" | Diffuse or nodular goiter
-| style="padding: 5px 5px; background: #F5F5F5;" | ?/Normal/?
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓/Normal/↑
-| style="padding: 5px 5px; background: #F5F5F5;" | ? but higher than in Type 2
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓ but higher than in Type 2
 | style="padding: 5px 5px; background: #F5F5F5;" | High urinary iodine
 |-
@@ Line 77: / Line 82: @@
 | style="padding: 5px 5px; background: #F5F5F5;" | Normal
 | style="padding: 5px 5px; background: #F5F5F5;" | Absent
-| style="padding: 5px 5px; background: #F5F5F5;" | ?/absent
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓/absent
 | style="padding: 5px 5px; background: #F5F5F5;" | High urinary iodine
 |-
@@ Line 83: / Line 88: @@
 | style="padding: 5px 5px; background: #F5F5F5;" | -
 | style="padding: 5px 5px; background: #F5F5F5;" | Diffuse or nodular goiter
-| style="padding: 5px 5px; background: #F5F5F5;" | Normal/?
+| style="padding: 5px 5px; background: #F5F5F5;" | Normal/↑
-| style="padding: 5px 5px; background: #F5F5F5;" | ?
+| style="padding: 5px 5px; background: #F5F5F5;" | ↑
 | style="padding: 5px 5px; background: #F5F5F5;" | Inappropriately normal or high TSH
 |-
@@ Line 90: / Line 95: @@
 | style="padding: 5px 5px; background: #F5F5F5;" | -
 | style="padding: 5px 5px; background: #F5F5F5;" | Diffuse or nodular goiter
-| style="padding: 5px 5px; background: #F5F5F5;" | Normal/?
+| style="padding: 5px 5px; background: #F5F5F5;" | Normal/↑
-| style="padding: 5px 5px; background: #F5F5F5;" | ?
+| style="padding: 5px 5px; background: #F5F5F5;" | ↑
 | style="padding: 5px 5px; background: #F5F5F5;" | -
 |-
@@ Line 98: / Line 103: @@
 | style="padding: 5px 5px; background: #F5F5F5;" | Variable
 | style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
-| style="padding: 5px 5px; background: #F5F5F5;" | ?
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓
-| style="padding: 5px 5px; background: #F5F5F5;" | ? Serum thyroglobulin
+| style="padding: 5px 5px; background: #F5F5F5;" | ↓ Serum thyroglobulin
-|-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Struma ovarii}}
-| style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" | Variable
-| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
-| style="padding: 5px 5px; background: #F5F5F5;" | ?
-| style="padding: 5px 5px; background: #F5F5F5;" | Abdominal RAIU
-|}
-{| align="center" style="border: 0px; font-size: 90%; margin: 3px;"
-! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Disease}}
-! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Findings}}
-|-
-| colspan="1" rowspan="5" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Thyroiditis}}
-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Direct chemical toxicity with inflammation}}
-| style="padding: 5px 5px; background: #F5F5F5;" | [[Amiodarone]], [[sunitinib]], [[pazopanib]], [[axitinib]], and other [[tyrosine kinase inhibitors]] may also be associated with a destructive [[thyroiditis]].<ref name="pmid2258582">{{cite journal |vauthors=Lambert M, Unger J, De Nayer P, Brohet C, Gangji D |title=Amiodarone-induced thyrotoxicosis suggestive of thyroid damage |journal=J. Endocrinol. Invest. |volume=13 |issue=6 |pages=527–30 |year=1990 |pmid=2258582 |doi= |url=}}</ref><ref name="pmid24282820">{{cite journal |vauthors=Ahmadieh H, Salti I |title=Tyrosine kinase inhibitors induced thyroid dysfunction: a review of its incidence, pathophysiology, clinical relevance, and treatment |journal=Biomed Res Int |volume=2013 |issue= |pages=725410 |year=2013 |pmid=24282820 |pmc=3824811 |doi=10.1155/2013/725410 |url=}}</ref>
-|-
-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Radiation thyroiditis}}
-| style="padding: 5px 5px; background: #F5F5F5;" | Patients treated with [[radioiodine]] may develop thyroid pain and tenderness 5 to 10 days later, due to radiation-induced injury and necrosis of thyroid follicular cells and associated [[inflammation]].
-|-
-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Drugs that interfere with the immune system}}
-| style="padding: 5px 5px; background: #F5F5F5;" | [[Interferon alfa-2a clinical pharmacology|Interferon-alfa]] is a well-known cause of [[thyroid]] abnormality. It mostly leads to the development of de novo [[antithyroid]] [[antibodies]].<ref name="pmid8351956">{{cite journal |vauthors=Vialettes B, Guillerand MA, Viens P, Stoppa AM, Baume D, Sauvan R, Pasquier J, San Marco M, Olive D, Maraninchi D |title=Incidence rate and risk factors for thyroid dysfunction during recombinant interleukin-2 therapy in advanced malignancies |journal=Acta Endocrinol. |volume=129 |issue=1 |pages=31–8 |year=1993 |pmid=8351956 |doi= |url=}}</ref>
-|-
-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Lithium}}
-| style="padding: 5px 5px; background: #F5F5F5;" | Patients treated with [[lithium]] are at a high risk of developing [[Thyroiditis|painless thyroiditis]] and [[Graves' disease]].
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-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Palpation thyroiditis}}
-| style="padding: 5px 5px; background: #F5F5F5;" | Manipulation of the [[thyroid gland]] during [[thyroid]] [[biopsy]] or neck [[surgery]] and vigorous palpation during the physical examination may cause transient hyperthyroidism.
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-| colspan="1" rowspan="4" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Exogenous and ectopic hyperthyroidism }}
-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Factitious ingestion of thyroid hormone}}
-| style="padding: 5px 5px; background: #F5F5F5;" |The diagnosis is based on the clinical features, laboratory findings, and 24-hour [[radioiodine]] uptake.<ref name="pmid2666114">{{cite journal |vauthors=Cohen JH, Ingbar SH, Braverman LE |title=Thyrotoxicosis due to ingestion of excess thyroid hormone |journal=Endocr. Rev. |volume=10 |issue=2 |pages=113–24 |year=1989 |pmid=2666114 |doi=10.1210/edrv-10-2-113 |url=}}</ref>
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-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Acute hyperthyroidism from a levothyroxine overdose}}
-| style="padding: 5px 5px; background: #F5F5F5;" |The diagnosis is based on the clinical features, laboratory findings, and 24-hour [[radioiodine]] uptake.<ref name="pmid23067331">{{cite journal |vauthors=Jha S, Waghdhare S, Reddi R, Bhattacharya P |title=Thyroid storm due to inappropriate administration of a compounded thyroid hormone preparation successfully treated with plasmapheresis |journal=Thyroid |volume=22 |issue=12 |pages=1283–6 |year=2012 |pmid=23067331 |doi=10.1089/thy.2011.0353 |url=}}</ref>
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-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Struma ovarii}}
-| style="padding: 5px 5px; background: #F5F5F5;" |Functioning [[thyroid]] tissue is present in an [[ovarian neoplasm]].
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-| style="padding: 5px 5px; background: #4479BA;" | {{fontcolor|#FFFFFF|Functional thyroid cancer metastases}}
-| style="padding: 5px 5px; background: #F5F5F5;" |Large bony [[metastases]] from widely metastatic [[follicular thyroid cancer]] cause symptomatic hyperthyroidism.
-|-
-| colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Hashitoxicosis }}
-| style="padding: 5px 5px; background: #F5F5F5;" |It is an autoimmune thyroid disease that initially presents with hyperthyroidism and a high [[radioiodine]] uptake caused by [[TSH receptor|TSH-receptor]] antibodies similar to [[Graves' disease]]. It is then followed by the development of [[hypothyroidism]] due to the infiltration of the [[thyroid gland]] with [[Lymphocyte|lymphocytes]] and the resultant autoimmune-mediated destruction of [[thyroid]] tissue, similar to chronic [[lymphocytic thyroiditis]].<ref name="pmid5171000">{{cite journal |vauthors=Fatourechi V, McConahey WM, Woolner LB |title=Hyperthyroidism associated with histologic Hashimoto's thyroiditis |journal=Mayo Clin. Proc. |volume=46 |issue=10 |pages=682–9 |year=1971 |pmid=5171000 |doi= |url=}}</ref>
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-| colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic adenoma and toxic multinodular goiter}}
-| style="padding: 5px 5px; background: #F5F5F5;" |Toxic adenoma and [[toxic multinodular goiter]] are results of focal/diffuse [[hyperplasia]] of [[thyroid]] follicular cells independent of [[TSH]] regulation. Findings of single or multiple [[nodules]] are seen on physical examination or [[thyroid]] scan.<ref name="pmid2040867">{{cite journal |vauthors=Laurberg P, Pedersen KM, Vestergaard H, Sigurdsson G |title=High incidence of multinodular toxic goitre in the elderly population in a low iodine intake area vs. high incidence of Graves' disease in the young in a high iodine intake area: comparative surveys of thyrotoxicosis epidemiology in East-Jutland Denmark and Iceland |journal=J. Intern. Med. |volume=229 |issue=5 |pages=415–20 |year=1991 |pmid=2040867 |doi= |url=}}</ref>
-|-
-| colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Iodine-induced hyperthyroidism  }}
-| style="padding: 5px 5px; background: #F5F5F5;" |It is uncommon but can develop after an [[iodine]] load, such as administration of contrast agents used for [[angiography]] or [[Computed tomography|computed tomography (CT)]], or [[iodine]]-rich drugs such as [[amiodarone]].
 |-
-| colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Trophoblastic disease and germ cell tumors }}
-| style="padding: 5px 5px; background: #F5F5F5;" |[[Thyroid-stimulating hormone]] and [[HCG]] have a common alpha-subunit and a beta-subunit with considerable homology. As a result, [[HCG]] has weak thyroid-stimulating activity and high [[titer]] [[HCG]] may mimic hyperthyroidism.<ref name="pmid19605510">{{cite journal |vauthors=Oosting SF, de Haas EC, Links TP, de Bruin D, Sluiter WJ, de Jong IJ, Hoekstra HJ, Sleijfer DT, Gietema JA |title=Prevalence of paraneoplastic hyperthyroidism in patients with metastatic non-seminomatous germ-cell tumors |journal=Ann. Oncol. |volume=21 |issue=1 |pages=104–8 |year=2010 |pmid=19605510 |doi=10.1093/annonc/mdp265 |url=}}</ref>
 |}