Sandbox:ddx graves

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Disease Findings
Direct chemical toxicity with inflammation Amiodarone, sunitinib, pazopanib, axitinib, and other tyrosine kinase inhibitors may also be associated with a destructive thyroiditis.
Direct chemical toxicity with inflammation Patients who treated with radioiodine, may develops thyroid pain and tenderness 5 to 10 days later, due to radiation-induced injury and necrosis of thyroid follicular cells and associated inflammation.
Drugs that interfere with the immune system nterferon-alfa is well known for associated thyroid abnormality. It mostly lead to development of de novo antithyroid antibodies.
Lithium Patients treated with lithium are at high risk to develop painless thyroiditis and Graves' disease.
Palpation thyroiditis Manipulation of thyroid gland during thyroid biopsy or neck surgery and vigorous palpation during physical examination may cause transient hyperthyroidism.
Exogenous and ectopic hyperthyroidism Factitious ingestion of thyroid hormone
Acute hyperthyroidism from a levothyroxine overdose
Struma ovarii
Functional thyroid cancer metastases
Hashitoxicosis It is autoimmune thyroid disease who initially present with hyperthyroidism and a high radioiodine uptake caused by TSH-receptor antibodies similar to Graves' disease followed by the development of hypothyroidism due to infiltration of thyroid gland with lymphocytes and resultant autoimmune-mediated destruction of thyroid tissue similar to chronic lymphocytic thyroiditis.[1]
Toxic adenoma and toxic multinodular goiter Toxic adenoma and toxic multinodular goiter are result of focal/diffuse hyperplasia of thyroid follicular cells independent to TSH regulation. Finding single or multiple nodules in physical examination or thyroid scan.[2]
Iodine-induced hyperthyroidism It is uncommon but, can develop after an iodine load, such as administration of contrast agents used for angiography or computed tomography (CT) or iodine-rich drugs such as amiodarone.
Trophoblastic disease and germ cell tumors


Disease Findings
Thyroiditis Direct chemical toxicity with inflammation Amiodarone, sunitinib, pazopanib, axitinib, and other tyrosine kinase inhibitors may also be associated with a destructive thyroiditis.
Radiation thyroiditis Patients who treated with radioiodine, may develops thyroid pain and tenderness 5 to 10 days later, due to radiation-induced injury and necrosis of thyroid follicular cells and associated inflammation.
Drugs that interfere with the immune system Interferon-alfa is well known for associated thyroid abnormality. It mostly lead to development of de novo antithyroid antibodies.
Lithium Patients treated with lithium are at high risk to develop painless thyroiditis and Graves' disease.
Palpation thyroiditis Manipulation of thyroid gland during thyroid biopsy or neck surgery and vigorous palpation during physical examination may cause transient hyperthyroidism.
Exogenous and ectopic hyperthyroidism Factitious ingestion of thyroid hormone
Acute hyperthyroidism from a levothyroxine overdose
Struma ovarii
Functional thyroid cancer metastases
Hashitoxicosis It is autoimmune thyroid disease who initially present with hyperthyroidism and a high radioiodine uptake caused by TSH-receptor antibodies similar to Graves' disease followed by the development of hypothyroidism due to infiltration of thyroid gland with lymphocytes and resultant autoimmune-mediated destruction of thyroid tissue similar to chronic lymphocytic thyroiditis.[1]
Toxic adenoma and toxic multinodular goiter Toxic adenoma and toxic multinodular goiter are result of focal/diffuse hyperplasia of thyroid follicular cells independent to TSH regulation. Finding single or multiple nodules in physical examination or thyroid scan.[2]
Iodine-induced hyperthyroidism It is uncommon but, can develop after an iodine load, such as administration of contrast agents used for angiography or computed tomography (CT) or iodine-rich drugs such as amiodarone.
Trophoblastic disease and germ cell tumors
  1. 1.0 1.1 Fatourechi V, McConahey WM, Woolner LB (1971). "Hyperthyroidism associated with histologic Hashimoto's thyroiditis". Mayo Clin. Proc. 46 (10): 682–9. PMID 5171000.
  2. 2.0 2.1 Laurberg P, Pedersen KM, Vestergaard H, Sigurdsson G (1991). "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". J. Intern. Med. 229 (5): 415–20. PMID 2040867.