Autoimmune thyroid disease patterns vs Thyroiditis and fibrosing thyroid patterns
How to tell Autoimmune thyroid disease patterns and Thyroiditis and fibrosing thyroid patterns apart when a board question makes them look alike.
Graves makes new hormone with high uptake; Hashimoto destroys toward hypothyroid; subacute thyroiditis leaks hormone with low uptake and pain; Riedel is woody fibrosis.
Side by side
Graves causes hyperthyroidism with diffuse uptake, TSH receptor antibodies, ophthalmopathy, and pretibial myxedema; Hashimoto causes chronic autoimmune hypothyroidism with anti-TPO or anti-thyroglobulin antibodies.
Subacute granulomatous thyroiditis causes painful post-viral thyroid with transient thyrotoxicosis and low uptake; Riedel causes hard woody fibrosing thyroid fixed to surrounding tissue.
Graves stimulates the TSH receptor; Hashimoto destroys thyroid follicles through autoimmune lymphocytic injury.
Subacute granulomatous thyroiditis releases preformed hormone from inflamed follicles; Riedel replaces thyroid and nearby tissue with dense fibrosis.
Graves has low TSH, high T3/T4, diffuse radioactive iodine uptake, and TSH receptor antibodies; Hashimoto has hypothyroid labs and anti-TPO antibodies.
Subacute thyroiditis has tender thyroid, elevated ESR, low radioactive iodine uptake; Riedel has a rock-hard thyroid with compressive symptoms.
The trap
Low TSH can occur in Graves and thyroiditis, so uptake and pain decide synthesis versus release.
The repair move
For thyroid stems, decide synthesis, destruction, chronic autoimmune failure, or fibrosing mass effect.
Try a free question
CoreA patient has weight loss, tremor, heat intolerance, diffuse goiter, ophthalmopathy, low TSH, high T4, and diffuse increased radioactive iodine uptake. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Graves disease. Hyperthyroidism with ophthalmopathy and diffuse increased uptake points to Graves disease.
Why the other choices are tempting
- B. Hashimoto usually causes hypothyroidism, though transient thyroid hormone release can occur early.
- C. Subacute thyroiditis is painful and has low uptake during thyrotoxicosis.
- D. Riedel thyroiditis causes a hard fibrosing thyroid with compressive symptoms.
- E. Factitious thyrotoxicosis has low uptake and lacks a stimulated gland.
Flashcards
Tap a card to flip it.
What uptake pattern points to Graves disease?
Diffuse increased radioactive iodine uptake points to Graves disease.
What antibodies point to Hashimoto thyroiditis?
Anti-thyroid peroxidase and anti-thyroglobulin antibodies point to Hashimoto thyroiditis.
Quick answers
What is the fastest way to tell Autoimmune thyroid disease patterns from Thyroiditis and fibrosing thyroid patterns?
Graves makes new hormone with high uptake; Hashimoto destroys toward hypothyroid; subacute thyroiditis leaks hormone with low uptake and pain; Riedel is woody fibrosis.
What is the key clue for Autoimmune thyroid disease patterns?
Graves causes hyperthyroidism with diffuse uptake, TSH receptor antibodies, ophthalmopathy, and pretibial myxedema; Hashimoto causes chronic autoimmune hypothyroidism with anti-TPO or anti-thyroglobulin antibodies.
What is the key clue for Thyroiditis and fibrosing thyroid patterns?
Subacute granulomatous thyroiditis causes painful post-viral thyroid with transient thyrotoxicosis and low uptake; Riedel causes hard woody fibrosing thyroid fixed to surrounding tissue.
What is the common trap with Autoimmune thyroid disease patterns vs Thyroiditis and fibrosing thyroid patterns?
Low TSH can occur in Graves and thyroiditis, so uptake and pain decide synthesis versus release.