Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Differentiating goiter from other diseases
Introduction
Overview
Overview
As goiter manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype.
Differentiating Goiter from other Diseases
Differentiating Goiter from other Diseases
- As goiter manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. The following are the various differential diagnoses: [1]
- Anaplastic Thyroid Carcinoma
- Follicular Thyroid Carcinoma
- Medullary Thyroid Carcinoma
- Papillary Thyroid Carcinoma
- Sarcoma
- Lipomas
- Fibroma
- Thyroid lymphoma
- Hashimoto thyroiditis
- Riedel thyroiditis
- Subacute thyroiditis
- Infectious thyroiditis
- Parathyroid adenoma
- Parathyroid cyst
- Thyroglossal duct cyst
- Branchial cleft cyst
- Pseudo-goiter
- Thyroid abscess
- Thyroid nodule
- Granulomatous disease of the thyroid
- Lymphadenopathy
- Carotid artery aneurysm
- Lymphatic malformation (cystic hygroma)
- Tumors of other structures in the neck
Differentials of thyroid gland enlargement
The table below outlines the differential diagnoses of neck swelling due to thyroid gland enlargement:[2]
| Disease | Findings |
|---|---|
| Multinodular goiter | Multinodular goiter is the multinodular enlargement of the thyroid gland. They are large nodules of more than 1 cm that produces symptoms of hyperthyroidism. |
| Grave’s disease | Grave’s disease is an autoimmune disease that affects the thyroid. It frequently results in hyperthyroidism and an enlarged thyroid. Pretibial myxedema and ophthalmopathy are some of the findings of grave’s disease. |
| Hashimoto’s disease | Hashimoto’s disease is an autoimmune disease in which the thyroid gland is attacked by a variety of cell-mediated and antibody-mediated immune processes, causing primary hypothyroidism. |
| Medullary thyroid carcinoma | Medullary thyroid carcinoma is a form of thyroid carcinoma which originates from the parafollicular cells (C cells), which produce the hormone calcitonin. |
| Thyroid lymphoma | Thyroid lymphoma is a rare malignant tumor which manifests as rapidly enlarging neck mass causing respiratory difficulty. |
| De Quervain’s thyroiditis | De Quervain’s thyroiditis is a subacute granulomatous thyroiditis preceded by an upper respiratory tract infection. |
| Acute suppurative thyroiditis | Acute suppurative thyroiditis is an uncommon thyroid disorder usually caused by bacterial infection. |
| Toxic adenoma | 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.[3] |
| Direct chemical toxicity with inflammation | Amiodarone, sunitinib, pazopanib, axitinib, and other tyrosine kinase inhibitors may also be associated with a destructive thyroiditis.[4][5] |
| Palpation thyroiditis | Manipulation of the thyroid gland during thyroid biopsy or neck surgery and vigorous palpation during the physical examination may cause transient hyperthyroidism. |
Differentials of thyroid gland enlargement and thyrotoxicosis
The following table summarizes the various differential diagnoses of thyroid gland enlargement plus thyrotoxicosis and their major features:
| Cause of thyrotoxicosis | TSH receptor antibodies | Thyroid US | Color flow Doppler | Radioactive iodine uptake/Scan | Other features |
|---|---|---|---|---|---|
| Graves’ disease | + | Hypoechoic pattern | ↑ | ↑ | Ophthalmopathy, dermopathy, acropachy |
| Toxic nodular goiter | – | Multiple nodules | – | Hot nodules at thyroid scan | – |
| 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 |
| Factitious thyrotoxicosis | – | Variable | Reduced/absent flow | ↓ | ↓ Serum thyroglobulin |
References
References
- ↑ Mahoney CP (1987). “Differential diagnosis of goiter”. Pediatr Clin North Am. 34 (4): 891–905. PMID 3302898.
- ↑ Thyroid adenoma. Wikipedia. https://en.wikipedia.org/wiki/Thyroid_adenoma Accessed on October 11, 2015
- ↑ 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.
- ↑ Lambert M, Unger J, De Nayer P, Brohet C, Gangji D (1990). “Amiodarone-induced thyrotoxicosis suggestive of thyroid damage”. J. Endocrinol. Invest. 13 (6): 527–30. PMID 2258582.
- ↑ Ahmadieh H, Salti I (2013). “Tyrosine kinase inhibitors induced thyroid dysfunction: a review of its incidence, pathophysiology, clinical relevance, and treatment”. Biomed Res Int. 2013: 725410. doi:10.1155/2013/725410. PMC 3824811. PMID 24282820.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]