eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Thyroiditis: Differential Diagnoses & Workup

Author: Robert P Hoffman, MD, Associate Professor of Pediatrics, Department of Pediatrics, Ohio State University College of Medicine
Contributor Information and Disclosures

Updated: May 1, 2009

Differential Diagnoses

Hyperthyroidism
Hypothyroidism

Workup

Laboratory Studies

  • Acute thyroiditis

    • Laboratory abnormalities in acute thyroiditis reflect the acute systemic illness.
    • Findings include leukocytosis with a left shift and an increased sedimentation rate.
    • Thyroid function test results are within the reference range.
  • Subacute thyroiditis

    • The primary laboratory abnormalities are consistent with abnormal thyroid function. Initially, the thyroid-stimulating hormone (TSH) level is suppressed, and the free thyroxine (T4) level is increased. As the disorder progresses, transient or sometimes permanent hypothyroidism may develop.
    • The WBC count is usually within the reference range but may be mildly elevated. High-sensitivity C-reactive protein levels are usually elevated in subacute thyroiditis.
  • Chronic thyroiditis

    • Laboratory abnormalities reflect thyroid function abnormality and evidence of autoimmunity.
    • TSH levels are increased in children with subclinical and overt hypothyroidism. Free T4 levels are within the reference range in the former and low in the latter. In children with hyperthyroidism, TSH levels are suppressed. Many children have normal thyroid function and normal TSH levels.
    • Antithyroid peroxidase (antithyrocellular, antimicrosomal) antibody levels elevated above the reference range are the most sensitive indicator of thyroid autoimmunity. Many children also have antithyroglobulin antibodies, although this is less sensitive and less specific.

Imaging Studies

  • Radioactive iodine thyroid scanning
    • Radioactive iodine thyroid scanning is not necessary for acute suppurative thyroiditis because the results are normal and do not aid in diagnosis. A scan may be helpful after diagnosis to identify a persistent thyroglossal duct as a route for infection.
    • This test is also unnecessary for chronic thyroiditis because the results can be misleading and may show increased uptake consistent with Graves disease, a multinodular goiter, or a hypofunctioning or hyperfunctioning nodule.
    • Radioactive iodine thyroid scanning is helpful in patients with hyperthyroidism who are thought to have subacute thyroiditis because the extremely low uptake is consistent with the thyrocellular destruction in progress.
  • Thyroid ultrasonography 
    • Thyroid ultrasonography is useful in revealing abscess formation in patients with acute thyroiditis.
    • The degree of hyopoechogenicity on ultrasonography is related to the degree of thyroid dysfunction but its clinical use in chronic thyroiditis is questionable and does not alter management in children with chronic thryoiditis.5
    • The overall of specificity of thyroid ultrasonography to identify specific concerns is questionable. A study in Germany found thyroid ultrasonography abnormalities in 40% of a random adult population, including nodules in 35.6%.6

Procedures

  • Fine-needle thyroid aspiration

    • This procedure is advocated by some to document the presence of thyroid lymphocytic infiltration in autoimmune thyroiditis. Histologic results are predictive of thyroid function; however, the results can be misinterpreted and can lead to unnecessary thyroid surgery.
    • Reserve this test for patients in whom underlying malignancy is suggested by a discrete thyroid nodule.
    • In patients with acute thyroiditis, needle aspiration can be used to obtain material for culture, enabling appropriate antibiotic therapy.

More on Thyroiditis

Overview: Thyroiditis
Differential Diagnoses & Workup: Thyroiditis
Treatment & Medication: Thyroiditis
Follow-up: Thyroiditis
Multimedia: Thyroiditis
References
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References

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  2. Fisher DA, Greueters, A. Thyroid disorders in childhood and adolesence. In: Sperling MA. Pediatric Endocrinology,. 3rd ed. Philadelphia, PA: Sunders Elevier; 2008:227-53.

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  16. McCanlies E, O'Leary LA, Foley TP, et al. Hashimoto's thyroiditis and insulin-dependent diabetes mellitus: differences among individuals with and without abnormal thyroid function. J Clin Endocrinol Metab. May 1998;83(5):1548-51. [Medline]. [Full Text].

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Further Reading

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Keywords

thyroiditis, acute thyroiditis, autoimmune thyroiditis, chronic lymphocytic thyroiditis, Hashimoto thyroiditis, subacute thyroiditis, thyroadenitis, acute suppurative thyroiditis, chronic thyroiditis, Riedel struma, Riedel thyroiditis, atrophic thyroiditis, goitrous thyroiditis, vitiligo, hypothyroidism, persistent thyroglossal duct, brachial cleft cysts, Down syndrome, Down’s syndrome, Turner syndrome, Turner’s syndrome, type 1 diabetes, Staphylococcus aureus, Streptococcus hemolyticus, pneumococcus, mumps, measles, influenza, infectious mononucleosis, Coxsackievirus infections, myocarditis, common cold, catscratch fever, sarcoidosis, Q fever, malaria, treatment, diagnosis

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Contributor Information and Disclosures

Author

Robert P Hoffman, MD, Associate Professor of Pediatrics, Department of Pediatrics, Ohio State University College of Medicine
Robert P Hoffman, MD is a member of the following medical societies: American Diabetes Association, American Pediatric Society, Christian Medical & Dental Society, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Arlan L Rosenbloom, MD, Adjunct Distinguished Service Professor Emeritus of Pediatrics, University of Florida; Fellow of the American Academy of Pediatrics; Fellow of the American College of Epidemiology
Arlan L Rosenbloom, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Epidemiology, American Pediatric Society, Endocrine Society, Florida Pediatric Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Lynne Lipton Levitsky, MD, Chief, Pediatric Endocrine Unit, Massachusetts General Hospital; Associate Professor, Department of Pediatrics, Harvard University Medical School
Lynne Lipton Levitsky, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Diabetes Association, American Pediatric Society, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Pfizer Grant/research funds P.I.; Tercica Grant/research funds PI, also occasional consultant

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital
Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research
Disclosure: Genentech, Inc. Honoraria Speaking and teaching; Pfizer, Inc. Honoraria Consulting

 
 
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