Thyroiditis Workup

  • Author: Robert P Hoffman, MD; Chief Editor: Stephen Kemp, MD, PhD   more...
 
Updated: Nov 16, 2011
 

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.
Next

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.[6]
    • 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%.[7]
Previous
Next

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.
Previous
Proceed to Treatment & Management
 
 
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 Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Arlan L Rosenbloom, MD  Adjunct Distinguished Service Professor Emeritus of Pediatrics, University of Florida College of Medicine; 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, Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Lynne Lipton Levitsky, MD  Chief, Pediatric Endocrine Unit, Massachusetts General Hospital; Associate Professor of Pediatrics, Harvard 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, Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Pfizer Grant/research funds P.I.; Tercica Grant/research funds Other; Eli Lily Grant/research funds PI; NovoNordisk Grant/research funds PI

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 Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD  Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas for Medical Sciences College of Medicine, 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: Nothing to disclose.

References

  1. Iacovelli P, Sinagra JL, Vidolin AP, et al. Relevance of thyroiditis and of other autoimmune diseases in children with vitiligo. Dermatology. 2005;210(1):26-30. [Medline].

  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.

  3. Demirbilek H, Kandemir N, Gonc EN, Ozon A, Alikasifoglu A, Yordam N. Hashimoto's thyroiditis in children and adolescents: a retrospective study on clinical, epidemiological and laboratory properties of the disease. J Pediatr Endocrinol Metab. Nov 2007;20(11):1199-205. [Medline].

  4. Fava A, Oliverio R, Giuliano S, Parlato G, Michniewicz A, Indrieri A, et al. Clinical Evolution of Autoimmune Thyroiditis in Children and Adolescents. Thyroid. Feb 18 2009;[Medline].

  5. Sattar N, Lazare F, Kacer M, Aguayo-Figueroa L, Desikan V, Garcia M, et al. Celiac disease in children, adolescents, and young adults with autoimmune thyroid disease. J Pediatr. Feb 2011;158(2):272-5.e1. [Medline].

  6. de Vries L, Bulvik S, Phillip M. Chronic autoimmune thyroiditis in children and adolescents: at presentation and during long-term follow-up. Arch Dis Child. Jan 2009;94(1):33-7. [Medline].

  7. Dobert N, Balzer K, Diener J, Wegscheider K, Vaupel R, Grunwald F. Thyroid sonomorphology, thyroid peroxidase antibodies and thyroid function: new epidemiological data in unselected German employees. Nuklearmedizin. 2008;47(5):194-9. [Medline].

  8. Karges B, Muche R, Knerr I, et al. Levothyroxine in euthyroid autoimmune thyroiditis and type 1 diabetes: a randomized, controlled trial. J Clin Endocrinol Metab. May 2007;92(5):1647-52. [Medline].

  9. Svensson J, Ericsson UB, Nilsson P, et al. Levothyroxine treatment reduces thyroid size in children and adolescents with chronic autoimmune thyroiditis. J Clin Endocrinol Metab. May 2006;91(5):1729-34. [Medline].

  10. Bauer DC, Brown AN. Sensitive thyrotropin and free thyroxine testing in outpatients. Are both necessary?. Arch Intern Med. Nov 11 1996;156(20):2333-7. [Medline].

  11. Bogazzi F, Bartalena L, Tomisti L, et al. Glucocorticoid response in amiodarone-induced thyrotoxicosis resulting from destructive thyroiditis is predicted by thyroid volume and serum free thyroid hormone concentrations. J Clin Endocrinol Metab. Feb 2007;92(2):556-62. [Medline].

  12. Dayan CM, Daniels GH. Chronic autoimmune thyroiditis. N Engl J Med. Jul 11 1996;335(2):99-107. [Medline].

  13. de Kerdanet M, Lucas J, Lemee F, Lecornu M. Turner's syndrome with X-isochromosome and Hashimoto's thyroiditis. Clin Endocrinol (Oxf). Nov 1994;41(5):673-6. [Medline].

  14. Hay ID. Thyroiditis: a clinical update. Mayo Clin Proc. Dec 1985;60(12):836-43. [Medline].

  15. Kennedy RL, Jones TH, Cuckle HS. Down's syndrome and the thyroid. Clin Endocrinol (Oxf). Dec 1992;37(6):471-6. [Medline].

  16. Mandac JC, Chaudhry S, Sherman KE, Tomer Y. The clinical and physiological spectrum of interferon-alpha induced thyroiditis: toward a new classification. Hepatology. Apr 2006;43(4):661-72. [Medline].

  17. 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].

  18. Nordyke RA, Gilbert FI Jr, Miyamoto LA, Fleury KA. The superiority of antimicrosomal over antithyroglobulin antibodies for detecting Hashimoto's thyroiditis. Arch Intern Med. Apr 12 1993;153(7):862-5. [Medline].

  19. Pearce EN, Bogazzi F, Martino E, et al. The prevalence of elevated serum C-reactive protein levels in inflammatory and noninflammatory thyroid disease. Thyroid. Jul 2003;13(7):643-8. [Medline].

  20. Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. Jun 26 2003;348(26):2646-55. [Medline].

  21. Rother KI, Zimmerman D, Schwenk WF. Effect of thyroid hormone treatment on thyromegaly in children and adolescents with Hashimoto disease. J Pediatr. Apr 1994;124(4):599-601. [Medline].

 
Previous
Next
 
Three multinuclear, giant cell granulomas observed in a fine-needle aspiration biopsy of the thyroid; from a patient with thyrotoxicosis from lymphocytic or subacute granulomatous thyroiditis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.