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Thyroiditis Workup

  • Author: Robert P Hoffman, MD; Chief Editor: Stephen Kemp, MD, PhD  more...
 
Updated: Sep 04, 2015
 

Laboratory Studies

Acute thyroiditis

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  • 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

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  • 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

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  • 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.
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Imaging Studies

Radioactive iodine thyroid scanning

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  • 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

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  • Thyroid ultrasonography is useful in revealing abscess formation in patients with acute thyroiditis.
  • The degree of hypoechogenicity 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 thyroiditis.[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]
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Procedures

Fine-needle thyroid aspiration

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  • 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.
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Contributor Information and Disclosures
Author

Robert P Hoffman, MD Professor and Program Director, Department of Pediatrics, Ohio State University College of Medicine; Pediatric Endocrinologist, Division of Pediatric, Endocrinology, Diabetes, and Metabolism, Nationwide Children's Hospital

Robert P Hoffman, MD is a member of the following medical societies: American College of Pediatricians, American Diabetes Association, American Pediatric Society, Christian Medical and Dental Associations, Endocrine Society, Midwest Society for Pediatric Research, Pediatric Endocrine Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Society for Pediatric Research

Disclosure: Received grant/research funds from Eli Lilly for pi; Received grant/research funds from NovoNordisk for pi; Received consulting fee from NovoNordisk for consulting; Partner received consulting fee from Onyx Heart Valve for consulting.

Chief Editor

Stephen Kemp, MD, PhD Former 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, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

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, Pediatric Endocrine Society, Society for Pediatric Research, Florida Chapter of The American Academy of Pediatrics, Florida Pediatric Society, International Society for Pediatric and Adolescent Diabetes

Disclosure: Nothing to disclose.

References
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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.
 
 
 
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