Diffuse Toxic Goiter (Graves Disease) Differential Diagnoses

Updated: Jul 27, 2015
  • Author: Bernard Corenblum, MD, FRCPC; Chief Editor: George T Griffing, MD  more...
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Diagnostic Considerations

If an associated ophthalmopathy is present, the diagnosis of diffuse toxic goiter is obvious.

Other common causes of hyperthyroidism include various forms of thyroiditis, hyperfunctioning (hot) nodule, multinodular goiter, iatrogenic (thyroxin and/or triiodothyronine ingestion). Iodine administration, such as drugs or contrast media, may precipitate hyperthyroidism in underlying nodular thyroid disease. Palpation of the thyroid gland gives useful clinical information in the separation of these entities.

Rare causes include TSH-secreting pituitary tumors, ectopic thyroxin production (struma ovarii), human chorionic gonadotropin (HCG) hypersecretion (trophoblastic disease, ectopic secretion), exogenous source (eg, hamburger thyrotoxicosis), and malingering (thyroxin ingestion). Peripheral resistance to thyroid hormone (receptor defect) may result in a complicated similar clinical picture.

Anxiety/psychotic state, pheochromocytoma, pregnancy and hyperemesis gravidarum, menopause, carcinoid syndrome, cocaine and other drug use are possible.

Primary systemic or organ diseases, such as atrial fibrillation, weight loss, or myopathy, require hyperthyroidism to be considered as an underlying cause.