Graves Disease Differential Diagnoses

Updated: Jan 04, 2023
  • Author: Sai-Ching Jim Yeung, MD, PhD, FACP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Diagnostic Considerations

A summary of the differential diagnoses for thyrotoxicosis is as follows:

  • Graves disease: Special features include a diffusely enlarged thyroid gland, thyroid bruits, ophthalmopathy, pretibial myxedema, and the presence of TSIs.

  • Subacute thyroiditis: Special features include a history of antecedent respiratory tract infection, neck tenderness, elevated sedimentation rate, low or absent radioactive iodine uptake, and a self-limited course. [4]

  • Silent thyroiditis: Special features include painless thyroiditis, which may be seen in postpartum women (postpartum thyroiditis); a self-limited course; and low radioiodine uptake.

  • Multinodular toxic goiter: Special features include a propensity to occur in elderly individuals and multiple nodules palpated or observed after thyroid scanning.

  • Toxic adenoma: Special features include a solitary palpable nodule and a hot nodule observed after thyroid scanning.

  • Factitious thyrotoxicosis: Special features include no goiter, a low thyroglobulin level, and low radioiodine uptake.

  • Iatrogenic thyrotoxicosis: The special feature is a history of thyroid hormone intake.

  • Iodide-induced thyrotoxicosis: The special feature is a propensity to occur in patients with a history of nodular thyroid disease who have been exposed to iodine-containing contrast agents or drugs such as amiodarone.

  • TSH-secreting pituitary adenoma: Special features include inappropriately elevated or normal TSH levels in the setting of elevated free levothyroxine (T4) and free triiodothyronine (T3) levels, evidence of other pituitary hormone deficiencies, elevated alpha subunit level, and compressive symptoms.

  • Beta-human choriogonadotropin–induced thyrotoxicosis: Special features include a positive pregnancy test result, a history of hydatidiform mole, choriocarcinoma, and embryonal carcinoma of the testis. Also, rarely, it may be observed in normal gestation.

Differential Diagnoses