Differences in Clinical and Laboratory Findings Among Graves’ Disease, Painless Thyroiditis and Subacute Thyroiditis Patients With Hyperthyroidism

Yanai, Hidekatsu; Hakoshima, Mariko; Katsuyama, Hisayuki

doi:10.14740/jem572

Cited by 6 publications

(8 citation statements)

References 21 publications

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“…In the guideline for Graves' disease, the fT3/fT4 ratio is helpful to exclude painless thyroiditis. Differences in clinical, endocrinological, immunological and biochemical findings and diagnostic imaging among Graves' disease, subacute thyroiditis and painless thyroiditis were shown in Table 2 [14]. As newly obtained findings, levels of fT3 and fT4 and the fT3/fT4 ratio were higher in the order of Graves' disease, subacute thyroiditis and painless thyroiditis.…”

Section: Differential Diagnosis Of Thyrotoxicosissupporting

confidence: 52%

“…In Japan, Graves' disease, painless thyroiditis and subacute thyroiditis are important in the differential diagnosis for thyrotoxicosis. We retrospectively picked up patients who had been diagnosed as having Graves' disease, painless thyroiditis and subacute thyroiditis who showed thyrotoxicosis, at National Center for Global Health and Medicine Kohnodai Hospital, between January 2010 and October 2018 [14]. The guideline for diagnosis of painless thyroiditis by Japan Thyroid Association includes thyrotoxicosis without pain of the thyroid gland and spontaneous improvement of thyrotoxicosis, elevation of serum fT4, suppression of TSH and negative for TRAb.…”

Section: Differential Diagnosis Of Thyrotoxicosismentioning

confidence: 99%

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Differential Diagnosis of Thyrotoxicosis

Yanai

2019

J Endocrinol Metab

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Hyperthyroidism is characterized by increased thyroid hormone synthesis and secretion from the thyroid gland, whereas thyrotoxicosis refers to the clinical syndrome of excess circulating thyroid hormones, irrespective of the source. Thyrotoxicosis is characterized by low serum thyroid-stimulating hormone (TSH) level and elevated serum levels of free thyroxine or free triiodothyronine, or both. Therefore, thyrotoxicosis is divided into two subtypes: thyrotoxicosis with hyperthyroidism such as Graves' disease and Plummer's disease, and thyrotoxicosis without hyperthyroidism such as painless and subacute thyroiditis. Here, I describe the differential diagnosis of hyperthyroidism; differentiation between Graves' disease and Plummer's disease; differentiation between Graves' disease with and without thyroid storm. Further, I show the differentiation among Graves' disease, painless thyroiditis and subacute thyroiditis. I believe that the proper diagnosis leads to appropriate treatment and management of thyrotoxicosis.

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Section: Differential Diagnosis Of Thyrotoxicosissupporting

confidence: 52%

Section: Differential Diagnosis Of Thyrotoxicosismentioning

confidence: 99%

Differential Diagnosis of Thyrotoxicosis

Yanai

2019

J Endocrinol Metab

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“…A third-generation assay for circulating antibodies to the thyrotropin receptor (TRAb) has been developed, offering a sensitivity of 95 and 100% specificity, but mild GD patients might be TRAb negative (12). Serum fT 3 levels in GD patients were significantly higher than in patients with painless thyroiditis and SAT (13). The free fT 3 /fT 4 of patients with painless thyroiditis overlapped with those of patients with GD.…”

Section: Introductionmentioning

confidence: 99%

Eosinophil/Monocyte Ratio Combined With Serum Thyroid Hormone for Distinguishing Graves' Disease and Subacute Thyroiditis

Zhou

Chen

et al. 2020

Front. Endocrinol.

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Background: Thyrotoxicosis is commonly classified into several entities according to different etiologies. Identifying the causes of thyroid dysfunction is critical for the subsequent selection of treatment. The free triiodothyronine to free thyroxine ratio (fT 3 /fT 4) is widely used but is still a controversial diagnostic measurement. Methods: A total of 290 patients including 141 healthy control subjects, 86 patients with untreated Graves' disease (GD,) and 63 patients with subacute thyroiditis (SAT) were enrolled in the study. The main aim was to evaluate the diagnostic value of different indexes from serum testing including fT 3 , fT 4 , eosinophils (Eo) and monocytes (Mo). The diagnostic performance of multiple indexes was evaluated separately using receiver operating characteristic curve analysis. Results: Sensitivities and specificities of fT 4 /fT 3 , Mo/Eo ratios and Mo/Eo ratio + fT 4 /fT 3 for diagnosing GD were 80.23 and 88.89, 82.56 and 60.32, and 74.4 and 87.3 with cutoff values of ≤2.841, ≤8.813 and >0.644, respectively. An equation of combined indicators including Mo, Eo, fT 3, and fT 4 data was developed to calculate a probability value and among all indexes studied the indicator combination formula gave the best diagnostic value, reaching sensitivity and specificity of 89.53 and 90.48%, respectively, with an optimum cutoff value at 0.561 for GD diagnosis. Conclusion: Compared to regular indexes (fT 4/ fT 3 and Mo/Eo), a newly developed indicator combination formula provided a higher prediction probability and may serve as a simple, cost-effective tool for differentiating GD from SAT patients, especially in undeveloped regions of China.

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“…Previous studies analyzed thyroid function test results according to age, sex, and etiology [ 9 , 10 ]. It has been suggested that T3, T4, and ratio of T3 to total thyroxine (T4) are high during early-onset Graves’ disease [ 11 , 12 ], which is characterized by an increase in thyroid hormone production [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Differential Diagnosis of Thyrotoxicosis by Machine Learning Models with Laboratory Findings

Kim

Baek

et al. 2022

Diagnostics

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Differential diagnosis of thyrotoxicosis is essential because therapeutic approaches differ based on disease etiology. We aimed to perform differential diagnosis of thyrotoxicosis using machine learning algorithms with initial laboratory findings. This is a retrospective study through medical records. Patients who visited a single hospital for thyrotoxicosis from June 2016 to December 2021 were enrolled. In total, 230 subjects were analyzed: 124 (52.6%) patients had Graves’ disease, 65 (28.3%) suffered from painless thyroiditis, and 41 (17.8%) were diagnosed with subacute thyroiditis. In consideration that results for the thyroid autoantibody test cannot be immediately confirmed, two different models were devised: Model 1 included triiodothyronine (T3), free thyroxine (FT4), T3 to FT4 ratio, erythrocyte sediment rate, and C-reactive protein (CRP); and Model 2 included all Model 1 variables as well as thyroid autoantibody test results, including thyrotropin binding inhibitory immunoglobulin (TBII), thyroid-stimulating immunoglobulin, anti-thyroid peroxidase antibody, and anti-thyroglobulin antibody (TgAb). Differential diagnosis accuracy was calculated using seven machine learning algorithms. In the initial blood test, Graves’ disease was characterized by increased thyroid hormone levels and subacute thyroiditis showing elevated inflammatory markers. The diagnostic accuracy of Model 1 was 65–70%, and Model 2 accuracy was 78–90%. The random forest model had the highest classification accuracy. The significant variables were CRP and T3 in Model 1 and TBII, CRP, and TgAb in Model 2. We suggest monitoring the initial T3 and CRP levels with subsequent confirmation of TBII and TgAb in the differential diagnosis of thyrotoxicosis.

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Differences in Clinical and Laboratory Findings Among Graves’ Disease, Painless Thyroiditis and Subacute Thyroiditis Patients With Hyperthyroidism

Cited by 6 publications

References 21 publications

Differential Diagnosis of Thyrotoxicosis

Differential Diagnosis of Thyrotoxicosis

Eosinophil/Monocyte Ratio Combined With Serum Thyroid Hormone for Distinguishing Graves' Disease and Subacute Thyroiditis

Differential Diagnosis of Thyrotoxicosis by Machine Learning Models with Laboratory Findings

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