Silent (painless) thyroiditis. Evidence of a geographic variation in frequency

Vitug, Angelica C.; Goldman, Joel M.

doi:10.1001/archinte.145.3.473

Cited by 22 publications

(11 citation statements)

References 21 publications

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“…Thyrotoxicosis in patients with painless thyroiditis and subacute thyroiditis is caused by thyroid destruction, and painless thyroiditis has been reported to account for 0-23% of all thyrotoxicosis cases [10][11][12]. Painless thyroiditis during the postpartum period, socalled postpartum thyroiditis, is 10 times more common in the general population than postpartum Graves' disease [13].…”

Section: Discussionmentioning

confidence: 99%

Ratio of Serum Free Triiodothyronine to Free Thyroxine in Graves' Hyperthyroidism and Thyrotoxicosis Caused by Painless Thyroiditis

Noh

Momotani²,

Fukada

et al. 2005

Endocr J

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Abstract. The serum T 3 to T 4 ratio is a useful indicator for differentiating destruction-induced thyrotoxicosis from Graves' thyrotoxicosis. However, the usefulness of the serum free T 3 (FT 3 ) to free T 4 (FT 4 ) ratio is controversial. We therefore systematically evaluated the usefulness of this ratio, based on measurements made using two widely available commercial kits in two hospitals. Eighty-two untreated patients with thyrotoxicosis (48 patients with Graves' disease and 34 patients with painless thyroiditis) were examined in Kuma Hospital, and 218 patients (126 with Graves' disease and 92 with painless thyroiditis) and 66 normal controls were examined in Ito Hospital. The FT 3 and FT 4 values, as well as the FT 3 / FT 4 ratios, were significantly higher in the patients with Graves' disease than in those with painless thyroiditis in both hospitals, but considerable overlap between the two disorders was observed. Receiver operating characteristic (ROC) curves for the FT 3 and FT 4 values and the FT 3 /FT 4 ratios of patients with Graves' disease and those with painless thyroiditis seen in both hospitals were prepared, and the area under the curves (AUC), the cut-off points for discriminating Graves' disease from painless thyroiditis, the sensitivity, and the specificity were calculated. AUC and sensitivity of the FT 3 /FT 4 ratio were smaller than those of FT 3 and FT 4 in both hospitals. The patients treated at Ito hospital were then divided into 4 groups according to their FT 4 levels (A: £2.3, B: >2.3~£3.9, C: 3.9~£5.4, D: >5.4 ng/dl), and the AUC, cutoff points, sensitivity, and specificity of the FT 3 /FT 4 ratios were calculated. The AUC and sensitivity of each group increased with the FT 4 levels (AUC: 57.8%, 72.1%, 91.1%, and 93.4%, respectively; sensitivity: 62.6%, 50.0%, 77.8%, and 97.0%, respectively). The means ± SE of the FT 3 /FT 4 ratio in the Graves' disease groups were 3.1 ± 0.22, 3.1 ± 0.09, 3.2 ± 0.06, and 3.1 ± 0.07, respectively, versus 2.9 ± 0.1, 2.6 ± 0.07, 2.5 ± 0.12, and 2.3 ± 0.15, respectively, in the painless thyroiditis groups. In the painless thyroiditis patients, the difference in the FT 3 /FT 4 ratio between group A and group D was significant (p<0.05). Thus, the FT 3 /FT 4 ratio in patients with Graves' disease likely remains unchanged as the FT 4 level rises, whereas this ratio decreases as the FT 4 level rises in patients with painless thyroiditis. In conclusion, the FT 3 /FT 4 ratios of patients with painless thyroiditis overlapped with those of patients with Graves' disease. However, this ratio was useful for differentiating between these two disorders when the FT 4 values were high.

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Section: Discussionmentioning

confidence: 99%

Ratio of Serum Free Triiodothyronine to Free Thyroxine in Graves' Hyperthyroidism and Thyrotoxicosis Caused by Painless Thyroiditis

Noh

Momotani²,

Fukada

et al. 2005

Endocr J

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“…The genetics of autoimmune thyroid disease and the importance of many predisposing genetic loci have been elucidated in familial studies (11)(12)(13) and linkage analyses (14 -16). Several environmental influences have been associated with the development of hypothyroidism in individuals with autoimmune thyroiditis, including increased dietary iodine content (17,18), lithium and amiodarone exposure (19,20), and cigarette smoke (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35).…”

Section: T Hyroid Autoimmunity Occurs Commonly In Thementioning

confidence: 99%

Smoke Exposure Is Associated with a Lower Prevalence of Serum Thyroid Autoantibodies and Thyrotropin Concentration Elevation and a Higher Prevalence of Mild Thyrotropin Concentration Suppression in the Third National Health and Nutrition Examination Survey (NHANES III)

Belin

Astor

Powe

et al. 2004

The Journal of Clinical Endocrinology & Metabolism

217

173

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“…First, PT is not rare. PT has a relatively high prevalence, accounting for 9-23% of all thyrotoxicosis cases (26). PT often present with milder symptoms, so many patients with PT will often go to a general practitioner, rather than a specialized thyroid clinic.…”

Section: Discussionmentioning

confidence: 99%

Differentiation between Graves' disease and painless thyroiditis by diffusion-weighted imaging, thyroid iodine uptake, thyroid scintigraphy and serum parameters

Meng

Zhang

Sun

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to assess the apparent diffusion coefficient (ADC) in diffusion-weighted imaging (DWI), thyroid radioactive iodine uptake (RAIU), thyroid scintigraphy and thyrotropin receptor antibody (TRAb) levels in the differential diagnosis between Graves' disease (GD) and painless thyroiditis (PT). A total of 102 patients with GD and 37 patients with PT were enrolled in the study. DWI was obtained with a 3.0-T magnetic resonance scanner, and ADC values were calculated. RAIU and thyroid scintigraphy were performed. Tissue samples were obtained from patients with GD (6 cases) following thyroidectomy, and from patients with PT (2 cases) following biopsy. Receiver operating characteristic (ROC) curves were drawn, optimal cut-off values were selected, and the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were assessed. It was found that the ADC, TRAb and RAIU were significantly higher in GD than in PT (P<0.05). ROC curves showed areas under the curves for RAIU, ADC and TRAb that were >0.900. RAIU was the reference method. Sensitivity, specificity, accuracy, PPV and NPV were 96. 078, 91.892, 95.000, 97.059 and 89.474% for ADC, and 88.235, 75.676, 84.892, 90.909 and 70.000% for TRAb, after the optimal thresholds of 1.837x10 -3 mm 2 /sec and 1.350 IU/ml were determined respectively. Histopathology showed that tissue cellularity in PT was much higher than in GD due to massive lymphocytic infiltration. The results of the present study indicate that RAIU, ADC and TRAb are of diagnostic value for differentiating between GD and PT. DWI has great potential for thyroid pathophysiological imaging because it reflects differences in tissue cellularity between GD and PT.

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Silent (painless) thyroiditis. Evidence of a geographic variation in frequency

Cited by 22 publications

References 21 publications

Ratio of Serum Free Triiodothyronine to Free Thyroxine in Graves' Hyperthyroidism and Thyrotoxicosis Caused by Painless Thyroiditis

Ratio of Serum Free Triiodothyronine to Free Thyroxine in Graves' Hyperthyroidism and Thyrotoxicosis Caused by Painless Thyroiditis

Smoke Exposure Is Associated with a Lower Prevalence of Serum Thyroid Autoantibodies and Thyrotropin Concentration Elevation and a Higher Prevalence of Mild Thyrotropin Concentration Suppression in the Third National Health and Nutrition Examination Survey (NHANES III)

Differentiation between Graves' disease and painless thyroiditis by diffusion-weighted imaging, thyroid iodine uptake, thyroid scintigraphy and serum parameters

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