Diagnostic Tests for Hashimoto's Thyroiditis
Hashimoto's Thyroiditis: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Hashimoto's Thyroiditis
includes:
Hashimoto's Thyroiditis Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Hashimoto's Thyroiditis:
- Thyroid: Home Testing:
- Menopause: Related Home Testing:
- Vaginal Health: Home Testing:
- Adrenal Gland Health: Home Testing:
- Breast Cancer: Related Home Tests:
Hashimoto's Thyroiditis Diagnosis: Book Excerpts
Tests and diagnosis discussion for Hashimoto's Thyroiditis:
Your doctor will perform a simple blood test that will be able to tell
if your body has the correct amount of thyroid hormones. This test
measures the blood TSH (Thyroid Stimulating Hormone) to determine if the
thyroid hormone levels are in the normal range. The range is set by your
doctor and should be discussed with you. Work with your doctor to find
what level is right for you. (Source: excerpt from Hashimoto's Thyroiditis: NWHIC)
Diagnostic Tests for Hashimoto's Thyroiditis: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Hashimoto's Thyroiditis.
EXOPHTHALMOS:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
In cases of bilateral exophthalmos, particularly if there is no fever or chemosis or ecchymosis, a thyroid profile is the most valuable test. Orbital MRI may also be done. However, Graves' disease may be present with normal thyroid function tests. Testing for thyrotropin receptor antibody and peroxidase antibodies should be done in these cases. Other endocrine studies may be necessary once hyperthyroidism has been excluded. In cases of unilateral exophthalmos, ultrasonography and plain films of the orbits and sinuses may be helpful, but a CT scan of the brain and sinuses is the most valuable diagnostic aid. Carotid angiography will need to be done to diagnose an arteriovenous fistula.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
THYROID ENLARGEMENT:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine tests include a CBC, sedimentation rate, urinalysis, thyroid profile with a TSH immunoassay, chemistry panel, chest x-ray, and EKG. Thyroid antibodies may be tested if Hashimoto's thyroiditis is suspected.
The most important study is a thyroid technetium-99m or iodine-123 uptake and scan. If the results of these are abnormal, then an endocrinologist or general surgeon should be consulted to assist in the interpretation. If the scan indicates a cold nodule, ultrasonography may be done to determine whether the nodule is cystic or solid. If it is cystic, generally it can be aspirated and followed. If it is solid, a biopsy or aspiration and biopsy should be undertaken. If there are malignant cells or at least suspicious cells for malignancy, surgery should be done. If the scan reveals a hot nodule and there is clinical and laboratory evidence of thyrotoxicosis, the patient should be treated with radioactive iodine or surgery. If the scan shows diffuse uptake of radioactive materials and there is clinical thyrotoxicosis, the patient also may be treated with radioactive iodine or surgery.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Exophthalmos:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin by asking when the patient first noticed exophthalmos. Is it associated with pain in or around the eye? If so, ask him how severe it is and how long he has had it. Then ask about recent sinus infection or vision problems. Take the patient's vital signs, noting a fever, which may accompany eye infection. Next, evaluate the severity of exophthalmos with an exophthalmometer. (See Detecting unilateral exophthalmos.) If the eyes bulge severely, look for cloudiness on the cornea, which may indicate ulcer formation. Describe any eye discharge and observe for ptosis. Then check visual acuity, with and without correction, and evaluate extraocular movements. Palpate the patient's thyroid for enlargement or goiter.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Thyroid enlargement:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
The patient’s history commonly reveals the cause of thyroid enlargement. Important data includes a family history of thyroid disease, onset of thyroid enlargement, any previous irradiation of the thyroid or the neck, recent infections, and the use of thyroid replacement drugs.
Begin the physical examination by inspecting the patient’s trachea for midline deviation. Although you can usually see the enlarged gland, you should always palpate it. To palpate the thyroid gland, you’ll need to stand behind the patient. Give the patient a cup of water, and have him extend his neck slightly. Place the fingers of both hands on the patient’s neck, just below the cricoid cartilage and just lateral to the trachea. Tell the patient to take a sip of water and swallow. The thyroid gland should rise as he swallows. Use your fingers to palpate laterally and downward to feel the whole thyroid gland. Palpate over the midline to feel the isthmus of the thyroid.
During palpation, be sure to note the size, shape, and consistency of the gland, and the presence or absence of nodules. Using the bell of a stethoscope, listen over the lateral lobes for a bruit. The bruit is often continuous.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Thyroid enlargement:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
The patient’s history commonly reveals the cause of thyroid enlargement. Important data include a family history of thyroid disease, when the thyroid enlargement began, any previous irradiation of the thyroid or the neck, recent infections, and the use of thyroid replacement drugs.
Begin the physical examination by inspecting the patient’s trachea for midline deviation. Although you can usually see the enlarged gland, you should always palpate it. To palpate the thyroid gland, you’ll need to stand behind the patient. Give the patient a cup of water, and have him extend his neck slightly. Place the fingers of both hands on the patient’s neck, just below the cricoid cartilage and just lateral to the trachea. Tell the patient to take a sip of water and swallow. The thyroid gland should rise as he swallows. Use your fingers to palpate laterally and downward to feel the whole thyroid gland. Palpate over the midline to feel the isthmus of the thyroid.
During palpation, be sure to note the size, shape, and consistency of the gland as well as the presence or absence of nodules. Using the bell of a stethoscope, listen over the lateral lobes for a bruit, which is commonly continuous.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Exophthalmos [Proptosis]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin by asking when the patient first noticed exophthalmos. Is it associated with pain in or around the eye? If so, ask him how severe it is and how long he has had it. Then ask about recent sinus infection or vision problems. Take the patient’s vital signs, noting fever, which may accompany an eye infection. Next, evaluate the severity of exophthalmos with an exophthalmometer. (See Detecting unilateral exophthalmos.) If the eyes bulge severely, look for cloudiness on the cornea, which may indicate ulcer formation. Describe any eye discharge and observe for ptosis. Then check visual acuity, with and without correction, and evaluate extraocular movements. Palpate the patient’s thyroid for enlargement or goiter.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Thyroid Enlargement/Goiter:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. General examination. Look for typical vital and physical signs consistent with hypothyroidism or thyrotoxicosis. Pemberton’s sign can be induced by having the patient raise both arms above the head.
B. Thyroid examination. Inspect the neck below the thyroid cartilage from the front, using cross-lighting to accentuate shadows and masses. Full extension of the neck enhances visibility of the gland. Inspection from the side with measurement of any prominence of the normally smooth and straight contour between the cricoid cartilage and the suprasternal notch is useful. Palpitation is done using the technique with which the examiner is most experienced and skilled. Approach the patient from either the front or behind and palpate using the fingers or thumbs. If felt between the cricoid cartilage and the suprasternal notch, the thyroid isthmus can be used to help locate the gland. Palpation of the lobes can be improved by relaxation of the sternocleidomastoid; for example, the left lobe can be defined better by having the patient slightly flex and rotate the neck to the left. Other useful maneuvers include measuring the circumference of the neck or the dimensions of each lobe. Note the location, size, consistency, mobility, and tenderness of any nodules. Having the patient swallow during both inspection and palpation causes the thyroid to move and aids in developing a three-dimensional impression of gland shape and size. This maneuver can also make a low-placed gland accessible. Categorize thyroid size as “normal” or “goiter,” and subcategorize “goiter” as “small” (two or less times normal) or “large” (more than two times normal) (2).
Testing
A. Laboratory testing. The sensitive TSH (sTSH) assay is the single best test to evaluate thyroid status. Elevated sTSH is highly suggestive of hypothyroidism (Chapter 14.4). If sTSH is suppressed, an elevated free thyroxine index (FTI) or free thyroxine (fT4) measured directly, confirms thyrotoxicosis (Chapter 14.8). In a patient with a suppressed sTSH and a normal FTI or fT4, serum triiodothyronine (T3) should be measured to assess for possible T3 thyrotoxicosis.
B. Diagnostic imaging. Nuclear scans and ultrasound studies are not warranted in the routine evaluation of simple or multinodular goiter (4). Ultrasonography may be helpful in patients with equivocal findings on palpation. Symptoms suggestive of substernal mechanical pressure require evaluation, usually by computed tomography (CT) or magnetic resonance imaging (MRI).
C. Other tests. Fine needle aspiration biopsy (FNAB) should be performed in cases of a solitary or dominant nodule found by palpation. Pulmonary function tests are warranted with evidence of inspiratory impairment. Barium swallow is indicated to evaluate goiter-associated dysphagia.
Diagnostic assessment
The evaluation of goiter focuses on the history, thyroid palpation, and functional status of the gland. An asymptomatic patient with a simple or multinodular goiter associated with a normal metabolic state does not necessarily require further diagnostic studies or treatment. Periodic assessment, at least annually, to evaluate growth, function, and symptoms is warranted. A palpable solitary nodule or dominant nodule in a multinodular gland should be evaluated by FNAB or excisional biopsy (Chapter 14.7). Goiter with compressive symptoms requires CT or MRI evaluation and referral for probable surgery. Further assess a goiter associated with an abnormal metabolic state as outlined for hypothyroidism (Chapter 14.4) or thyrotoxicosis (Chapter 14.8). Thyroid hormone suppression of any goiter type is controversial, and the risks associated with subclinical hyperthyroidism must be included in the risk-to-benefit analysis (5).
References
1. Petrone LR. A primary care approach to the adult patient with nodular thyroid disease. Arch Fam Med 1996;5:92–100.
2. Siminoski K. Does this patient have a goiter? JAMA 1995;273:813–817.
3. Peter HJ, Burgi U, Gerber H. Pathogenesis of nontoxic diffuse and nodular goiter. In: Braverman LE, Utiger RD, eds. Werner and Ingbar’s the thyroid, 7th ed. Philadelphia: JB Lippincott, 1996:890–895.
4. Tan GH, Gharib H. Thyroid nodular disease: diagnostic evaluation and management [Letter]. Arch Intern Med 1997;157:575.
5. Gharib H, Mazzaferri EL. Thyroxine suppressive therapy in patients with nodular thyroid disease. Ann Intern Med 1998;128:386–394.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Thyroid Nodule:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
As with the history, physical examination is neither sensitive nor specific for malignancy.
A. General examination. Look for typical vital and physical signs consistent with hypothyroidism or thyrotoxicosis.
B. Thyroid examination. Inspect the neck below the thyroid cartilage from the front and side, using cross-lighting to accentuate shadows and masses. Full extension of the neck enhances visibility of the gland. During palpation, approach the patient from either the front or behind and palpate using the fingers or thumbs. Having the patient swallow during both inspection and palpation causes the thyroid to move and aids in developing a three-dimensional impression of the gland. Note the location, size, consistency, mobility, and tenderness of all nodules. Findings suggestive of cancer include a nodule that is hard, irregular, nontender, greater than 4 cm in size, fixed to surrounding structures or associated with local lymphadenopathy.
Testing
A. Laboratory testing. Serum thyroid-stimulating hormone, performed by a sensitive method (sTSH), should be assessed in every patient. It is the best screen for both hypothyroidism (elevated sTSH—Chapter 14.4) and thyrotoxicosis (suppressed sTSH—Chapter 14.8). A family history of medullary thyroid cancer or multiple endocrine neoplasia, type II, warrants a basal serum calcitonin (4).
B. Diagnostic imaging. Because diagnostic imaging cannot reliably differentiate benign from malignant nodules, it is not part of the routine assessment of thyroid nodules. Diagnostic imaging, however, may be helpful in certain circumstances. Ultrasonography can be useful when findings on palpation are inconclusive regarding the presence of a single nodule or a dominant nodule in a multinodular gland (5). Some clinicians also apply ultrasonography when an abnormality has been detected fortuitously by other imaging procedures or in patients with a history of head and neck irradiation (1). A radionuclide scan, usually done with 123I, can also be helpful when thyroid palpation is inconclusive or to differentiate the functional status of nodules in a multinodular gland. A nodule identified as hyperfunctioning by radionuclide scan is almost invariably benign, but such lesions constitute less than 10% of all nodules.
C. Fine-needle aspiration biopsy (FNAB), performed and interpreted by experienced individuals, is the most important test in the evaluation of thyroid nodules. In various studies, FNAB has demonstrated a sensitivity of 68% to 98% (mean, 83%) and specificity of 72% to 100% (mean, 92%). Use of FNAB has allowed many centers to increase the yield of thyroid cancer in excised nodules from 15% to 45% (2).
Diagnostic assessment
When the initial examination is suggestive of cancer, an immediate surgical consultation is appropriate. In all other patients, FNAB is the cornerstone in the evaluation of solitary or dominant thyroid nodules.
A. Management strategy. The cytopathologic interpretation of the FNAB dictates management. If the specimen is insufficient for diagnosis, repeat FNAB is necessary. Even in experienced hands, approximately 10% of biopsies are nondiagnostic (1). If the biopsy is clearly benign, periodic follow-up is necessary. If the biopsy is malignant, suspicious, or indeterminate, surgical consultation is warranted.
B. Follow-up. During follow-up of nodules not surgically explored, the significant historical and physical elements previously discussed should be reexamined. Although the intervals of follow-up will vary, based on patient and nodule characteristics, a standard protocol is to reexamine patients at intervals of 1.5, 3, 6, and 12 months, and then annually if the nodule is stable. Consider the judicious use of laboratory testing, diagnostic imaging, and repeat FNAB, again based on patient and nodule characteristics. Thyroid hormone suppression is commonly used in both the diagnosis and treatment of thyroid nodules. Recent controlled trials have raised questions about this practice. If suppressive therapy is considered, the risks associated with subclinical hyperthyroidism must be included in the risk-to-benefit analysis (2).
References
1. Singer PA, Cooper DS, Daniels GH, et al. Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. Arch Intern Med 1996;156:
2165–2172.
2. Thyroid Nodule Task Force of the American Association of Clinical Endocrinologists and the American College of Endocrinology. AACE Clinical Practice Guidelines for the Diagnosis and Management of Thyroid Nodules. Endocrine Prac 1996;2:78–84.
3. Petrone LR. A primary care approach to the adult patient with nodular thyroid disease. Arch Fam Med 1996;5:92–100.
4. Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med 1993;328:
553–559.
5. Tan GH, Gharib H. Solitary thyroid nodule: comparison between palpation and ultrasonography. Arch Intern Med 1995;155:2418–2423.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Neck Mass/Thyroid Enlargement:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Patients often present for evaluation of a “neck mass” that is a normal structure such as the hyoid, and they will insist that it is new or asymmetric.
With thyroid enlargement, the mass will be low in the neck and extend across the midline. Occasionally, a prominent thyroid nodule will mimic a lymph node but is in an atypical location. The thyroid gland rises and falls with swallowing. The only other structure to do this is a thyroglossal duct cyst.
In a multinodular goiter, a malignancy should be suspected when there is a dominant nodule or cervical adenopathy.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Thyroid Nodule:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
The major task of physical examination is the detection of nodules. A palpable nodule can be detected in 4% to 7% of adults, but these are present in approximately 50% on ultrasound. The history or physical examination should rarely dissuade one from proceeding to thyroid scan and/or fine needle aspiration.
Approximately 5% of nodules are cancer. High-risk features include: rapid growth, a very firm nodule, fixation, vocal cord paralysis, enlarged regional lymph nodes, distant metastases, and family history of medullary cancer. Moderate risk features are: Age less than 20 years or greater than 60 years, history of neck irradiation (.100 cGy .15 years before), solitary nodule, diameter greater than 4 cm, and questionable fixation.
A thyroid nodule in a hyperthyroid patient is virtually never malignant, but a prominent or hard nodule in a multinodular goiter must be evaluated for cancer.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Exophthalmos:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
The patient may present with exposure keratitis, resulting from an inability to close the eyelid fully, or with diplopia resulting from unilaterally impaired extraocular movement. By standing behind the patient, tilting the head back, and viewing down the brow ridge, as little as 2 mm of eye protrusion can be detected.
Unilateral pulsating proptosis can be caused by an AV fistula between the internal carotid and the cavernous sinus in a basilar skull fracture, by an aneurysm of the ophthalmic artery, or by a rapidly enlarging and highly vascular orbital neoplasm. These vascular lesions produce a pulsating tinnitus and a dimming of vision.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Exophthalmos:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin the assessment by taking the patient’s vital signs, noting fever, which may accompany eye infection. Next, evaluate the severity of exophthalmos with an exophthalmometer. (See Detecting unilateral exophthalmos.) If the eyes bulge severely, look for cloudiness on the cornea, which may indicate ulcer formation. Describe any eye discharge and observe for ptosis. Then check visual acuity, with and without correction, and evaluate extraocular movements. Palpate the patient’s thyroid for enlargement or goiter.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Thyroid enlargement:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin the physical assessment by inspecting the patient’s trachea for midline deviation. Although you can usually see the enlarged gland, you should always palpate it. (See Palpating the thyroid gland, page 650.)
During palpation, be sure to note the size, shape, and consistency of the gland, and the presence or absence of nodules. Using the bell of a stethoscope, listen over the lateral lobes for a bruit. The bruit is usually continuous.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Thyroid enlargement:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
The patient's history commonly reveals the cause of thyroid enlargement. Important data includes a family history of thyroid disease, onset of thyroid enlargement, any previous irradiation of the thyroid or the neck, recent infections, and the use of thyroid replacement drugs.
Begin the physical examination by inspecting the patient's trachea for midline deviation. Although you can usually see the enlarged gland, you should always palpate it. To palpate the thyroid gland, you'll need to stand behind the patient. Give the patient a cup of water, and have him extend his neck slightly. Place the fingers of both hands on the patient's neck, just below the cricoid cartilage and just lateral to the trachea. Tell the patient to take a sip of water and swallow. The thyroid gland should rise as he swallows. Use your fingers to palpate laterally and downward to feel the whole thyroid gland. Palpate over the midline to feel the isthmus of the thyroid.
During palpation, be sure to note the size, shape, and consistency of the gland, and the presence or absence of nodules. Using the bell of a stethoscope, listen over the lateral lobes for a bruit. The bruit is often continuous.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Exophthalmos [Proptosis]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin by asking when the patient first noticed exophthalmos. Is it associated with pain in or around the eye? If so, ask him how severe it is and how long he has had it. Then ask about recent sinus infection or vision problems. Take the patient's vital signs, noting a fever, which may accompany eye infection. Next, evaluate the severity of exophthalmos with an exophthalmometer. (See Detecting unilateral exophthalmos.) If the eyes bulge severely, look for cloudiness on the cornea, which may indicate ulcer formation. Describe any eye discharge and observe for ptosis. Then check visual acuity, with and without correction, and evaluate extraocular movements. Palpate the patient's thyroid for enlargement or goiter.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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