Differential Diagnosis for Graves Disease
Given the possibility of Graves disease, the following differential diagnoses should be considered:
- Single most likely diagnosis
- Toxic Multinodular Goiter: This condition is a common cause of hyperthyroidism, similar to Graves disease, and should be considered as it presents with similar symptoms such as weight loss, palpitations, and exophthalmos, although the latter is less common.
- Other Likely diagnoses
- Thyroiditis: Conditions like subacute or silent thyroiditis can cause hyperthyroidism and should be differentiated from Graves disease through clinical presentation and laboratory tests.
- Solitary Toxic Nodule: A single nodule in the thyroid gland that produces thyroid hormones independently of the normal feedback mechanism can cause hyperthyroidism.
- Factitious Hyperthyroidism: Ingestion of exogenous thyroid hormone can mimic the symptoms of Graves disease and other hyperthyroid conditions.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Thyroid Storm: A life-threatening complication of untreated or inadequately treated hyperthyroidism, which requires immediate recognition and treatment.
- Pituitary Adenoma (TSH-secreting): Although rare, a TSH-secreting pituitary adenoma can cause hyperthyroidism and, if missed, can lead to serious complications including vision loss and hormonal imbalances.
- Rare diagnoses
- Struma Ovarii: A rare ovarian tumor that can produce thyroid hormones, leading to hyperthyroidism.
- Familial Nonautoimmune Hyperthyroidism: A rare genetic condition that affects the thyroid gland's ability to regulate hormone production.
- HCG-induced Hyperthyroidism: Seen in conditions with high levels of human chorionic gonadotropin (hCG), such as choriocarcinoma or hyperemesis gravidarum, which can stimulate the thyroid gland to produce excess thyroid hormones.
Each of these diagnoses has a distinct set of clinical features and diagnostic criteria that can help differentiate them from Graves disease. Accurate diagnosis is crucial for appropriate management and treatment.