Differential Diagnosis for Graves' Disease
- Single most likely diagnosis
- Toxic Multinodular Goiter: This condition is often considered in the differential diagnosis of Graves' disease due to its similar presentation of hyperthyroidism, although the pathophysiology and treatment differ. A key distinguishing feature is the presence of multiple nodules in the thyroid gland.
- Other Likely diagnoses
- Thyroiditis (subacute or silent): These inflammatory conditions of the thyroid can cause hyperthyroidism due to the release of pre-formed thyroid hormones into the bloodstream. They are distinguished from Graves' disease by the absence of autoantibodies and often a painful thyroid gland in subacute thyroiditis.
- Factitious Hyperthyroidism: This condition, caused by the ingestion of exogenous thyroid hormone, can mimic Graves' disease in its presentation but lacks the autoimmune features and typically does not have a goiter.
- Thyrotoxicosis due to a Thyroid Adenoma: A solitary toxic nodule can produce thyroid hormones independently of the normal feedback mechanisms, leading to hyperthyroidism. It is distinguished by the presence of a single nodule and the absence of diffuse thyroid enlargement.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Thyrotoxic Crisis: Although not a separate diagnosis from Graves' disease but rather a complication, it is crucial to recognize the signs of thyrotoxic crisis, which can be life-threatening. Early identification and treatment are vital.
- Metastatic Thyroid Cancer: Rarely, metastatic thyroid cancer can produce thyroid hormones, leading to hyperthyroidism. Missing this diagnosis could have severe consequences due to the potential for rapid progression of the cancer.
- Rare diagnoses
- Struma Ovarii: A rare ovarian tumor that contains thyroid tissue, which can produce thyroid hormones and cause hyperthyroidism. It is an important consideration in women with hyperthyroidism and a pelvic mass.
- Choriocarcinoma: This rare tumor can produce human chorionic gonadotropin (hCG), which has some thyroid-stimulating activity, leading to hyperthyroidism. It is a consideration in pregnant women or those with a history of choriocarcinoma.