DISEASES OF THE THYROID - CLINICAL FINDINGS
Pancreatic Disease	Symptoms	Signs	Abnormal Lab Test Results	Abnormal Imaging Findings	Initial Treatment	General and Follow-Up Treatment	Age Range(s) Typically Found	Prognosis
Graves' Disease	Weight loss, heat intolerance, palpitations, anxiety, tremors, increased appetite	Diffuse goiter, ophthalmopathy (exophthalmos), pretibial myxedema	↓TSH, ↑T3, ↑T4, positive TSI antibodies	Diffuse increased uptake on radioactive iodine scan	Beta-blockers, methimazole or PTU	Definitive treatment with radioactive iodine, surgery, or lifelong medication	20-40 years	Good with treatment; can lead to complications if untreated
Hashimoto's Thyroiditis	Fatigue, weight gain, cold intolerance, depression, dry skin, constipation	Goiter, bradycardia, puffy face, periorbital edema, delayed reflexes	↑TSH, ↓T3, ↓T4, positive anti-TPO antibodies	Heterogeneous echotexture on ultrasound, hypoechoic areas	Levothyroxine	Lifelong levothyroxine therapy, monitor TSH levels	Middle-aged and older adults	Good with lifelong therapy; risk of myxedema coma if untreated
Toxic Multinodular Goiter	Hyperthyroid symptoms similar to Graves' but without ophthalmopathy	Multinodular goiter, no exophthalmos	↓TSH, ↑T3, ↑T4, no TSI antibodies	Multiple nodules with variable iodine uptake	Beta-blockers, methimazole or PTU	Definitive treatment with radioactive iodine or surgery if severe	Older adults	Good with treatment, but may require lifelong management
Thyroid Cancer	Lump in the neck, hoarseness, difficulty swallowing, neck pain	Firm, irregular thyroid nodule, cervical lymphadenopathy	Normal or abnormal thyroid function tests, elevated calcitonin (medullary carcinoma)	Thyroid nodule on ultrasound, microcalcifications, hypoechogenicity	Surgery, radioactive iodine, chemotherapy (depending on type)	Regular follow-up with ultrasound, thyroglobulin monitoring	Any age, but more common in adults	Variable; excellent for papillary carcinoma, worse for anaplastic carcinoma
Postpartum Thyroiditis	Hyperthyroid symptoms followed by hypothyroid symptoms postpartum	Thyroid enlargement, transition from hyper to hypo state	Initial ↓TSH, ↑T3, ↑T4 followed by ↑TSH, ↓T3, ↓T4	Variable uptake on iodine scan depending on phase	Supportive care, beta-blockers if symptomatic	Monitor thyroid function postpartum, treat if hypothyroid phase persists	Women postpartum (weeks to months after delivery)	Usually self-limited, but can lead to long-term hypothyroidism
Subacute Thyroiditis	Painful, tender thyroid with transient hyperthyroid symptoms	Tender thyroid gland, fever, malaise	↓TSH, ↑T3, ↑T4 initially, then normalization	Low uptake on radioactive iodine scan, inflamed thyroid on ultrasound	NSAIDs or corticosteroids for pain relief	Self-limited, follow-up thyroid function tests	Middle-aged individuals, post-viral	Self-limited, resolves within months
Congenital Hypothyroidism	Feeding difficulties, hypotonia, jaundice, large tongue, developmental delay	Large fontanelles, coarse facial features, poor growth	↑TSH, ↓T3, ↓T4, low thyroxine-binding globulin	Absent or hypoplastic thyroid on ultrasound	Levothyroxine	Lifelong thyroid hormone replacement, developmental monitoring	Newborns	Good with early treatment; untreated can lead to intellectual disability
Iodine-Induced Hyperthyroidism	Hyperthyroid symptoms after iodine exposure (contrast media, amiodarone)	Hyperthyroid state in susceptible individuals with iodine exposure	↓TSH, ↑T3, ↑T4, history of iodine exposure	Increased iodine uptake in thyroid	Stop iodine exposure, consider methimazole	Monitor thyroid function, avoid further iodine exposure	Any age with iodine exposure	Good if iodine exposure is discontinued and managed early