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CLINICAL PERSPECTIVE
Classification of Thyroid Diseases: Suggestions for
a Revision
FABRIZIO MONACO
Department of Endocrinology, University G. D’Annunzio, 66100 Chieti, Italy
1428
Monaco • Clinical Perspective J Clin Endocrinol Metab, April 2003, 88(4):1428 –1432 1429
TABLE 1. Abridged classification of thyroid diseases is now necessary to distinguish whether the excess is due to
thyroid hyperfunction and overproduction of thyroid hor-
I. Diseases characterized by (tissue) euthyroidism
mones or to excess levels without thyroid hyperfunction and
A. Euthyroid goitera
1. Diffuse (chronic) increased biosynthesis, i.e. excess intake, excess release with-
2. Nodular (chronic) out synthesis, or syndromes of pituitary resistance to thyroid
3. Diffuse (transient) hormones. In the latter cases it is more appropriate to use the
B. Tumors term thyrotoxicosis, which indicates the presence of an ex-
1. Benign (single nodule)
2. Malignant cessive amount of thyroid hormones not overproduced by
a. Differentiated (papillary and follicular) the gland. If the hormones are produced by the thyroid, we
b. Undifferentiated (anaplastic) have hyperthyroidism with thyroid gland hyperfunction; if
c. Medullary the excess level of thyroid hormones is not derived from the
C. Thyroiditis
thyroid or is derived from the thyroid by excess secretion
1. Acute thyroiditis
2. Subacute thyroiditis (De Quervain’s) (in the euthyroid rather than production, we have thyrotoxicosis without thy-
I. Diseases characterized by (tissue) euthyroidism 1. Chronic autoimmune thyroiditis (with or without goiter)e
A. Euthyroid goiter (chronic)a 2. Iatrogenic (surgery, 131I-therapy)e
1. Diffuse 3. Diffuse and nodular goiter
a. Sporadic 4. Severe iodine deficiencyf
b. Endemic (iodine deficiency) b. Neonatal congenital (ectopia, agenesis,
2. Nodular dyshormonogenesis (iodine metabolism, thyroglobulin
a. Uninodular biosynthesis, enzymatic defects)
1. Sporadic 2. Pituitary (or secondary) hypothyroidism (tumor,
2. Endemic (iodine deficiency) inflammation, infiltration, trauma, TSH deficiency, isolated
b. Multinodular or panhypopituitarism)
1. Sporadic 3. Hypothalamic (or tertiary) hypothyroidism (tumor,
2. Endemic (iodine deficiency) inflammation, infiltration, trauma)
3. Euthyroid diffuse goiter (transient) B. Without hypothyroidism
a. Menarche, pregnancy, menopause (in iodine-deficient 1. Generalized and peripheral resistance to thyroid hormones
This classification takes into account the fact that most References
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