Combined Mycophenolate Mofetil and Prednisone Therapy in Tamoxifen- and Prednisone-Resistant Reidel's Thyroiditis

Levy, Joshua M.; Hasney, Christian P.; Friedlander, Paul L.; Kandil, Emad; Occhipinti, Elise; Kahn, Marc J.

doi:10.1089/thy.2009.0324

Cited by 27 publications

(19 citation statements)

References 17 publications

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“…It decreases the expression of TGF-␤, resulting in inhibition of both fibroblast proliferation and collagen production (4), and it has been shown to cause significant reduction in the size of fibrosis and clinical symptoms in most but not all the cases of RT reported (5,11). Doses of 10 to 30 mg twice daily have been used to treat RT.…”

Section: Discussionmentioning

confidence: 99%

“…Levy et al (5) reported the use of mycophenolate mofetil, in combination with high-dose prednisolone (100 mg/d) in a refractory case, which resulted in significant reduction in the size of thyroid mass. Mycophenolate mofetil had also been used together with prednisolone in the treatment of retroperitoneal fibrosis (21), a condition with which RT is associated.…”

Section: Discussionmentioning

confidence: 99%

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Novel Use of Rituximab in a Case of Riedel's Thyroiditis Refractory to Glucocorticoids and Tamoxifen

Soh

Pham

O’Hehir

et al. 2013

The Journal of Clinical Endocrinology & Metabolism

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A 42-year-old woman presented with a rapidly enlarging right-sided thyroid mass and underwent hemithyroidectomy. Riedel's thyroiditis was only diagnosed upon surgical decompression of the right carotid artery 2 years later. She became more symptomatic as Riedel's thyroiditis progressed, and mediastinal fibrosclerosis developed over the next 12 months. Oral prednisolone failed to improve her condition, and she was commenced on tamoxifen. Despite initial improvement, her symptoms recurred 2 years later, mainly arising from compression of the trachea and esophagus at the thoracic inlet. Fluorodeoxyglucose positron emission tomographic scan showed locally advanced active invasive fibrosclerosis in the neck and mediastinum. An elevated activin-A level of 218 pg/mL was consistent with active inflammation. IgG subtypes (including IgG4) were normal. Two courses of iv methylprednisolone were given but only produced transient improvement. Subsequently, the patient received 3 doses of i.v. rituximab at monthly intervals and had prompt sustained symptomatic improvement. Activin-A level decreased to 122 pg/mL 10 months after rituximab therapy. Fluorodeoxyglucose positron emission tomographic scan 6 weeks after therapy showed reduction in inflammation. A further scan at 10 months demonstrated ongoing response to rituximab. This is a case of refractory Riedel's thyroiditis with symptomatic, biochemical, and radiological improvement that has persisted 14 months after rituximab. The likelihood and duration of response to rituximab in Riedel's thyroiditis requires further study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Novel Use of Rituximab in a Case of Riedel's Thyroiditis Refractory to Glucocorticoids and Tamoxifen

Soh

Pham

O’Hehir

et al. 2013

The Journal of Clinical Endocrinology & Metabolism

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“…Doses of 10-20 mg of tamoxifen either in combination with continued glucocorticoid therapy or as a monotherapy have been reported to be successful, especially in symptom control and reduction in pathological tissue mass [46,47]. Case reports have suggested that the combination of mycophenolate mofetil, which directly inhibits T and B lymphocytic proliferation and antibody production, with prednisolone can be used in glucocorticoid and tamoxifen- resistant patients [48]. …”

Section: Managementmentioning

confidence: 99%

Immunoglobulin G4-Related Thyroid Diseases

Kottahachchi¹,

Topliss²

2016

Eur Thyroid J

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Immunoglobulin G4-related disease (IgG4-RD) is a new disease category involving many organ systems, including the endocrine system in general and the thyroid in particular. Since an initial association was made between hypothyroidism and autoimmune (IgG4-related) pancreatitis, more forms of IgG4-related thyroid disease (IgG4-RTD) have been recognized. Four subcategories of IgG4-RTD have so far been identified: Riedel thyroiditis (RT), fibrosing variant of Hashimoto thyroiditis (FVHT), IgG4-related Hashimoto thyroiditis, and Graves disease with elevated IgG4 levels. Although a male predominance is seen for IgG4-RD in general, RT and FVHT have a female preponderance. The pathogenesis of IgG4-RD is not completely understood; however, genetic factors, antigen-antibody reactions, and an allergic phenomenon have been described. Diagnosis of IgG4-RD requires a combination of clinical features, serological evidence, and histological features. Histology is the mainstay of diagnosis, with IgG4 immunostaining. Although serum IgG4 levels are usually elevated in IgG4-RD, raised serum IgG4 is neither necessary nor adequate for diagnosis. Imaging supports the diagnosis and is a useful tool in disease monitoring. Management of IgG4-RTD is both medical and surgical. Steroids are the first-line treatment and may produce a swift response. Tamoxifen and rituximab are second-line agents used in steroid-resistant patients. Surgical debulking is carried out in RT solely as a procedure to relieve obstruction. Other endocrine associations described with IgG4-RD are hypophysitis and Hashimoto encephalopathy. IgG4-RTD is an uncommon disease entity, and prompt diagnosis and treatment can improve outcomes.

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“…[9] Proposed mechanisms of positive action of tamoxifen in this and associated inflammatory conditions involve the induction of autocrine secretion of TGF-β1 as observed in both estrogen receptor-positive and -negative tumor samples in vitro [9]. A recent report demonstrates significant reduction of goiter size using a combination of mycophenolate mofetil (1 g twice daily) and 100 mg prednisone daily in a case that failed to respond to the tamoxifen and prednisolone [10]. Low-dose irradiation has also been attempted in patients with Riedel's thyroiditis.…”

Section: Commentmentioning

confidence: 99%

Riedel’s Thyroiditis Mimicking as Anaplastic Thyroid Carcinoma: Unusual Presentation

Hakeem

Chandramathyamma

Hakeem

et al. 2016

Indian J Surg Oncol

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Riedel's thyroiditis is a rare inflammatory process which not only involves thyroid gland but also the surrounding vital structures. It may also be associated with various forms of systemic fibrotic disorders. The exact etiology is not known, but currently most favored view is that of a localized form of systemic fibrotic process. We report a case of Riedel's thyroiditis in a patient, highlighting a rare presentation mimicking anaplastic carcinoma. Clinical awareness of such presentation of Riedel's thyroiditis would enhance our ability to make this diagnosis promptly. Apart from avoiding or minimizing aggressive surgical intervention, awareness of such clinical entity may avoid complications and hence morbidity. Our case also highlights the difficulty in histological diagnosis which is very important to rule out malignancy and avoiding any major surgical intervention fraught with complications. Good response to high dose steroids as seen in our case is the current accepted treatment of choice.

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Combined Mycophenolate Mofetil and Prednisone Therapy in Tamoxifen- and Prednisone-Resistant Reidel's Thyroiditis

Cited by 27 publications

References 17 publications

Novel Use of Rituximab in a Case of Riedel's Thyroiditis Refractory to Glucocorticoids and Tamoxifen

Novel Use of Rituximab in a Case of Riedel's Thyroiditis Refractory to Glucocorticoids and Tamoxifen

Immunoglobulin G4-Related Thyroid Diseases

Riedel’s Thyroiditis Mimicking as Anaplastic Thyroid Carcinoma: Unusual Presentation

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