Hashimoto's Thyroiditis and Graves' Disease Associated with Retroperitoneal Fibrosis

Abstract

Retroperitoneal fibrosis is a rare disease of uncertain pathogenesis. However, its possible association with several immunopathologic conditions, the possibility of systemic involvement by the fibrous process, the presence of various autoantibodies, and the frequent response to immunosuppressive treatment all support an autoimmune pathogenesis. Riedel's thyroiditis is a rare disease the pathogenesis of which is also thought to be immune-mediated based on its optimal response to steroids; Riedel's thyroiditis is also frequently reported in association with retroperitoneal fibrosis. We describe here two cases of autoimmune thyroid disease associated with retroperitoneal fibrosis, the first with features of primary myxedema, the second of primary thyrotoxicosis. Histology of retroperitoneal fibrosis is documented and it is compatible with an immunopathologic condition. Thus, these two cases add further support to the hypothesis of an autoimmune pathogenesis of retroperitoneal fibrosis and indicate the importance of carefully monitoring for the development of other autoimmune disorders, i.e., of the thyroid gland, in patients with retroperitoneal fibrosis.

Invasive Fibrous Thyroiditis (Riedel Thyroiditis): The Mayo Clinic Experience, 1976–2008

“…Several cases of antecedent or coincident Hashimoto's thyroiditis have been reported with IFT (5,30). Several reviews have noted a high incidence of positive thyroid antibody titers in patients with IFT (31).…”

Association between idiopathic retroperitoneal fibrosis and autoimmune thyroiditis: A case–control study

“…These observations, together with the fact that it responds to immunosuppressive therapy [6,7] support the concept that it represents a manifestation of a systemic immune-mediated disorder. Data on the association between IRF and autoimmune thyroid diseases are scanty and mostly limited to case reports [8][9][10]. In some of these reports, IRF was diagnosed in patients with multifocal fibrosclerosis, which has now been revisited as immunoglobulin G-4 (IgG4)-related disease, a condition characterized by tissue infiltration by IgG4 + plasma cells, abundant fibrosis and frequently raised serum IgG4 levels [11].…”

Atypical Presentation of Riedel’s Thyroiditis: Multifocal Nodular Fibrosis and Resolution with Levothyroxine

“…A fibrosing variant of Hashimoto’s thyroiditis has been described [4]; however, the absence of germinal cell centres and Hürthle cells, and presence of local fibrous infiltration make this diagnosis unlikely. Notably, Hashimoto’s thyroiditis has been reported in association with idiopathic retroperitoneal fibrosis in a number of case studies [21,22,23]. …”