Riedel’s thyroiditis: Diagnostic and therapeutic difficulties

Ünsal, Özlem; Akpınar, Meltem; Akova, Pinar; Özgüven, Banu Yılmaz; Coşkun, Berna Uslu

doi:10.5350/semb.20170307062327

Cited by 2 publications

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References 24 publications

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“…Thyroid parenchyma replacement by fibrous tissue results in progressive thyroid enlargement [ 1 , 2 ] and permanent destruction of thyroid epithelial tissue, leading to primary hypothyroidism [ 2 , 3 ]. In spite of the nonmalignant, inflammatory nature of Riedel’s thyroiditis, the affected gland may lead to obstruction of vital structures in the neck, causing dysphagia and dyspnea [ 2 , 4 ]. Fibrous tissue may extend outside of the thyroid capsule and has been reported to destroy the parathyroid glands and cause hypoparathyroidism [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

IgG4-Related Fibrous Thyroiditis (Riedel’s Thyroiditis): A Case Report

et al. 2020

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Patient: Female, 69-year-old Final Diagnosis: Riedel thyroiditis Symptoms: Dysphagia • goiter Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Rare disease Background: Riedel’s thyroiditis is a rare form of immunoglobulin G (IgG) 4-related invasive fibrosis of the thyroid gland; given its scarce incidence, standardized therapeutic guidelines are unavailable. Although complications are unusual, obstructive symptoms produced by the stony-hard goiter may put patients’ lives at risk. The diagnosis must be biopsy-proven, and treatment consists of thyroid hormone replacement and anti-inflammatory drugs, although sometimes thyroidectomy may be required. Case Report: A 69-year-old woman presented with a 7-month history of progressive hypothyroidism and obstructive dysphagia. On physical examination, she had a large, stony-hard goiter. A Doppler ultrasound study revealed a massive, avascular enlargement of the thyroid gland. A computed tomography scan failed to demonstrate any extrathyroidal extension of the abnormal tissue. A Tru-Cut biopsy of the thyroid was performed. Extensive replacement of thyroid follicles by prominent bands of fibrous tissue was observed, with follicular obliteration and mild focal occlusive phlebitis. A lymphoplasmacytic infiltrate was clearly identified; no oxyphilic nor giant cells were found. On immunohistochemistry, the immunoglobulin G (IgG) 4/IgG ratio in the plasma cell infiltrate was 40%; increased serum IgG4 levels were also found, supporting the diagnosis of Riedel’s thyroiditis. The patient was successfully treated with levothyroxine replacement and tamoxifen with prompt resolution of obstructive symptoms. Conclusions: Fibrous thyroiditis should be considered in the differential diagnosis of primary hypothyroidism in a patient with a stony-hard goiter. Although steroids are often used as a therapeutic strategy for this disease, our patient had an excellent therapeutic response to tamoxifen, avoiding adverse effects associated with steroid therapy, the higher cost of monoclonal antibody therapy, and surgery-associated risks.

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Section: Introductionmentioning

confidence: 99%

IgG4-Related Fibrous Thyroiditis (Riedel’s Thyroiditis): A Case Report

et al. 2020

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Riedel Thyroiditis

Zala

Berhane

Juhlin

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Riedel’s thyroiditis (RT) is a rare inflammatory autoimmune disease that is often a clinically diagnostic dilemma due to its insidious presentation and non-specific symptoms. Objective The aim of the present systematic review and meta-analysis is to clarify the presentation, management and outcomes of RT. Study Selection A systematic search of PubMed/MEDLINE and Web of Science was conducted to identify relevant reports published up to September 2019. Data Extraction First author, country, patient sex, ethnicity, presentation, biochemical status, duration of symptoms, histology, treatment, follow-up duration, and short- and long-term outcomes. Data Synthesis Data from 212 RT patients was retrieved. The mean age was 47 years with a predominantly female population (81%). Neck swelling (89%), dyspnea (50%), neck pain (41%) were the most common presenting symptoms. Inflammatory markers were elevated in 70-97% and thyroid antibody positivity was present in less than 50%. Up to 82% underwent surgical intervention, with the most common being total thyroidectomy in 34% of individuals. Glucocorticoids were utilized in 70% of individuals with median duration 3 months. Prognosis was reasonable with 90% having resolution or improvement of symptoms. Conclusions This analysis is the largest and most comprehensive to date of RT and provides clinicians with vital information on the common presentation features that may alert to the diagnosis and to highlight management options.

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Riedel’s thyroiditis: Diagnostic and therapeutic difficulties

Cited by 2 publications

References 24 publications

IgG4-Related Fibrous Thyroiditis (Riedel’s Thyroiditis): A Case Report

IgG4-Related Fibrous Thyroiditis (Riedel’s Thyroiditis): A Case Report

Riedel Thyroiditis

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