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.

Competing interests: LJMB reports travel expenses but no honorarium to present at an Endocrinology Trainee education event from Novo Nordisk Australia, outside the submitted work. JES reports personal fees from AstraZeneca, personal fees from Eli Lilly, personal fees from Novo Nordisk, personal fees from Sanofi, personal fees from Mylan Pharmaceuticals, personal fees from Boehringer Ingelheim, personal fees from Merck Sharp and Dohme, and personal fees from Abbott, outside the submitted work.

Type 1 diabetes and Graves’ disease are chronic autoimmune conditions, characterised by a dysregulated immune response. In type 1 diabetes, there is beta cell destruction and subsequent insulin deficiency whereas in Graves’ disease, there is unregulated excessive thyroid hormone production. Both diseases result in significant psychosocial, physiological and emotional burden. There are associated risks of diabetic ketoacidosis and hypoglycaemia in type 1 diabetes and risks of thyrotoxicosis and orbitopathy in Graves’ disease. Advances in the understanding of the immunopathogenesis and response to immunotherapy in type 1 diabetes and Graves’ disease have facilitated the introduction of targeted therapies to induce self-tolerance, and subsequently, the potential to induce long-term remission if effective. We explore current research surrounding the use of antigen specific immunotherapies, with a focus on human studies, in type 1 diabetes and Graves’ disease including protein based, peptide based, dendritic-cell based and nanoparticle-based immunotherapies, including discussion of factors to be considered when translating immunotherapies to clinical practice.