A case of reversible hypoparathyroidism in a patient with Riedel's thyroiditis treated with glucocorticoids

Abstract

A 48‐year‐old woman with a history of primary hypothyroidism, presented with compressive symptoms secondary to a rapid enlargement of a preexisting goiter. She had no clinical signs of hypocalcemia. Biological tests revealed hypoparathyroidism. Cervicothoracic computed tomography scan showed a heterogeneous compressive goiter. The patient was treated with levothyroxine, calcium, and alfacalcidol. A total thyroidectomy was not performed because of the hard adhesion to neighboring structures. Histopathological examination of the thyroid biopsy was consistent with the diagnosis of Riedel's thyroiditis (RT). The patient was treated with glucocorticoids. The outcome was marked by the resolution of compressive symptoms and the decrease of the thyroid gland volume. Serum calcium and parathyroid hormone levels reached normal ranges after the discontinuation of vitaminocalcic supplementation. Hypoparathyroidism may be clinically asymptomatic in a patient with RT as in our case. Early administration of glucocorticoids may be effective in reducing the fibrosclerotic process and lead to the recovery of parathyroid dysfunction.

Reshaping the Concept of Riedel’s Thyroiditis into the Larger Frame of IgG4-Related Disease (Spectrum of IgG4-Related Thyroid Disease)

“…Since 2019, nine case reports of a single patient per paper have been published according to our methods [ 6 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] ( Table 2 ).…”

“…On admission, a patient (who is eventually confirmed with RT) may have a long history of multinodular goiter, Hashimoto’s thyroiditis (in terms of elevated serum positive antibodies against thyroid according to usual diagnosis in daily practice), or hypoechoic pattern at ultrasound with or without associated hypothyroidism and not being categorized as RT during this time period unless a sudden/progressive thyroid enlargement with compression effects emerges [ 6 , 44 ]. Gökçay Canpolat et al [ 52 ] reported that only 25% of their series had positive anti-thyroid antibodies, suggesting that not all individuals display serological confirmation of Hashimoto’s thyroiditis.…”

“…Hypoparathyroidism due to RT-associated extensive fibrosis is found at first presentation, as well as a surgically-induced form in cases that require a large dissection or display adherent lesions at cervical areas [ 53 ]. For instance, Salhi et al [ 44 ] reported an adult female in her late 40s admitted for RT after a long evolution of goiter with hypothyroidism; she was diagnosed with transitory hypoparathyroidism at first RT presentation which remitted after a 1-year therapy with prednisone (20 mg/day) [ 44 ]. Shafi et al [ 49 ] described a male case with RT who was already under therapy with calcium and alfacalcidol in addition to levothyroxine when the final recognition of RT was conducted [ 49 ].…”

“…Serum IgG4 might not be increased in local (thyroid) forms of RT (with no other spreading of IgG4-RD) while immunohistochemistry provides a meticulous insight into IgG4-positive staining, which provides a clue regarding the specific case (regardless of the concentration of the serum IgG4 profile) [ 45 ]. Five out of the nine single case reports had a serum IgG4 assay available (only 2/5 had higher than normal values), while all subjects had a histological confirmation of the condition [ 6 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ].…”

“…Navarro-Sánchez et al [ 48 ] described the case of a 69-year-old female who was treated only with tamoxifen (20 mg per day for 2 months) in addition to levothyroxine replacement (100 µg per day) for hypothyroidism and registered an excellent response [ 48 ]. Of course, all the subjects admitted with a history of hypothyroidism, with RT-induced hypothyroidism, or those who developed post-thyroidectomy hypothyroidism received lifelong levothyroxine replacement [ 6 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ].…”