Reidel’s Thyroiditis, a Diagnostic and Management Challenge: A Case Report and Review of the Literature

Abstract

Riedel's thyroiditis is a very rare inflammatory condition. It affects not only the thyroid gland but also the adjacent vital structures. It may also be associated with different forms of systemic fibrotic disorders. The exact etiology is unknown, but currently, the most favorable opinion is that it is a localized form of the systemic fibrotic process. We report the case of a 38-year-old woman, presented with a 10-month history of progressive hypothyroidism, dysphonia, and dysphagia. A Doppler ultrasound study revealed massive thyroid enlargement with multiple Eu TIRADS 3 and 4 nodules. Fine needle aspiration was noncontributive on two occasions. A hard subtotal thyroidectomy was performed. Pathological study confirmed Riedel's thyroiditis with the presence of IgG4 antibodies in immunohistochemistry. The patient was successfully treated with levothyroxine replacement and corticosteroid therapy with rapid resolution of obstructive symptoms. The case descriptions highlight the diagnostic challenge of this disease, describe the response to surgical management and corticosteroid therapy, and give a short review of the subject.

Riedel’s Thyroiditis: Pitfalls in Diagnosis and Subsequent Complications

“…Less commonly, alternative medical treatments have also been used in the treatment of Riedel's thyroiditis. Case reports have mentioned successful treatment with mycophenolate mofetil, rituximab, and low dose radiation [ 16 ]. These therapies are often considered in refractory cases.…”

IgG4-related sclerosing thyroiditis (Riedel-Struma): a review of clinicopathological features and management

“…Several authors accept that surgical treatment is not indicated, at least initially [ 6 , 7 , 34 ]. However, particularly historically, total thyroidectomy has been attempted [ 9 – 37 ] to relieve compression symptoms [ 5 , 34 , 71 ]. Nonetheless, in the presence of significant extrathyroidal extension, surgery can be challenging and if the great vessels of the neck are encased (see above) may not be possible.…”

“…Standard dosages are 100 mg of prednisone daily [ 5 ]. Administration can start with lower doses (from 15 to 60 mg) and even stay at these if the response is satisfactory [ 9 – 13 , 15 , 18 , 19 , 24 , 27 , 31 , 33 , 36 , 43 , 44 , 46 – 49 , 78 , 79 , 94 , 96 , 99 ]. In the case of smokers, the dose should be increased and the therapy repeated [ 7 ].…”

“…In the event of hyperthyroidism, radioiodine therapy or, in uncontrolled cases, external beam radiotherapy may be used [ 43 ], and levothyroxine is administered when hypothyroidism occurs [ 9 , 10 , 12 , 16 , 18 , 20 , 22 – 25 , 27 , 28 , 31 , 33 , 34 , 36 , 47 , 49 , 99 , 111 ].…”

“…There is a gender predilection with females affected three times more often than males [ 1 , 5 – 8 ]. Thyroidectomy has traditionally been performed for this condition [ 9 – 37 ]. RT is a rare disease with an incidence of approximately 1:100,000 to 1.6:100,000 [ 38 – 42 ].…”