Riedel's Thyroiditis

Graham, Ann-Maree; Gilliland, I. C.

doi:10.1136/bmj.2.5146.225-a

Cited by 13 publications

(11 citation statements)

References 3 publications

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“…RT was linked with other fibrosclerotic diseases and thought to be a part of IgG4-RD, due to the extensive thyroidal fibrosis and the discovery of associated organ involvement such as retroperitoneal fibrosis [10], pancreatic fibrosis, mediastinal fibrosis, orbital pseudotumour [11], and sclerosing cholangitis [12]. Elevated serum IgG4 levels have not been documented in RT.…”

Section: Immunoglobulin G4 Related Thyroid Diseasesmentioning

confidence: 99%

Clinical Update in Aspects of the Management of Autoimmune Thyroid Diseases

Topliss

2016

Endocrinol Metab

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Aspects of autoimmune thyroid disease updated in this review include: immunoglobulin G4 (IgG4)-related thyroid disease (Riedel's thyroiditis, fibrosing variant of Hashimoto's thyroiditis, IgG4-related Hashimoto's thyroiditis, and Graves' disease with elevated IgG4 levels); recent epidemiological studies from China and Denmark indicating that excess iodine increases the incidence of Hashimoto's thyroiditis and hypothyroidism; immunomodulatory agents (ipilimumab, pembrolizumab, nivolumab) activate immune response by inhibiting T-cell surface receptors which down-regulate immune response, i.e., cytotoxic T-lymphocyte antigen 4 and programmed cell death protein 1 pathways; alemtuzumab is a humanised monoclonal antibody to CD52 which causes immune depletion and thyroid autoimmune disease especially Graves' hyperthyroidism; small molecule ligand (SML) agonists which activate receptors, SML neutral antagonists, which inhibit receptor activation by agonists, and SML inverse agonists which inhibit receptor activation by agonists and inhibit constitutive agonist independent signaling have been identified. SML antagonism of thyroid-stimulating hormone-receptor stimulatory antibody could treat Graves' hyperthyroidism and Graves' ophthalmopathy; and thyroxine treatment of subclinical hypothyroidism can produce iatrogenic subclinical hyperthyroidism with the risk of atrial fibrillation and osteoporosis. The increased risk of harm from subclinical hyperthyroidism may be stronger than the potential benefit from treatment of subclinical hypothyroidism.

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Section: Immunoglobulin G4 Related Thyroid Diseasesmentioning

confidence: 99%

Clinical Update in Aspects of the Management of Autoimmune Thyroid Diseases

Topliss

2016

Endocrinol Metab

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“…RT usually presents as a firm mass in the neck with the compressive symptoms of tracheal narrowing, dysphagia, and vocal cord paralysis [25]. However, in about a third of patients with RT, 1 or more of the other fibrosing disorders develops over the next decade [28].…”

Section: Riedel Thyroiditismentioning

confidence: 99%

“…Although most patients are clinically euthyroid at presentation, 30-40% eventually develop hypothyroidism as the gland is progressively infiltrated [30]. Antibody titres against thyroglobulin (Tg-Ab) and thyroperoxidase (TPO-Ab) are elevated in 90% [25] in RT, but most likely due to concurrent HT rather than an autoimmune etiology of RT [31]. Hypocalcaemia is common due to the involvement of parathyroid glands in the fibroinflammatory process [32].…”

Section: Riedel Thyroiditismentioning

confidence: 99%

“…RT is a rare form of chronic thyroiditis that is characterized by extensive fibrosis involving the thyroid gland and its surrounding tissues [25]. In 1896, Riedel initially recognized hard and infiltrative lesions in the thyroid gland in 2 cases which were thought to be malignant but were histologically proven to be otherwise [26].…”

Section: Riedel Thyroiditismentioning

confidence: 99%

“…RT was linked with other fibrosclerotic diseases and thought to be a part of IgG4-RD due to the extensive thyroidal fibrosis and due to the discovery of associated organ involvement, such as retroperitoneal fibrosis [25,29], pancreatic fibrosis, mediastinal fibrosis, orbital pseudotumour [28], and sclerosing cholangitis [12]. RT usually presents as a firm mass in the neck with the compressive symptoms of tracheal narrowing, dysphagia, and vocal cord paralysis [25].…”

Section: Riedel Thyroiditismentioning

confidence: 99%

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Immunoglobulin G4-Related Thyroid Diseases

Kottahachchi¹,

Topliss²

2016

Eur Thyroid J

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Immunoglobulin G4-related disease (IgG4-RD) is a new disease category involving many organ systems, including the endocrine system in general and the thyroid in particular. Since an initial association was made between hypothyroidism and autoimmune (IgG4-related) pancreatitis, more forms of IgG4-related thyroid disease (IgG4-RTD) have been recognized. Four subcategories of IgG4-RTD have so far been identified: Riedel thyroiditis (RT), fibrosing variant of Hashimoto thyroiditis (FVHT), IgG4-related Hashimoto thyroiditis, and Graves disease with elevated IgG4 levels. Although a male predominance is seen for IgG4-RD in general, RT and FVHT have a female preponderance. The pathogenesis of IgG4-RD is not completely understood; however, genetic factors, antigen-antibody reactions, and an allergic phenomenon have been described. Diagnosis of IgG4-RD requires a combination of clinical features, serological evidence, and histological features. Histology is the mainstay of diagnosis, with IgG4 immunostaining. Although serum IgG4 levels are usually elevated in IgG4-RD, raised serum IgG4 is neither necessary nor adequate for diagnosis. Imaging supports the diagnosis and is a useful tool in disease monitoring. Management of IgG4-RTD is both medical and surgical. Steroids are the first-line treatment and may produce a swift response. Tamoxifen and rituximab are second-line agents used in steroid-resistant patients. Surgical debulking is carried out in RT solely as a procedure to relieve obstruction. Other endocrine associations described with IgG4-RD are hypophysitis and Hashimoto encephalopathy. IgG4-RTD is an uncommon disease entity, and prompt diagnosis and treatment can improve outcomes.

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Invasive Fibrous (Riedel's) Thyroiditis With Bilateral Fibrous Parotitis

Hines¹

1970

JAMA

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Riedel's Thyroiditis

Cited by 13 publications

References 3 publications

Clinical Update in Aspects of the Management of Autoimmune Thyroid Diseases

Clinical Update in Aspects of the Management of Autoimmune Thyroid Diseases

Immunoglobulin G4-Related Thyroid Diseases

Invasive Fibrous (Riedel's) Thyroiditis With Bilateral Fibrous Parotitis

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