Riedel's thyroiditis as a diagnostic dilemma - A case report and review of the literature

Shafi, Alam Ara; Saad, Nourah Bin; Alharthi, Bandar N

doi:10.1016/j.amsu.2020.02.006

Cited by 13 publications

(29 citation statements)

References 23 publications

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“…Riedel’s thyroiditis is an extremely rare disease with a reported incidence of approximately 1 in 100 000, with a higher incidence in women (female/male ratio of 3.5: 1) [ 1 , 7 ]. It is more common in middle-aged adults (30–50 years of age) [ 1 , 7 ] and should be considered in the differential diagnosis of primary hypothyroidism after excluding more common etiologies, particularly in patients in which a stony-hard goiter is evident. Although Riedel’s thyroiditis is a benign, inflammatory condition, it can become an emergency due to airway obstruction.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

“…Normal thyroid parenchyma is replaced by abundant collagen fibers that take on the appearance of keloid bands. An inflammatory infiltrate that consists mainly of lymphocytes and plasma cells is readily apparent in Riedel’s thyroiditis [ 7 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Until now, there have been almost 200 cases reported in the literature. is sclerotic process may not only be limited to only the thyroid but also invades the surrounding vital structures such as vessels, nerves, trachea, esophagus, and parathyroid that leads to compressive symptoms and endocrine abnormalities [2]. It is a rare condition, with a prevalence of 1 per 100,000 inhabitants, which affects more frequently women between 30 and 50 years of age.…”

Section: Introductionmentioning

confidence: 99%

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

Errahali

Hammoumi

Issouani

et al. 2021

Case Reports in Endocrinology

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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.

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“…The incidence rate is estimated to 0.06-1.06 per 100,000 population. Females are more affected than males [6,7]. Although no pathognomonic clinical sign de nes this disease, compressive signs and endocrine abnormalities may be present [6].…”

Section: Introductionmentioning

confidence: 99%

Riedel's Thyroiditis Within an Elderly Patient Revealed by Tracheal Compression: a Case Report

Traore¹,

Aman²,

Coulibaly³

et al. 2021

Preprint

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Background : Riedel's thyroiditis (RT) is a rare fibrosclerotic disease that affects the thyroid gland and surrounding tissues. The etiology is unknown, and it rarely affects the elderly.Case Presentation : A 56-year-old man, with no particular medical history, was seen in consultation at the Surgery Department of the Treichville Teaching University Hospital for a painless swelling of the anterior base of the neck. Physical examination showed a patient with inspiratory dyspnea probably due to tracheal compression. The patient underwent a subtotal thyroidectomy because of the clinical symptomatology and the persistence of dyspnea. Macroscopically, the thyroid mass was well-encapsulated, weighed 80g, and measured 10 cm x 5 cm x 2 cm. After section, we observed whitish fibrous nodules associated with pinkish-brownish band. Histologically, the architecture of thyroid tissue was restructured by dense and diffuse collagenous fibrosis in which rare atrophic thyroid vesicles were found. The fibrous areas were infiltrated by inflammatory elements, including lymphocytes, plasmocytes, and eosinophilic polynuclear cells. No malignant cells were found. Masson's trichrome staining confirmed the fibrous nature of the thyroid tissue, which is essential for the certain diagnosis of Riedel's thyroiditis. There was no postoperative complication Conclusion : Riedel's thyroiditis is a rare disease that is difficult to diagnose preoperatively despite advances in imaging and fine needle cytology screening methods. Histological examination of the sample confirms the diagnosis of Riedel's thyroiditis. Thyroidectomy is indicated in patients with compression symptoms. Clinicians should suspect Riedel's thyroiditis in patients with a hard thyroid mass with compressive symptoms, despite its rarity.

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Riedel's thyroiditis as a diagnostic dilemma - A case report and review of the literature

Cited by 13 publications

References 23 publications

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

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

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

Riedel's Thyroiditis Within an Elderly Patient Revealed by Tracheal Compression: a Case Report

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