Riedel’s Thyroiditis: Report of Two Cases and Literature Review

Abstract

Riedel’s thyroiditis is a rare entity consisting of a fibrotic process of the thyroid which can generate gland destruction, infiltration of cervical structures and even airway obstruction. It has been associated with systemic fibrotic disorders, autoimmune diseases, and more recently with spectrum of diseases related to excess of Immunoglobulin G type 4 (IgG4). Two cases of Riedel’s thyroiditis by IgG4, confirmed by immunohistochemistry and was managed surgically with favorable results during the follow-up time, are presented. These case descriptions highlight the diagnostic challenge of this disease, describe the response with surgical management, and make a brief update on the subject.

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

“…Due to the low incidence of Riedel's thyroiditis, adequate management of the disease appears di cult. Most authors have described that RT therapy should aim at treating hypo or hyperthyroidism and control brosis-related complications, including airway compression that can lead to recurrent pneumonia, that may be harmful for the patient [13]. In our case, resection of the obstructing segment was indicated.…”

“…Our patient had none of these autoimmune diseases. Clinically, there are no pathognomonic features of RT [13]. The most common sign of RT is an enlarged thyroid which is usually hard or even stony.…”

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

“…Decompressive surgery could be useful as a way to relieve airway obstruction. Thyroidectomy might be indicated in some patients, although the presence of fibrous tissue in the neck may increase the rate of morbidity associated with it [ 3 ]. Steroids are among the most accessible therapeutic options [ 2 , 3 ], although at the cost of their long-term adverse effects.…”

“…Riedel’s thyroiditis is an exceedingly rare disease of the thyroid, originally described in 1894 by the German surgeon Bernhard Moritz Carl Ludwig Riedel [ 1 ]. Thyroid parenchyma replacement by fibrous tissue results in progressive thyroid enlargement [ 1 , 2 ] and permanent destruction of thyroid epithelial tissue, leading to primary hypothyroidism [ 2 , 3 ]. In spite of the nonmalignant, inflammatory nature of Riedel’s thyroiditis, the affected gland may lead to obstruction of vital structures in the neck, causing dysphagia and dyspnea [ 2 , 4 ].…”

“…In spite of the nonmalignant, inflammatory nature of Riedel’s thyroiditis, the affected gland may lead to obstruction of vital structures in the neck, causing dysphagia and dyspnea [ 2 , 4 ]. Fibrous tissue may extend outside of the thyroid capsule and has been reported to destroy the parathyroid glands and cause hypoparathyroidism [ 3 ].…”