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Riedel Thyroiditis Clinical Presentation

  • Author: Chris K Guerin, MD, FACE; Chief Editor: George T Griffing, MD  more...
 
Updated: Apr 25, 2014
 

History and Physical Examination

Riedel thyroiditis (RT) is characterized by the replacement of normal thyroid parenchyma with dense fibrotic tissue and by the extension of this fibrosis to adjacent structures of the neck. Most patients are euthyroid, but hypothyroidism is noted in approximately 30% of cases. Rarely, hyperthyroidism can occur, but this is probably secondary to a coexisting condition.

Clinical features of RT closely resemble those of anaplastic carcinoma of the thyroid. Patients note a nonpainful, rapidly growing thyroid mass.

Patients typically present with a hard, fixed, painless goiter. The character of the thyroid gland is often described as stony or woody. The onset of the goiter may be sudden, but it is usually gradual.

Local compressive symptoms are frequent and can include the following:

  • Neck tightness or pressure
  • Dyspnea
  • Dysphagia
  • Hoarseness
  • Choking
  • Cough

Such symptoms are the result of the increasing thyroid mass or are due to the extension of the fibrotic process to adjacent neck structures (eg, strap muscles, trachea, esophagus, recurrent laryngeal nerve).

Hypoparathyroidism is rare and presumably reflects fibrotic involvement of the parathyroid glands. Recurrent laryngeal nerve paralysis is also uncommon, but it can be observed in extensive disease.[10]

Approximately one third of patients with RT have an associated extracervical manifestation of multifocal fibrosclerosis. These manifestations can include the following[7] :

  • Retroperitoneal fibrosis
  • Mediastinal fibrosis
  • Orbital pseudotumor
  • Pulmonary fibrosis
  • Sclerosing cholangitis
  • Lacrimal gland fibrosis
  • Fibrosing parotitis
 
 
Contributor Information and Disclosures
Author

Chris K Guerin, MD, FACE Director, Diabetes Education Services, Chief, Division of Endocrinology, Tri-City Medical Center; Assistant Clinical Professor of Medicine, University of California, San Diego School of Medicine

Chris K Guerin, MD, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, American Society of Hypertension, National Lipid Association, American Diabetes Association, Endocrine Society

Disclosure: Nothing to disclose.

Coauthor(s)

John Boone, MD Consulting Staff, Department of Otolaryngology, Naval Hospital Oak Harbor

John Boone, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Acknowledgements

Stephanie L Lee, MD, PhD Associate Professor, Department of Medicine, Boston University School of Medicine; Director of Thyroid Health Center, Associate Chief, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center; Fellow, Association of Clinical Endocrinology

Stephanie L Lee, MD, PhD is a member of the following medical societies: American College of Endocrinology, American Thyroid Association, and Endocrine Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Kent Wehmeier, MD Professor, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, St Louis University School of Medicine

Kent Wehmeier, MD is a member of the following medical societies: American Society of Hypertension, Endocrine Society, and International Society for Clinical Densitometry

Disclosure: Nothing to disclose.

References
  1. Riedel BM. Die chronische, zur Bildung eisenharter Tumoren fuhrende Entzundung der Schilddruse. Verh Dtsch Ges Chir. 1896. 25:101-5.

  2. Schwaegerle SM, Bauer TW, Esselstyn CB Jr. Riedel's thyroiditis. Am J Clin Pathol. 1988 Dec. 90(6):715-22. [Medline].

  3. Fatourechi MM, Hay ID, McIver B, Sebo TJ, Fatourechi V. Invasive fibrous thyroiditis (riedel thyroiditis): the mayo clinic experience, 1976-2008. Thyroid. 2011 Jul. 21(7):765-72. [Medline].

  4. Pusztaszeri M, Triponez F, Pache JC, Bongiovanni M. Riedel's thyroiditis with increased IgG4 plasma cells: evidence for an underlying IgG4-related sclerosing disease?. Thyroid. 2012 Sep. 22(9):964-8. [Medline].

  5. Divatia M, Kim SA, Ro JY. IgG4-related sclerosing disease, an emerging entity: a review of a multi-system disease. Yonsei Med J. 2012 Jan. 53(1):15-34. [Medline]. [Full Text].

  6. Dahlgren M, Khosroshahi A, Nielsen GP, Deshpande V, Stone JH. Riedel's thyroiditis and multifocal fibrosclerosis are part of the IgG4-related systemic disease spectrum. Arthritis Care Res (Hoboken). 2010 Sep. 62(9):1312-8. [Medline].

  7. Oguz KK, Kiratli H, Oguz O, et al. Multifocal fibrosclerosis: a new case report and review of the literature. Eur Radiol. 2002 May. 12(5):1134-8. [Medline].

  8. Levy JM, Hasney CP, Friedlander PL, Kandil E, Occhipinti EA, Kahn MJ. Combined mycophenolate mofetil and prednisone therapy in tamoxifen- and prednisone-resistant Reidel's thyroiditis. Thyroid. 2010 Jan. 20(1):105-7. [Medline].

  9. Soh SB, Pham A, O'Hehir RE, Cherk M, Topliss DJ. Novel use of rituximab in a case of Riedel's thyroiditis refractory to glucocorticoids and tamoxifen. J Clin Endocrinol Metab. 2013 Sep. 98(9):3543-9. [Medline].

  10. Hennessey JV. Clinical review: Riedel's thyroiditis: a clinical review. J Clin Endocrinol Metab. 2011 Oct. 96(10):3031-41. [Medline].

  11. Perimenis P, Marcelli S, Leteurtre E, et al. [Riedel's thyroiditis: current aspects]. Presse Med. 2008 Jun. 37(6 Pt 2):1015-21. [Medline].

  12. Li Y, Nishihara E, Kakudo K. Hashimoto's thyroiditis: old concepts and new insights. Curr Opin Rheumatol. 2011 Jan. 23(1):102-7. [Medline].

  13. Morselli-Labate AM, Pezzilli R. Usefulness of serum IgG4 in the diagnosis and follow up of autoimmune pancreatitis: A systematic literature review and meta-analysis. J Gastroenterol Hepatol. 2009 Jan. 24(1):15-36. [Medline].

  14. Khosroshahi A, Stone JR, Pratt DS, Deshpande V, Stone JH. Painless jaundice with serial multi-organ dysfunction. Lancet. 2009 Apr 25. 373(9673):1494. [Medline].

  15. Drieskens O, Blockmans D, Van den Bruel A, et al. Riedel's thyroiditis and retroperitoneal fibrosis in multifocal fibrosclerosis: positron emission tomographic findings. Clin Nucl Med. 2002 Jun. 27(6):413-5. [Medline].

  16. Kotilainen P, Airas L, Kojo T, et al. Positron emission tomography as an aid in the diagnosis and follow-up of Riedel's thyroiditis. Eur J Intern Med. 2004. 15:186-9.

  17. Beahrs OH, McConahey WM, Woolner LB. Invasive fibrous thyroiditis (Riedel's struma). J Clin Endocrinol Metab. 1957 Feb. 17(2):201-20. [Medline].

  18. Lorenz K, Gimm O, Holzhausen HJ, et al. Riedel's thyroiditis: impact and strategy of a challenging surgery. Langenbecks Arch Surg. 2007 Jul. 392(4):405-12. [Medline].

  19. Lo JC, Loh KC, Rubin AL, et al. Riedel's thyroiditis presenting with hypothyroidism and hypoparathyroidism: dramatic response to glucocorticoid and thyroxine therapy. Clin Endocrinol (Oxf). 1998 Jun. 48(6):815-8. [Medline].

  20. Vaidya B, Harris PE, Barrett P, et al. Corticosteroid therapy in Riedel's thyroiditis. Postgrad Med J. 1997 Dec. 73(866):817-9. [Medline].

  21. Few J, Thompson NW, Angelos P, et al. Riedel's thyroiditis: treatment with tamoxifen. Surgery. 1996 Dec. 120(6):993-8; discussion 998-9. [Medline].

  22. De M, Jaap A, Dempster J. Tamoxifen therapy in steroid resistant Reidel's thyroiditis. Scott Med J. 2001 Apr. 46(2):56-7. [Medline].

  23. Jung YJ, Schaub CR, Rhoades R, et al. A case of Riedel's thyroiditis treated with tamoxifen: another successful outcome. Endocr Pract. 2004. 10(6):483-6.

  24. Pritchyk K, Newkirk K, Garlich P, et al. Tamoxifen therapy for Riedel's thyroiditis. Laryngoscope. 2004 Oct. 114(10):1758-60. [Medline].

  25. Levy JM, Hasney CP, Friedlander PL, Kandil E, Occhipinti EA, Kahn MJ. Combined mycophenolate mofetil and prednisone therapy in tamoxifen- and prednisone-resistant Reidel's thyroiditis. Thyroid. 2010 Jan. 20(1):105-7. [Medline].

  26. Khosroshahi A, Stone JH. A clinical overview of IgG4-related systemic disease. Curr Opin Rheumatol. 2011 Jan. 23(1):57-66. [Medline].

 
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Gross pathology of Riedel thyroiditis. The cut edge is avascular, with a characteristic white color. Image courtesy of SL Lee.
Riedel thyroiditis. The atrophic thyroid follicles are surrounded by a dense, inflammatory infiltrate composed of lymphocytes, plasma cells, and eosinophils and accompanied by dense fibrosis. The wide bands of keloid-type collagen located between the individual follicles and surrounding clusters are a common feature of this condition.
Riedel thyroiditis. This vein shows infiltration of its wall by a heavy, inflammatory infiltrate.
Riedel thyroiditis. The inflammatory infiltrate and dense, pink bands of fibrosis can obliterate thyroid follicles. Image courtesy of SL Lee.
 
 
 
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