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Riedel Thyroiditis Medication

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

Medication Summary

As previously stated, corticosteroid therapy is the medical treatment of choice for patients with Riedel thyroiditis (RT).[20] These drugs have been found in most studies to reduce goiter size and relieve local compressive symptoms, although apparently not all patients benefit from treatment.

Tamoxifen can be used as a first-line therapy in patients with RT, or it can be employed as an alternative treatment if corticosteroid treatment fails. Levothyroxine is used to correct RT-associated hypothyroidism.[19]

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Corticosteroids

Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. These agents modify the body's immune response to diverse stimuli.

Prednisone

 

Prednisone is an immunosuppressant for the treatment of autoimmune disorders. It may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear leukocyte activity. The drug stabilizes lysosomal membranes and suppresses lymphocytes and antibody production.

Prednisolone (Pediapred, Prelone, Orapred)

 

Prednisolone may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear (PMN) leukocyte activity. It is a commonly used oral agent.

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Antineoplastic Agents

Class Summary

Tamoxifen is used to treat progressive Riedel thyroiditis (RT) that is not responsive to corticosteroids or surgical decompression, or is administered to patients with contraindications to corticosteroid therapy. It provides symptomatic improvement, as well as size reduction of the involved tissue as measured on CT scans.

Mycophenolate is an immunosuppressive therapy often used to prevent rejection after transplantation and/or in graft versus host disease. It has been used in disorders characterized by systemic fibrosis. In one study, significant improvement was noted after 90 days when used in combination with prednisone.[25]

Tamoxifen

 

The proposed mechanism of action for tamoxifen is not antiestrogen activity but rather the induction of transforming growth factor beta (a potent inhibitor of fibroblast proliferation).

Mycophenolate (Cell-Cept)

 

The proposed mechanism of action is inhibition of both T- and B- cell lymphoctye proliferation. It may also directly inhibit fibrosis, at least in animal models.[25]

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Thyroid Hormones

Class Summary

Thyroid hormones are used to correct hypothyroidism associated with Riedel thyroiditis (RT).

Levothyroxine (Levothroid, Levoxyl, Synthroid, Unithroid)

 

Levothyroxine rapidly inhibits the release of thyroid hormones via a direct effect on the thyroid gland; it also inhibits the synthesis of thyroid hormones. Iodide also appears to attenuate cyclic adenosine monophosphate (cAMP) ̶ mediated effects of TSH. In active form, levothyroxine influences the growth and maturation of tissues. It is involved in normal growth, metabolism, and development.

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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
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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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