Riedel's thyroiditis

Riedel's thyroiditis, is a chronic form of thyroiditis. It is now believed that Riedel's thyroiditis is one manifestation of a systemic disease that can affect many organ systems called IgG4-related disease. It is often a multi-organ disease affecting pancreas, liver, kidney, salivary and orbital tissues and retroperitoneum. The hallmarks of the disease are fibrosis and infiltration by IgG4 secreting plasma cells.[1]

Riedel's thyroiditis
Other namesRiedel's struma
SpecialtyEndocrinology Edit this on Wikidata

Signs and symptoms

IgG4-related autoimmune diseases are characterized by excessive fibrosis. In case of Riedel's thyroiditis, fibrosis extends beyond the capsule and involves contiguous neck structures, clinically simulating thyroid carcinoma. There is a rapid thyroid enlargement. Compression of trachea, dysphagia are probable outcomes. Marked thyroid follicular cell atrophy confirms hypothyroidism. Signs of hypothyroidism include myxedema, lethargy, cold-intolerance, apathy, slowed intellectual functions, dysthymia or simply depressive-mood, decreased sympathetic activity induced constipation and decreased perspiration. Reduced cardiac output contributes shortness of breath and decreased blood flow explains skin pallor. [2]

Pathophysiology

Riedel's thyroiditis is characterized by a replacement of the normal thyroid parenchyma by a dense fibrosis that invades adjacent structures of the neck and extends beyond the thyroid capsule.[3] This makes the thyroid gland stone-hard (woody) and fixed to adjacent structures. The inflammatory process infiltrates muscles and causes symptoms of tracheal compression. Surgical treatment is required to relieve tracheal or esophageal obstruction.

Diagnosis

It typically present as a painless, hard anterior neck mass, which progresses over weeks to years to produce symptoms of compression, including dysphagia, dyspnea choking and hoarseness. Patients may present with symptoms of hypothyroidism and hypoparathyroidism as the gland is replaced by Fibrous tissues . Physical examination reveals a hard "woody" thyroid gland with fixation to surrounding tissue.[4] The diagnosis needs to be confirmed by open thyroid biopsy because the firm and Fibrous nature of the gland renders FNAB inadequate.

Treatment

Therapy usually consists of prednisolone, nonetheless some cases may require surgery. Tamoxifen has been proposed as part of a treatment plan.[5]

Treatment is directed to surgical relief of compressive symptoms. Tamoxifen may also be beneficial. The type of surgery which is indicated here is isthmectomy.

Prevalence

Riedel's thyroiditis is classified as rare.[6] Most patients remain euthyroid, but approximately 30% of patients become hypothyroid and very few patients are hyperthyroid. It is most commonly seen in women.[7]

Eponym

It is named for Bernhard Riedel. He first recognized the disease In 1883 and published its description in 1896.[8][9]

References
  1. John H. Stone; Yoh Zen; Vikram Deshpande (February 2012). "IgG4-Related Disease". New England Journal of Medicine. 366 (6): 539–51. doi:10.1056/NEJMra1104650. PMID 22316447.
  2. Kumar, V., Abbas, A. and Aster, J. (2020) Robbins and Cotran Pathologic Basis of Diseases. 10th Edition, Elsevier, Amsterdam.
  3. Cho MH, Kim CS, Park JS, et al. (August 2007). "Riedel's thyroiditis in a patient with recurrent subacute thyroiditis: a case report and review of the literature". Endocr. J. 54 (4): 559–62. doi:10.1507/endocrj.K06-186. PMID 17603227.
  4. Nagrath, Arun (2012), "Chapter-02 Principle of Surgery", Pediatric Secrets 1 Edition, Jaypee Brothers Medical Publishers (P) Ltd., p. 4, doi:10.5005/jp/books/11578_2, ISBN 9789350257753, retrieved 2022-08-17
  5. Dabelic N, Jukic T, Labar Z, Novosel SA, Matesa N, Kusic Z (April 2003). "Riedel's thyroiditis treated with tamoxifen" (PDF). Croat. Med. J. 44 (2): 239–41. PMID 12698518.
  6. Harach, HR; Williams, ED (Sep 1983). "Fibrous thyroiditis – an immunopathological study". Histopathology. 7 (5): 739–51. doi:10.1111/j.1365-2559.1983.tb02286.x. PMID 6195075. S2CID 31592244.
  7. "Riedel Thyroiditis: Background, Etiology, Epidemiology". January 24, 2022 – via eMedicine. {{cite journal}}: Cite journal requires |journal= (help)
  8. B. M. C. L. Riedel. Die chronische, zur Bildung eisenharter Tumoren führende Entzündung der Schilddrüse. Verhandlungen der deutschen Gesellschaft für Chirurgie, 1896, 25: 101–105.
  9. synd/3242 at Who Named It?
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