Thyroiditis, Riedel

• • Rare condition

  • Invasive fibrosis of the thyroid gland

  • Symptoms appear gradually

Epidemiology

• • Extremely rare

  • Usually presents in middle-aged women

Symptoms and Signs

• • Large, nontender, woody mass in the thyroid region

  • Stridor

  • Dysphagia

  • Hoarse voice

Laboratory Findings

• • Biopsy shows marked fibrosis and chronic inflammation

  • Hypothyroid (late stage)

  • Absent or low titers of antithyroid antibodies

• • Inflammatory process involves surrounding muscles and causes tracheal compression or esophageal obstruction

  • Etiology is unknown

  • May be associated with fibrosis of other organ systems, such as the retroperitoneum

Rule Out

• • Thyroid carcinoma

• • Physical exam

  • Thyroid function tests

  • Cervical ultrasound

  • Fine needle aspiration

• • Corticosteroid therapy often requires long-term maintenance therapy

  • Low-dose radiation may be beneficial if corticosteroids or surgery is unsuccessful

Surgery

Indications

• • Esophageal or tracheal compression

Medications

• • Corticosteroid therapy

  • Thyroid hormone replacement if hypothyroid

Prognosis

• • Multifocal fibrosis may develop in a few patients as many as 10 years after diagnosis with Reidel thyroiditis; this may be life-threatening

References