With riedels thyroiditis, thyroid refers to the thyroid gland, and itis means inflammation. Riedels thyroiditis is a rare chronic inflammatory disease of the thyroid gland first recognized by bernhard riedel in 1893. Surgical treatment alone is often unsatisfactory in permanently alleviating airway compression, dysphagia, neck immobility, pain, or chronic fatigue syndrome. Mar 18, 2014 the aim of this study was to analyze and compare clinico pathological aspects of riedels thyroiditis rt and the fibrous variant of hashimotos thyroiditis htfv, and to show their immunohistochemical features. Compared to rt, htfv patients had hypothyroidism, no pressure symptoms, and frequently diagnostic fineneedle aspiration biopsy. The hallmarks of the disease are fibrosis and infiltration by igg4 secreting plasma cells. Thyroiditis is an inflammation of the thyroid gland that may be painful and tender when caused by infection, radiation, or trauma, or painless when caused by autoimmune conditions, medications, or. Riedels thyroiditis a case report with genes expression. Bernhard moritz carl ludwig riedel who first described it. Riedel thyroiditis, or riedels thyroiditis rt, is a rare, chronic inflammatory disease of the thyroid gland characterized by a dense fibrosis that replaces normal thyroid parenchyma.
Mostly, there is preexisting thyroid disease carcinoma, hashimotos thyroiditis, or multinodular goiter, congenital anomalies e. Riedels thyroiditis and multifocal fibrosclerosis are. Patients will experience a hyperthyroid period as the cellular lining of colloid spaces fails. Riedels thyroiditis fibrous thyroiditis, rt is an extremely rare form of thyroiditis, leading to a gradual parenchymal transformation to connective tissue.
Riedels 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. However, when surgical exploration is performed the finding of a hard fibrous mass replacing the thyroid, firmly adherent to surrounding planes, and a microscopic pattern of interstitial fibrosis with a lymphoplasmacytic infiltrate and atrophic thyroid follicles establishes a. Occlusive phlebitis, a diagnostic feature in riedels thyroiditis. We discuss the presentation, investigation and management of this very rare condition. Since riedels thyroiditis is a rare disease, there is lack of research for specific therapy. It is often a multiorgan disease affecting pancreas, liver, kidney, salivary and orbital tissues and retroperitoneum. Riedels thyroiditis in a patient with recurrent subacute. Fibrous thyroiditisan immunopathological study harach. Histopathology con firmed the di ag no sis of riedels thyroiditis. Because of inconclusive cytology, a total thyroidectomy was. Riedels thyroiditis is a rare but fascinating condition that remains poorly understood more than 100 years after its initial description. A 55yearold female was referred to our department for an unexplained onset of cervical discomfort.
We have compared the histological and immunohistochemical characteristics of three cases diagnosed as riedels thyroiditis with five cases of the fibrous variant of hashimotos thyroiditis. It is sometimes considered as a manifestation of a wider systemic disease with fibrosis of the retroperitoneum, mediastinum, as well as lymphocytic infiltration of extraocular orbital muscles, salivary and lacrimal glands 4. In a large series of thyroidectomies, the incidence is given as 0. Riedel s thyroiditis is a rare disease which has in the past been confused with the much commoner fibrous variant of hashimoto s thyroiditis. Riedel s thyroiditis is often suspected on clinical grounds of being an undifferentiated carcinoma.
Epidemiology and demographics riedels thyroiditis is a rare disease with an approximate incidence. Riedels thyroiditis is a rare entity in which fibrous tissue replaces the thyroid gland and tends to extend into the surrounding tissues. We report the case of a 72yearold caucasian woman who presented with a goiter, which showed a rapid increase in size at ultrasound check, suggesting malignancy. Although riedel s thyroiditis and the fibrosing variant of hashimoto s thyroiditis were once considered morphologic variants of the same disease, since the 1970s these diseases have been considered as distinct clinicopathologic entities. Riedels thyroiditis is often suspected on clinical grounds of being an undifferentiated carcinoma. The fibrotic process invades adjacent structures of the neck and extends beyond the thyroid capsule. Clinically this is a hard, palpable goiter, which could cause pain, compressive symptoms, and affect adjacent structures as the parathyroid glands, musculature in the neck and cause. Hematoxylin and eosin staining of the thyroid lesions revealed lymphoplasmacytic infiltration, severe fibrosis a, b, and obliterative phlebitis c, d. Synonyms include riedels struma, ligneous thyroiditis and invasive fibrous or chronic sclerosing thyroiditis. The relationship of riedels thyroiditis to other forms of thyroiditis is not clear. Riedels thyroiditis masquerading as anaplastic thyroid.
Genetic background of riedel s thyroiditis remains unknown. After a period of time with tapering dose of corticosteroid therapy the mass. Herein, we describe our results of studies on genes expression levels in riedel s thyroiditis. Riedels thyroiditis, is a chronic form of thyroiditis. The coexistence of both diseases in a patient is rare and is probably coincidental in this instance. Riedels thyroiditis is a rare fibrotic condition which not only involves the thyroid gland but also infiltrates the important surrounding structures in the neck 1, 2. So, riedels thyroiditis is a condition where there is inflammation of the thyroid gland, which slowly causes fibrous tissue to replace the normal thyroid tissue. Jan 20, 2010 riedel s thyroiditis is a rare thyroid disease characterized by dense fibrous tissues that replace the thyroid gland and invade the adjacent structures that can mimic thyroid malignancy. Our re port in di cates that tamoxifen can be a valu able drug ther apy in the treat ment of riedels thyroiditis.
Fibrous variant of hashimotos thyroiditis as a diagnostic. Riedels thyroiditis is a very rare form of chronic thyroiditis exhibiting an inflammatory proliferative fibrotic process, which destroys the gland and permeates throughout the capsule. Surgical treatment alone is often unsatisfactory in permanently alleviating airway compression, dysphagia, neck. Riedel thyroiditis is a rare chronic inflammatory disease of the thyroid gland and is characterized by the invasion of the thyroid gland and surrounding structures by dense fibrous tissues 1, 2. Riedel s thyroiditis is a rare benign pathology of unclear etiology, characterized by a densely fibrotic inflammatory process involving the thyroid gland and the adjacent neck tissues. The condition is named after the german surgeon dr. They include conditions that cause acute illness with severe thyroid pain eg, subacute thyroiditis and infectious thyroiditis and conditions in which there is no clinically evident inflammation and the illness is manifested primarily by thyroid dysfunction or. Reports about imaging features of riedel s thyroiditis are limited in the radiologic literature.
Proteomic approach used in the diagnosis of riedels. It is important to distinguish riedel s thyroiditis from thyroid carcinoma. Herein, we describe our results of studies on genes expression levels in riedels thyroiditis. We describe herein ct and mr imaging features of riedels thyroiditis in a case of. Histopathological images from patient 1 left column and patient 2 right column are shown. Riedels thyroiditis mimicking as anaplastic thyroid. We describe herein ct and mr imaging features of riedel s thyroiditis in a case of. She was diagnosed with subacute thyroiditis based on clinical manifestation and laboratory results. Discussion riedels thyroiditis is a very rare form of chronic thyroiditis exhibiting an inflammatory proliferative fibrotic process, which destroys the gland and permeates throughout the capsule. Jun 17, 2016 riedel s thyroiditis is a rare benign pathology of unclear etiology, characterized by a densely fibrotic inflammatory process involving the thyroid gland and the adjacent neck tissues.
It is characterized by an extensive fibrous proliferation without extension into the surrounding structures. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Reports about imaging features of riedels thyroiditis are limited in the radiologic literature. We report the case of 48year old woman with riedel s thyroiditis who has presented unusual course of disease with nonspecific cervical discomfort, though as with no pain andor no compression symptoms. May 15, 2006 thyroiditis is an inflammation of the thyroid gland that may be painful and tender when caused by infection, radiation, or trauma, or painless when caused by autoimmune conditions, medications, or. Thyroid uk other thyroid disorders riedels thyroiditis. Histopathology confirmed the diagnosis of riedels thyroiditis. Most recently all these pathologies are considered as manifestations of the same pathology known as igg4. A thyroid biopsy with histologic features of both riedels. Occlusive phlebitis, a diagnostic feature in riedel s thyroiditis. Riedels thyroiditis and fibrous variant of hashimotos.
She presented a voluminous goiter of hard consistence. Riedels thyroiditis is a rare thyroid disease characterized by dense fibrous tissues that replace the thyroid gland and invade the adjacent structures that can mimic thyroid malignancy. In this article, we describe an unusual case of riedel s thyroiditis and discuss its imagery and pathology. We report the case of 48year old woman with riedels thyroiditis who has presented unusual course of disease with nonspecific cervical discomfort, though as with no pain andor no compression symptoms. Riedels thyroiditis is an often disabling disease with clinical and histologic similarity to several other fibrous inflammatory disorders. It is often a multiorgan disease affecting pancreas, liver, kidney. There is a paucity of robust epidemiological data because the worlds literature consists primarily of case reports and small case series. Riedels thyroiditis american journal of clinical pathology. The term thyroiditis encompasses a diverse group of disorders characterized by some form of thyroid inflammation. Genetic background of riedels thyroiditis remains unknown. Riedels thyroiditis is a rare disorder of unknown etiology and may be seen isolated or as a part of multifocal fibrosclerosis. Sarcoma of the thyroid region mimicking riedels thyroiditis.
Riedel s thyroiditis, a rare thyroid disease, can be difficult to diagnose prior to surgical removal and can be confused with malignancy both clinically and cytologically. Riedels thyroiditis wikimili, the free encyclopedia. It is now believed that riedels thyroiditis is one manifestation of a systemic disease that can affect many organ systems called igg4related disease. It is important to distinguish riedels thyroiditis from thyroid carcinoma. Fibrous variant of hashimotos thyroiditis is a rare condition occurring in about 10% cases, mainly middle age people.
Riedels thyroiditis is a rare form of chronic thyroiditis that is characterized by an inflammatory proliferative fibrosing process. Mar 07, 2017 riedel thyroiditis, or riedel s thyroiditis rt, is a rare, chronic inflammatory disease of the thyroid gland characterized by a dense fibrosis that replaces normal thyroid parenchyma. In order to clarify the clinical and pathologic features of this rare disorder, a recent case of riedels thyroiditis is presented, 6 additional cases from the surgical pathology files of the cleveland clinic foundation are reported, and the 178 cases. We present a case of a 59yearold africancaribbean man who presented with a rapidly growing hard neck mass, a hoarse. Riedels thyroiditis is a rare inflammatory process involving the thyroid and surrounding cervical tissues and is associated with various forms of systemic fibrosis. Clinicopathological features of riedels thyroiditis. Riedel s thyroiditis is an often disabling disease with clinical and histologic similarity to several other fibrous inflammatory disorders. Thank you for your interest in spreading the word about the bmj.
Riedels presentation is complex, including a thyroid mass associated with local symptoms, characteristic biochemical abnormalities such as hypocalcemia and hypothyroidism, as well as the involvement of a wide range of other organ systems. Riedel s thyroiditis is a rare disorder of unknown etiology and may be seen isolated or as a part of multifocal fibrosclerosis. Jan 29, 2018 riedels thyroiditis fibrous thyroiditis, rt is an extremely rare form of thyroiditis, leading to a gradual parenchymal transformation to connective tissue. The aim of this study was to analyze and compare clinico pathological aspects of riedels thyroiditis rt and the fibrous variant of hashimotos thyroiditis htfv, and to show their immunohistochemical features. 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. Potential characterizations have included riedels thyroiditis as a thyroid or cervical location for a systemic fibrosing disorder with identical histopathological features, a variant of hashimotos thyroiditis, a primary inflammatory disorder of the thyroid, or even a manifestation of endstage subacute thyroiditis 1, 11, 12. As with many autoimmune diseases, most of the time doctors prescribe steroids for treating the symptoms of riedels thyroiditis. Compared to rt, htfv patients had hypothyroidism, no pressure symptoms, and frequently diagnostic fineneedle aspiration. Our report indicates that tamoxifen can be a valuable drug therapy in the treatment of riedels thyroiditis. Riedels thyroiditis, also called riedels struma is a chronic form of thyroiditis it is now believed that riedels thyroiditis is one manifestation of a systemic disease that can affect many organ systems called igg4related disease. Riedel thyroiditis, or riedel s thyroiditis rt, is a rare, chronic inflammatory disease of the thyroid gland characterized by a dense fibrosis that replaces normal thyroid parenchyma. We have compared the histological and immunohistochemical characteristics of three cases diagnosed as riedel s thyroiditis with five cases of the fibrous variant of hashimoto s thyroiditis. Initial lesion is focal, then oxyphilic metaplasia of follicular cells and nodularity.
Riedel s thyroiditis, is a chronic form of thyroiditis. In this article, we describe an unusual case of riedels thyroiditis and discuss its imagery and pathology. Riedels thyroiditis riedels thyroiditis is a very rare form of thyroid disease which causes a dense fibrosis scarring of the connective tissue that replaces normal thyroid tissue. Riedels thyroiditis is a rare disease which has in the past been confused with the much commoner fibrous variant of hashimotos thyroiditis. It is often a multiorgan disease affecting pancreas, liver, kidney, salivary and orbital tissues and. A case of riedels thyroiditis in a 51yearold woman presenting with symptoms of subacute thyroiditis, is reported. Although riedels thyroiditis and the fibrosing variant of hashimotos thyroiditis were once considered morphologic variants of the same disease, since the 1970s these diseases have been considered as distinct clinicopathologic entities. Riedels thyroiditis is exceedingly rare, occurring in some series one 50th as frequently as hashimotos thyroiditis 1115. This fibrotic process spreads to tissue in the neck outside the thyroid capsule. Acute thyroiditis usually bacterial, acute thyroiditis can also be fungal, mycobacterial or parasitic fig. Extensive stony hard fibrosis involving a goitrous thyroid gland and infiltration into adjacent muscle and other structures, obliterating tissue planes at surgery.
Riedels thyroiditis is a rare disorder of unknown etiology and may be seen isolated or as a part of multifocal. This condition is characterized by overgrowth of connective tissue which often extends into neighboring structures. All 3 riedels thyroiditis thyroidectomy samples in this series stained positively for igg4. It is now believed that riedel s thyroiditis is one manifestation of a systemic disease that can affect many organ systems called igg4related disease.
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