II. Pathophysiology

  1. Idiopathic destructive Thyroiditis resulting in fibrosis of Thyroid and adjacent neck
  2. May be associated with more generalized fibrosis
    1. Idiopathic Multifocal Fibrosclerosis

III. Epidemiology

  1. Onset age 30 to 60 years

IV. Symptoms

  1. Symptoms are related to local compression on esophagus and trachea (typically symptoms are more significant than the actual Goiter size)
  2. Compressive symptoms
    1. Stridor or Dyspnea
    2. Dysphagia
    3. Hoarseness

V. Signs

  1. Very firm (rock or wood-like) Thyroid swelling (Goiter)
  2. Hypothyroidism (30%)

VI. Labs

  1. Thyroid Function Tests (T4 Free and TSH)
    1. Most patients are euthyroid (70%)
    2. Hypothyroidism (Increased Serum TSH and decreased T4 Free) in up to 30% of cases
  2. Antithyroid peroxidase antibodies (>60%)
  3. Serum Calcium
    1. Hypocalcemia occurs if fibrosis affects the adjacent Parathyroid Glands

VII. Imaging

  1. Radioiodine Uptake (Thyroid uptake and scan)
    1. Low uptake (contrast with Grave's Disease)

VIII. Diagnosis

  1. Thyroid biopsy

IX. Management: Tracheal or esophageal compression

  1. First-line
    1. Surgical decompression
  2. Other agents (no definitive treatment)
    1. Corticosteroids
    2. Mycophenolate (Cellcept)
    3. Methotrexate
    4. Tamoxifen (suppresses fibroblast proliferation)

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Related Studies

Ontology: Riedel's thyroiditis (C0154162)

Concepts Disease or Syndrome (T047)
ICD10 E06.5
SnomedCT 89024000, 237540002, 190298005
English THYROIDITIS CHRONIC <RIEDELS>, Reidel's thyroiditis, Riedel's thyroiditis (diagnosis), THYROIDITIS CHRONIC RIEDELS, Riedel thyroiditis, reidel struma, riedel thyroiditis, invasive fibrous thyroiditis, riedels thyroiditis, riedel's thyroiditis, Invasive thyroiditis, Ligneous thyroiditis (disorder), Ligneous thyroiditis, Riedel's thyroiditis, Invasive fibrous thyroiditis, Struma fibrosa thyroid, Woody thyroiditis, Riedel's thyroiditis (disorder), Riedel; struma, Riedel; thyroiditis, ligneous; thyroiditis, struma; Riedel, thyroiditis; Riedel, thyroiditis; ligneous, thyroiditis; woody, woody; thyroiditis
Dutch invasieve thyroïditis, Riedel thyreoïditis, Reidel's thyroïditis, Riedel; struma, Riedel; thyroïditis, houtachtig; thyroïditis, lignosa; thyroïditis, struma; Riedel, thyroïditis; Riedel, thyroïditis; houtachtig, thyroïditis; lignosa
French Thyroïdite de Riedel, Thyroïdite ligneuse, Thyroïdite invasive
German invasive Thyreoiditis, Ligneous Thyroiditis, Riedel-Thyroiditis
Italian Tiroidite invasiva, Tiroidite lignea, Tiroidite di Riedel
Portuguese Tiroidite invasiva, Tiroidite de Riedel, Tiroidite lenhosa
Spanish Tiroiditis invasiva, Tiroiditis leñosa, Tiroiditis de Riedel, tiroiditis de Riedel (trastorno), tiroiditis de Riedel, tiroiditis fibrosa invasiva, tiroiditis leñosa, tiroiditis por estruma fibroso
Japanese 木様甲状腺炎, リーデル甲状腺炎, 侵入性甲状腺炎, リーデルコウジョウセンエン, モクヨウコウジョウセンエン, シンニュウセイコウジョウセンエン
Czech Thyroiditis lignea, Riedlova tyreoiditida, Invazivní tyreoiditida
Hungarian Riedel-thyreoiditis, Invasiv thyreoiditis, Thyreoiditis ligneosa

Ontology: Fibrous autoimmune thyroiditis (C0271813)

Concepts Pathologic Function (T046)
ICD9 245.3
ICD10 E06.5
SnomedCT 190298005, 84362007
English Chronic fibrous thyroiditis, chronic fibrous thyroiditis, chronic fibrous thyroiditis (diagnosis), Thyroiditis fibrous chronic, Chr fibrous thyroiditis, Chronic thyroiditis, fibrous variant, Fibrous autoimmune thyroiditis, Hashimoto thyroiditis, fibrous variant, Noninvasive fibrous thyroiditis, Fibrous autoimmune thyroiditis (disorder), chronic; thyroiditis, fibrous, thyroiditis; chronic, fibrous
Italian Tiroidite fibrosa cronica
Dutch chronische fibreuze thyreoïditis, chronisch; thyroïditis, fibreus, thyroïditis; chronisch, fibreus, thyreoïditis fibreus chronisch
German chronische fibroese Thyreoiditis, Thyreoiditis fibroes chronisch
Japanese 慢性線維性甲状腺炎, マンセイセンイセイコウジョウセンエン
Czech Chronický fibrózní zánět štítné žlázy, Chronická fibrózní tyreoiditida
Hungarian Chronikus fibrosus thyreoiditis
Spanish tiroiditis crónica, variante fibrosa, tiroiditis de Hashimoto, variante fibrosa (trastorno), tiroiditis de Hashimoto, variante fibrosa, tiroiditis fibrosa autoinmune, Tiroiditis fibrosa crónica
Portuguese Tiroidite fibrosa crónica
French Thyroïdite fibreuse chronique