Thyroid

Riedel's Thyroiditis

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Riedel's Thyroiditis, Riedel Thyroiditis, Fibrous Thyroiditis

  • 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
  • Epidemiology
  1. Onset age 30 to 60 years
  • Symptoms
  1. Symptoms are related to local compression on esophagus and trachea (typically symptoms are more significant than the actual Goiter size)
  2. Stridor or Dyspnea
  3. Dysphagia
  • Signs
  1. Very firm (rock or wood-like) Thyroid swelling
  2. Hypothyroidism (30%)
  • 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
  • Imaging
  1. Radioiodine Uptake (Thyroid uptake and scan)
    1. Low uptake (contrast with Grave's Disease)
  • Diagnosis
  1. Thyroid biopsy
  • Management
  • Tracheal or esophageal compression
  1. First-line
    1. Surgical decompression
  2. Other agents
    1. Corticosteroids
    2. Mycophenolate (Cellcept)
    3. Methotrexate
    4. Tamoxifen (suppresses fibroblast proliferation)