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Related Experiment Videos

A rare case of orbital involvement in Riedel's thyroiditis.

V Egsgaard Nielsen1, P Hecht, A S Krogdahl

  • 1Departments of Oto-Rhino-Laryngology, Odense University Hospital, Odense C, Denmark. viveque@hotmail.com

Journal of Endocrinological Investigation
|February 5, 2004
PubMed
Summary

Riedel's thyroiditis, a rare condition causing hypothyroidism and a hard goiter, can present with orbital pseudotumor. Treatment with L-thyroxine improved both thyroid and orbital symptoms.

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Area of Science:

  • Endocrinology
  • Ophthalmology
  • Rheumatology

Background:

  • Riedel's thyroiditis is a rare, chronic inflammatory condition affecting the thyroid gland, characterized by dense fibrosis.
  • Differential diagnosis of a stony hard, painful goiter includes infectious thyroiditis, Hashimoto's thyroiditis, and thyroid malignancy.
  • Orbital pseudotumor, also known as idiopathic orbital inflammation, can affect the orbital tissues, including the lacrimal glands.

Observation:

  • A 59-year-old female presented with hypothyroidism, a painful, stony hard goiter, fever, elevated inflammatory markers (sedimentation rate, C-reactive protein), and high anti-thyroid peroxidase antibodies (anti-TPOab).
  • Simultaneously, she exhibited clinical and radiological signs of bilateral orbital pseudotumor involving the lacrimal glands.
  • The patient's symptoms and thyroid size improved with L-thyroxine therapy.

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Findings:

  • This case highlights the co-occurrence of Riedel's thyroiditis and orbital pseudotumor with lacrimal gland involvement.
  • The successful treatment of both thyroid and orbital manifestations with L-thyroxine suggests a potential link or shared underlying fibrosclerotic process.
  • Elevated anti-thyroid peroxidase antibodies (anti-TPOab) were noted, which can be seen in various thyroid conditions.

Implications:

  • This case underscores the importance of considering Riedel's thyroiditis in the differential diagnosis of goiter, especially when accompanied by inflammatory signs.
  • The association with orbital pseudotumor suggests that multifocal fibrosclerosis, including orbital sclerosing fibrosis, may be linked to Riedel's thyroiditis.
  • Clinicians should maintain a broad differential diagnosis for goiter and ophthalmopathy, recognizing rare presentations and potential systemic associations.