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
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.
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.
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.