Riedel's thyroiditis: impact and strategy of a challenging surgery

Area of Science:

• Endocrinology
• Surgical Oncology

Background:

• Riedel's thyroiditis (RT) lacks an established surgical standard.
• Surgery is typically reserved for severe compressive symptoms or suspected malignancy.
• Obscured surgical planes and extensive infiltration complicate RT management.

Purpose of the Study:

• To evaluate the clinical manifestation, treatment, and outcomes of surgical intervention in RT.
• To determine the role and efficacy of surgery in RT cases refractory to conservative management.

Main Methods:

• Presentation of a unique series of eight consecutive RT patients.
• Analysis of clinical data, surgical procedures (total and sub-total thyroidectomies), complications, and follow-up.
• Histopathological confirmation of RT and exclusion of malignancy.

Main Results:

• Symptomatic relief of cervical and airway obstruction was achieved in all surgically treated patients.
• Complications included transient hypoparathyroidism and one case of bilateral laryngeal nerve palsy.
• Two patients experienced mediastinal RT recurrence 1 and 6 years post-surgery.

Conclusions:

• Surgery for RT is valuable for symptomatic relief when conservative treatment fails.
• More extensive procedures do not improve outcomes and do not prevent recurrence.
• RT surgery demands specialized expertise and intra-operative neuromonitoring.