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Riedel's thyroiditis: clinical presentation, treatment and outcomes.
Henrik Falhammar1,2, Carl Christofer Juhlin3,4, Caroline Barner5
1Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.
Endocrine
|January 31, 2018
Summary
Riedel's thyroiditis (RT) is a rare inflammatory thyroid condition. Early recognition and treatment, including steroids and monitoring for fibrosing manifestations, are crucial for patient outcomes.
Area of Science:
- Endocrinology
- Pathology
- Immunology
Background:
- Riedel's thyroiditis (RT) is a rare, chronic inflammatory condition affecting the thyroid gland.
- Characterized by extensive fibrosis, RT can cause compression of adjacent structures, leading to symptoms like hoarseness, dyspnea, and dysphagia.
- The goiter associated with RT is typically hard and firm due to the fibrotic process.
Observation:
- A retrospective review of patients with RT at Karolinska University Hospital (2003-2015) identified six cases.
- The majority of patients (five out of six) were female, with a median age of 50 years at presentation.
- Follow-up data revealed hypothyroidism in five patients and extrathyroidal manifestations in four, with one exhibiting distant fibrosis.
Findings:
- One patient demonstrated an elevated IgG4/IgG ratio (>40%), suggesting a potential role for IgG4-related disease.
- Treatment modalities included tracheostomy, isthmectomy, and total thyroidectomy.
- Pharmacological treatments involved glucocorticoids, tamoxifen, mycophenolate mofetil, and Rituximab, with varying degrees of success.
Implications:
- Prompt diagnosis and appropriate management of RT are essential for preventing complications.
- Glucocorticoids remain a primary treatment, but alternative antifibrotic agents should be considered.
- Awareness of potential fibrosing manifestations in other organs and the utility of immunohistochemistry for IgG-4 assessment are critical for comprehensive patient care.