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IgG4-Related Fibrous Thyroiditis (Riedel's Thyroiditis): A Case Report.

Valeria Navarro-Sánchez¹, Luis Antonio Marín-Castañeda¹, Cecilia A Gallegos²

¹Department of Biochemistry and Medicine, La Salle University School of Medicine, Mexico City, Mexico.

The American Journal of Case Reports

|November 12, 2020

Summary

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Riedel's thyroiditis, a rare IgG4-related condition, can cause hypothyroidism and obstructive goiter. Tamoxifen effectively treated a patient, resolving symptoms without steroids or surgery.

Area of Science:

Endocrinology
Immunology
Pathology

Background:

Riedel's thyroiditis is a rare, invasive IgG4-related fibrotic condition affecting the thyroid gland.
Standardized treatment guidelines are lacking due to its low incidence.
Obstructive symptoms from stony-hard goiter pose significant risks.

Observation:

A 69-year-old woman presented with hypothyroidism and dysphagia due to a large, stony-hard goiter.
Imaging revealed massive, avascular thyroid enlargement without extrathyroidal extension.
Thyroid biopsy showed extensive fibrosis, follicular obliteration, and IgG4-rich lymphoplasmacytic infiltrate.

Findings:

Immunohistochemistry confirmed a high IgG4/IgG ratio (40%) and elevated serum IgG4 levels, supporting Riedel's thyroiditis diagnosis.

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The patient achieved symptom resolution with levothyroxine and tamoxifen therapy.

This contrasts with typical steroid or surgical interventions.

Implications:

Riedel's thyroiditis should be considered in hypothyroidism with stony-hard goiter.
Tamoxifen offers an effective alternative to steroids, monoclonal antibodies, or surgery.
This approach minimizes adverse effects and treatment costs.