Riedel's thyroiditis discovered at tracheostomy

A 55-year-old woman with a long-standing history of diabetes mellitus controlled with insulin was admitted under the Medical Unit to the Royal Sussex County Hospital, Brighton, on 27 December 1981, with a history of diarrhoea and anorexia of several weeks' duration. Prior to admission she had complained of a cough and her condition had been deteriorating rapidly for two days. On admission she had signs of pneumonia and this was confirmed on chest X-ray which showed diffuse shadowing on the right. The patient was placed on antibiotics, but her condition worsened over the next 24 hours and she suffered a respiratory arrest from which she was, however, successfully resuscitated. Subsequent to this event she was transferred to the Intensive Therapy Unit. Here her condition continued to deteriorate, with bilateral pneumonic changes and an uncertain degree of cerebral damage. On 7 January 1982, the E.N.T. Department was approached with a view to performing a tracheostomy in view of the need for prolonged ventilation. The patient was noted to be clinically myxoedematous and thyroid function tests confirmed this with a free thyroxine level of 0.4 pmol./litre. Other thyroid function tests were: Total T4-2 nmol./l.; TBG-216 nmol./l.; T3U-107; FTI-2. The ESR was 54 mm. in the first hour.