Background: Riedel’s thyroiditis is a rare form of chronic inflammatory disease affecting the thyroid gland. It is characterised by the replacement of the thyroid parenchyma by fibrous tissue. It also affects the adjacent vital structures. Due to its characteristic presentations, Riedel’s thyroiditis may not be immediately diagnosed. Objectives: Through this clinical case, we aimed to describe the pathology and clinical characteristics of Riedel’s thyroiditis and the diagnostic, therapeutic, and progressive modalities. Methods: A 62-year-old woman with no particular pathological history is consulted at the outpatient clinic for anterior cervical swelling that has been present for more than 5 years and is associated with respiratory discomfort and dysphagia to solids. Clinical examination, ultrasound, lab tests and injected cervical computed tomography (CT) were performed. These tests were completed with pathological examination. Results: General conditions were normal. Anterior cervical swelling, marked on the right, of hard consistency, causing cervical shielding with healthy surrounding skin, was observed at the examination. A compressive goitre was first suspected. Thyroid tests showed hypothyroidism. The CT revealed a hypodense goitre with micro-calcifications developed at the expense of the right lobe and exerting a mass effect on the trachea and oesophagus. Aspiration thyroid was not conclusive given the suspicion of the malignant nature of the goitre, and the decision to perform a right loboisthmectomy was taken. Pathological examination of the biopsy showed atrophy of the thyroid parenchyma with dense septal fibrosis punctuated by lymphocytes and extending throughout the tissue associated with inflammation—an appearance in favour of Riedel’s thyroiditis. The patient was treated with Levothyroxine and corticoids. Conclusions: This case points out the challenges in diagnosing Riedel’s Thyroiditis and the complexity of the pathology that requires a rigorous diagnostic approach and appropriate treatment for the best outcome.
References
[1]
Crile, G. (1948) Thyroiditis. AnnalsofSurgery, 127, 640-654. https://doi.org/10.1097/00000658-194804000-00005
Zimmermann‐Belsing, T. and Feldt‐Rasmussen, U. (1994) Riedel’s Thyroiditis: An Autoimmune or Primary Fibrotic Disease? JournalofInternalMedicine, 235, 271-274. https://doi.org/10.1111/j.1365-2796.1994.tb01071.x
[4]
Riedel, B.M. (1896) Die chronische, zur Bildung eisenharter Tumoren fuhrende Entzundung der Schilddruse. Verhandlungen der deutschen Gesellschaft für Chirurgie, 25, 101-105.
[5]
Riedel, B.M. (1896) Vorstellung eines Kranken mit chronischer Strumitis. Verhandlungen der deutschen Gesellschaft für Chirurgie, 26, 127-129.
[6]
Riedel, B.M. (1910) Ueber Verlauf und Ausgang der chronischer Strumitis. Munchener Medizinische Wochenschrift, 57, 1946-1947.
[7]
Majety, P. and Hennessey, J.V. (2022) Acute and Subacute, and Riedel’s Thyroiditis. Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School. https://www.ncbi.nlm.nih.gov/books/NBK285553/
[8]
Czarnywojtek, A., Pietrończyk, K., Thompson, L.D.R., Triantafyllou, A., Florek, E., Sawicka-Gutaj, N., et al. (2023) IGG4-Related Sclerosing Thyroiditis (Riedel-Struma): A Review of Clinicopathological Features and Management. VirchowsArchiv, 483, 133-144. https://doi.org/10.1007/s00428-023-03561-2
[9]
Heufelder, A.E. and Hay, I.D. (1994) Evidence for Autoimmune Mechanisms in the Evolution of Invasive Fibrous Thyroiditis (Riedel’s Struma). TheClinicalInvestigator, 72, 788-793. https://doi.org/10.1007/bf00180548
[10]
Fatourechi, M.M., Hay, I.D., McIver, B., Sebo, T.J. and Fatourechi, V. (2011) Invasive Fibrous Thyroiditis (Riedel Thyroiditis): The Mayo Clinic Experience, 1976-2008. Thyroid, 21, 765-772. https://doi.org/10.1089/thy.2010.0453
[11]
Shiva Kumar, Y.G., Minhthao, N. and Vishnu, V.G. (2024) Riedel Thyroiditis. StatPearls Publishing LLC.
Chopra, D., Wool, M.S., Crosson, A. and Sawin, C.T. (1978) Riedel’s Struma Associated with Subacute Thyroiditis, Hypothyroidism, and Hypoparathyroidism. TheJournalofClinicalEndocrinology&Metabolism, 46, 869-871. https://doi.org/10.1210/jcem-46-6-869
[14]
Shafi, A.A., Saad, N.B. and AlHarthi, B. (2020) Riedel’s Thyroiditis as a Diagnostic Dilemma—A Case Report and Review of the Literature. AnnalsofMedicineandSurgery, 52, 5-9. https://doi.org/10.1016/j.amsu.2020.02.006
[15]
Blanco, V.M., Páez, C.A., Victoria, A.M., Arango, L.G., Arrunategui, A.M., Escobar, J., et al. (2019) Riedel’s Thyroiditis: Report of Two Cases and Literature Review. CaseReportsinEndocrinology, 2019, Article ID: 5130106. https://doi.org/10.1155/2019/5130106
[16]
Marín, F., Araujo, R., Páramo, C., Lucas, T. and Salto, L. (1989) Riedel’s Thyroiditis Associated with Hypothyroidism and Hypoparathyroidism. PostgraduateMedicalJournal, 65, 381-383. https://doi.org/10.1136/pgmj.65.764.381
[17]
Lo, J.C., Loh, K., Rubin, A.L., Cha, I. and Greenspan, F.S. (1998) Riedel’s Thyroiditis Presenting with Hypothyroidism and Hypoparathyroidism: Dramatic Response to Glucocorticoid and Thyroxine Therapy. ClinicalEndocrinology, 48, 815-818. https://doi.org/10.1046/j.1365-2265.1998.00449.x
[18]
hakeem, A.H., Chandramathyamma, S.K., Hakeem, I.H., Wani, F.J. and Gomez, R. (2016) Riedel’s Thyroiditis Mimicking as Anaplastic Thyroid Carcinoma: Unusual Presentation. IndianJournalofSurgicalOncology, 7, 359-362. https://doi.org/10.1007/s13193-016-0513-5
[19]
Shafi, A.A., Saad, N.B. and AlHarthi, B. (2020) Riedel’s Thyroiditis as a Diagnostic Dilemma—A Case Report and Review of the Literature. AnnalsofMedicineandSurgery, 52, 5-9. https://doi.org/10.1016/j.amsu.2020.02.006
[20]
Guia Lopes, M.L., Cidade, J.P., Cunha, C., Limbert, C. and Sequeira Duarte, J. (2024) Life-Threatening Airway Obstruction by Riedel’s Thyroiditis: A Rare Presentation and Diagnostic Dilemma. Endocrinology, Diabetes&MetabolismCaseReports, 2024, Article No. 24-0053. https://doi.org/10.1530/edm-24-0053
[21]
Darouichi, M. and Constanthin, P.E. (2016) Riedel’s Thyroiditis. RadiologyCaseReports, 11, 175-177. https://doi.org/10.1016/j.radcr.2016.05.017
[22]
Ozgen, A. and Cila, A. (2000) Riedel’s Thyroiditis in Multifocal Fibro Sclerosis: CT and MR Imaging Findings. American Journal of Neuroradiology, 21, 320-321.
[23]
Kotilainen, P., Airas, L., Kojo, T., Kurki, T., Kataja, K., Minn, H., et al. (2004) Positron Emission Tomography as an Aid in the Diagnosis and Follow-Up of Riedel’s Thyroiditis. EuropeanJournalofInternalMedicine, 15, 186-189. https://doi.org/10.1016/j.ejim.2004.03.002
[24]
Lauwyck, J.Y., Van Walleghem, L.P. and De Geeter, F. (2015) IgG4-Related Disease: The Utility of (18) F-FDG PET/CT in Diagnosis and Treatment. HellenicJournalofNuclearMedicine, 18, 155-159.
[25]
Kumar, N., Gupta, R., Sayed, S., Moloo, Z., Vinayak, S. and Ahmed, M. (2018) Difficulties in Diagnosis of Riedel’s Thyroiditis on Aspiration Cytology: A Case Report and Brief Review of the Literature. DiagnosticCytopathology, 47, 512-516. https://doi.org/10.1002/dc.24130
[26]
Falhammar, H., Juhlin, C.C., Barner, C., Catrina, S., Karefylakis, C. and Calissendorff, J. (2018) Riedel’s Thyroiditis: Clinical Presentation, Treatment and Outcomes. Endocrine, 60, 185-192. https://doi.org/10.1007/s12020-018-1526-3
[27]
De, M., Jaap, A. and Dempster, J. (2001) Tamoxifen Therapy in Steroid Resistant Reidel’s Thyroiditis. ScottishMedicalJournal, 46, 56-57. https://doi.org/10.1177/003693300104600211
[28]
Wang, C., Wu, T., Lee, C. and Huang, S. (2012) A Misdiagnosed Riedel’s Thyroiditis Successfully Treated by Thyroidectomy and Tamoxifen. JournaloftheFormosanMedicalAssociation, 111, 719-723. https://doi.org/10.1016/j.jfma.2012.07.012
[29]
Navarro-Sánchez, V., Marín-Castañeda, L.A., Gallegos, C.A., Quiroz, O. and Ahumada-Ayala, M. (2020) Igg4-Related Fibrous Thyroiditis (Riedel’s Thyroiditis): A Case Report. AmericanJournalofCaseReports, 21, e928046. https://doi.org/10.12659/ajcr.928046
