Reidel’s Thyroiditis, a Diagnostic and Management Challenge: A Case Report and Review of the Literature

Riedel's thyroiditis is a very rare inflammatory condition. It affects not only the thyroid gland but also the adjacent vital structures. It may also be associated with different forms of systemic fibrotic disorders. The exact etiology is unknown, but currently, the most favorable opinion is that it is a localized form of the systemic fibrotic process. We report the case of a 38-year-old woman, presented with a 10-month history of progressive hypothyroidism, dysphonia, and dysphagia. A Doppler ultrasound study revealed massive thyroid enlargement with multiple Eu TIRADS 3 and 4 nodules. Fine needle aspiration was noncontributive on two occasions. A hard subtotal thyroidectomy was performed. Pathological study confirmed Riedel's thyroiditis with the presence of IgG4 antibodies in immunohistochemistry. The patient was successfully treated with levothyroxine replacement and corticosteroid therapy with rapid resolution of obstructive symptoms. The case descriptions highlight the diagnostic challenge of this disease, describe the response to surgical management and corticosteroid therapy, and give a short review of the subject.

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Riedel’s Thyroiditis: Report of Two Cases and Literature Review

Case Reports in Endocrinology ◽

10.1155/2019/5130106 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Victor Manuel Blanco ◽

Camilo Andrés Páez ◽

Angela María Victoria ◽

Luis Guillermo Arango ◽

Ana María Arrunategui ◽

...

Keyword(s):

Literature Review ◽

Immunoglobulin G ◽

Rare Entity ◽

Diagnostic Challenge ◽

Riedel’S Thyroiditis ◽

Fibrotic Process ◽

The Subject ◽

Fibrotic Disorders ◽

Riedel's Thyroiditis

Riedel’s thyroiditis is a rare entity consisting of a fibrotic process of the thyroid which can generate gland destruction, infiltration of cervical structures and even airway obstruction. It has been associated with systemic fibrotic disorders, autoimmune diseases, and more recently with spectrum of diseases related to excess of Immunoglobulin G type 4 (IgG4). Two cases of Riedel’s thyroiditis by IgG4, confirmed by immunohistochemistry and was managed surgically with favorable results during the follow-up time, are presented. These case descriptions highlight the diagnostic challenge of this disease, describe the response with surgical management, and make a brief update on the subject.

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A Case Report Demonstrating How the Clinical Presentation of the Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma Can Mimic Benign Riedel’s Thyroiditis

Case Reports in Endocrinology ◽

10.1155/2015/686085 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Jennifer Walsh ◽

Tomas P. Griffin ◽

Carmel B. Ryan ◽

James Fitzgibbon ◽

Patrick Sheahan ◽

...

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Lymph Nodes ◽

Inflammatory Cells ◽

Needle Aspiration ◽

Neck Mass ◽

Papillary Thyroid ◽

Riedel’S Thyroiditis ◽

Diffuse Sclerosing Variant ◽

Riedel's Thyroiditis

A 44-year-old female presented with a two-month history of a neck mass, sore throat, hoarseness, and intermittent dysphagia. Examination revealed a “woody” hard swelling arising from the right lobe of the thyroid. Clinically this was felt to be classical Riedel’s thyroiditis (RT). Thyroid ultrasound showed a diffusely enlarged, low echogenicity thyroid with a multinodular goitre. An abnormal nodule extending across the isthmus was noted. Following a nondiagnostic fine needle aspiration, an open core biopsy was performed. This showed dense sclerotic fibrosis punctuated by nodular mononuclear inflammatory cells, which obscured follicular epithelial cells consistent with a fibrosing thyroiditis (Riedel’s thyroiditis). A biopsy of pretracheal lymph nodes showed a sclerotic process throughout the lymph nodes and nests of epithelium bands with squamous differentiation obscured by a fibrous process. These findings raised the differential diagnosis of diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) with metastasis to lymph nodes. A total thyroidectomy and pretracheal lymph node dissection were performed. The final histological diagnosis was DSV-PTC. When managing a patient with presumed RT it is important to consider malignancy in the differential. DSV-PTC is one of the more aggressive forms of thyroid cancer but with early diagnosis and appropriate treatment patients may have excellent outcomes.

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Corticosteroid therapy in Riedel's thyroiditis.

Postgraduate Medical Journal ◽

10.1136/pgmj.73.866.817 ◽

1997 ◽

Vol 73 (866) ◽

pp. 817-819 ◽

Cited By ~ 36

Author(s):

B. Vaidya ◽

P. E. Harris ◽

P. Barrett ◽

P. Kendall-Taylor

Keyword(s):

Corticosteroid Therapy ◽

Riedel’S Thyroiditis ◽

Riedel's Thyroiditis

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Extra-nodal Rosai-Dorfman Disease Confined to Breast

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.087 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S41-S42

Author(s):

E Ozluk ◽

R Shackelford

Keyword(s):

Plasma Cells ◽

African American Woman ◽

American Woman ◽

Lymphocytic Infiltration ◽

Needle Aspiration ◽

Left Breast ◽

Unknown Etiology ◽

Diagnostic Challenge ◽

Ductal Cells ◽

Rosai Dorfman Disease

Abstract Introduction/Objective First described by Rosai and Dorfman in 1969, Rosai-Dorfman Disease (RDD) is an uncommon, idiopathic, reactive lymph node process with an unknown etiology. It may involve extra-nodal organs including the skin, bone, soft tissue, and eyes. However, breast involvement is rare and RDD confined to breast without nodal involvement is extremely uncommon. Methods Here we present a case of RDD confined to breast. The patient was a 51-year-old African American woman who was found to have an irregular, solid left breast mass on routine mammogram, which had speculated irregular margins and measured of 37.0 x 32.0 x 32.0 mm. She did not have any symptoms, nor any palpable lymph nodes. The clinician stated that the lesion was highly suspicious for a breast malignancy and requested a fine needle aspiration (FNA) of the mass, followed by total excision. Results An FNA was interpreted as atypical histiocytic cells in a mixed lymphoid background. Histopathologic examination revealed an ill-defined mass with sheets of histiocytes, plasma cells, and a mixed lymphocytic population, with occasional germinal centers. Some of the histiocytes were spindle shaped and associated with storiform collagen deposition. The histiocytes had single and multiple nuclei and exhibited occasional emperipolesis. Immunohistochemical staining with S100 diffusely highlighted the histiocytes, whereas CD1a was negative. CD3 and CD20 immunostains were positive for mixed-type lymphocytic infiltration. Cytokeratin staining was performed and reassuringly stained only the benign ductal cells. A diagnosis of RDD of the breast was made, based on these histopathologic findings. Conclusion We report an example of an extra-nodal RDD involving the mammary gland that was initially suspected to be breast carcinoma. RDD may still be a diagnostic challenge, especially in a patient with suspected carcinoma. It is the pathologist’s role to lead the clinician to the proper diagnosis and render a correct histopathologic diagnosis.

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HASHIMOTO'S STRUMA LYMPHOMATOSA AND RIEDEL'S THYROIDITIS TREATED BY RADIUM

The Lancet ◽

10.1016/s0140-6736(55)90626-7 ◽

1955 ◽

Vol 265 (6874) ◽

pp. 1127-1128

Author(s):

J.F. Heggie

Keyword(s):

Riedel’S Thyroiditis ◽

Riedel's Thyroiditis

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Improvement in the Detection of Cystic Metastatic Papillary Thyroid Carcinoma by Measurement of Thyroglobulin in Aspirated Fluid

BioMed Research International ◽

10.1155/2016/8905916 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6

Author(s):

Yong Wang ◽

Huan Zhao ◽

Yi-Xiang J. Wang ◽

Min-Jie Wang ◽

Zhi-Hui Zhang ◽

...

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Characteristic Curve ◽

Needle Aspiration ◽

Normal Serum ◽

Papillary Thyroid ◽

Diagnostic Challenge ◽

Cutoff Value ◽

Fine Needle ◽

Minimum Detection Level

Cystic change in metastatic lymph nodes of papillary thyroid carcinoma (PTC) is a diagnostic challenge for fine needle aspiration (FNA) because of the scant cellularity. The aim of this study was to evaluate the measurement of thyroglobulin in fine needle aspirate (Tg-FNA) for detecting metastatic PTC in patients with cystic neck lesions and to validate the optimal cutoff value of Tg-FNA. A total of 75 FNA specimens of cystic lesions were identified, including 40 of metastatic PTC. Predetermined threshold levels of 0.04 (minimum detection level), 0.9, 10.0, and 77.0 ng/mL (maximum normal serum-Tg level) were used to evaluate the diagnostic accuracy of Tg-FNA for metastatic PTC detection. The areas under the receiver operating characteristic curve for diagnosing metastatic PTC of Tg-FNA values of 0.04, 0.9, 10.0, and 77.0 ng/mL were 0.5 (95% confidence interval [CI], 0.382–0.618), 0.645 (95% CI, 0.526–0.752), 0.945 (95% CI, 0.866–0.984), and 0.973 (95% CI, 0.907–0.996), respectively. With a cutoff value of 77.0 ng/mL, the combination of Tg-FNA and FNA cytology showed superior diagnostic power (97.5% sensitivity and 100% specificity) compared to FNA cytology alone (80% sensitivity and 100% specificity). We recommend a Tg-FNA cutoff of 77.0 ng/mL, the maximum normal serum-Tg level, for cystic neck lesions.

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