Extracervical fibrosclerosis causing obstruction of a ventriculo-peritoneal shunt in a patient with hydrocephalus and invasive fibrous thyroiditis (Riedel's struma)

Riedel Thyroiditis

CONTEXT

Riedel thyroiditis (RT) is a rare inflammatory autoimmune disease that is often a clinically diagnostic dilemma because of its insidious presentation and nonspecific symptoms.

OBJECTIVE

The aim of the present systematic review and meta-analysis is to clarify the presentation, management, and outcomes of RT.

STUDY SELECTION

A systematic search of PubMed/MEDLINE and Web of Science was conducted to identify relevant reports published up to September 2019.

DATA EXTRACTION

First author, country, patient sex, ethnicity, presentation, biochemical status, duration of symptoms, histology, treatment, follow-up duration, and short- and long-term outcomes.

DATA SYNTHESIS

Data from 212 RT patients were retrieved. The mean age was 47 years with a predominantly female population (81%). Neck swelling (89%), dyspnea (50%), and neck pain (41%) were the most common presenting symptoms. Inflammatory markers were elevated in 70% to 97% and thyroid antibody positivity was present in less than 50%. Up to 82% underwent surgical intervention, with the most common being total thyroidectomy in 34% of individuals. Glucocorticoids were used in 70% of individuals with median duration 3 months. Prognosis was reasonable with 90% having resolution or improvement of symptoms.

CONCLUSIONS

This analysis is the largest and most comprehensive to date of RT and provides clinicians with vital information on the common presentation features that may alert to the diagnosis and highlight management options.

Invasive fibrous thyroiditis (Riedel thyroiditis): the Mayo Clinic experience, 1976-2008

BACKGROUND

Invasive fibrous thyroiditis (IFT) is the rarest form of thyroiditis, and reports are often limited to case reports and small case series. In this study, we aimed to summarize our institutional experience with IFT since 1976.

METHODS

We retrospectively reviewed the cases of all patients with IFT evaluated at Mayo Clinic, Rochester, Minnesota, from 1976 through 2008, with special emphasis on clinical presentation, associated risk factors, associated comorbid conditions, complications, and treatment.

RESULTS

Twenty-one patients met our inclusion criteria of (i) IFT confirmed by pathologic review at our institution and (ii) evidence of extension of fibrosis outside the thyroid capsule. Most patients (17, 81%) were women (mean age, 42 years). Presenting symptoms included pain (24%), dysphagia (33%), vocal cord paralysis (29%), and tracheal narrowing (48%). Three patients had associated hypoparathyroidism. Sixteen (76%) had a history of tobacco use, and 10 (48%) were current smokers. Fibrosing mediastinitis was present in four, orbital fibrosis in one, retroperitoneal fibrosis in three, and pancreatic fibrosis in one (38% had extracervical fibrotic processes). Eighteen patients had partial thyroidectomy, 7 (39%) of whom had surgical complications involving vocal cords and parathyroid. Two required tracheostomy. Thirteen had corticosteroid therapy; six received tamoxifen. There was no cause-specific mortality, and the fibrotic process stabilized or partially resolved in all patients.

CONCLUSIONS

IFT often is associated with a systemic extracervical fibrotic process and tobacco use. Attempted thyroid resection often results in postoperative complications. Long-term follow-up showed no deaths from IFT and showed stability of the thyroiditis.

Hashimoto's thyroiditis associated with idiopathic retroperitoneal fibrosis: case report and review of the literature

Idiopathic retroperitoneal fibrosis (IRF) is a rare disease of unknown origin, characterised by an inflammatory proliferative fibrosing process occurring in the retroperitoneum. Hashimoto's thyroiditis (HT) is a form of chronic thyroiditis that in some cases shows an extensive replacement of thyroid parenchyma by fibrous tissue. We report the rare association of IRF with HT in a 68-year-old woman presenting with pulmonary oedema, acute renal failure due to bilateral hydronephrosis and a firm diffuse goitre with hypothyroidism. The so far reported cases of IRF associated with chronic thyroiditis are reviewed, and the possible aetiopathogenetic link between these two entities is discussed.

Uso do tamoxifeno no tratamento da tireoidite de Riedel: relato de um caso

O tratamento da tireoidite de Riedel (TR) consiste em cirurgia nos casos de fibrose local limitada. Na maioria dos casos, entretanto, necessita-se do uso de agentes antiinflamatórios, como os glicocorticóides ou, nos casos de falha ou recidiva, o tamoxifeno pode ser útil. Relatamos um caso de TR em uma mulher negra de 55 anos, associada a hipotireoidismo e hipoparatireoidismo. Avaliamos o tratamento com tamoxifeno na dose de 20mg duas vezes ao dia, durante onze meses. Após sessenta dias de tratamento, a paciente não relatava os sintomas compressivos antes apresentados. Entretanto, em um seguimento de onze meses, houve pouca melhora objetiva avaliada por ultrassonografia e tomografia seriados de região cervical. O tamoxifeno pode ser útil na TR, principalmente quando o uso do glicocorticóide é contra-indicado. A duração ideal do uso desta terapia não está definida.

A rare case of orbital involvement in Riedel's thyroiditis

We report a case of Riedel's thyroiditis in a 59-yr-old Caucasian female. She presented hypothyroidism and a stony hard, painful goiter. Due to fever, a high sedimentation rate and a high C-reactive protein (CRP), as well as high levels of anti-thyroid peroxidase antibodies (anti-TPOab), differential diagnostic considerations included acute and subacute thyroiditis as well as Hashimoto's thyroiditis and thyroid malignancy. At the same time the patient had clinical and radiological features of bilateral orbital pseudotumor with lacrimal gland involvement. During L-thyroxine therapy orbital symptoms and signs improved and thyroid size decreased. This case report serves as a reminder of differential diagnostic considerations in the etiology of goiter as well as ophthalmopathy. Although extremely rare, orbital sclerosing fibrosis can be seen in conjunction with Riedel's thyroiditis as part of multifocal fibrosclerosis.

Cerebral venous sinus thrombosis: a late sequel of invasive fibrous thyroiditis

Riedel's invasive fibrous thyroiditis (IFT) is a rare disease of unknown etiology characterized by a dense fibrosis involving the thyroid gland and its surrounding tissues. Clinically, patients present with a stony hard goiter frequently associated with compressive symptoms. Involvement of the surrounding neck structures by IFT can lead to various clinical sequelae. We report the case of a 55-year-old woman with known IFT who developed thrombosis in the right internal jugular vein that progressed to the right sigmoid, transverse, and superior sagittal sinuses. IFT could have predisposed to cerebral venous sinus thrombosis by causing venous stasis, vascular damage and possibly a hypercoagulable state. To our knowledge, this is the first report of cerebral venous sinus thrombosis that developed as a complication of IFT.