Thyroiditis

The interpretation of the serum protein-bound iodine: A review

The effects of physiological and environmental factors, of thyroid and non-thyroid diseases, and of drugs on the serum protein-bound iodine are described and discussed.

Combined Riedel's Disease and Fibrosing Hashimoto's Thyroiditis: A Report of Three Cases with Two Showing Coexisting Papillary Carcinoma

Extensive sclerosis of the thyroid gland can be seen in both benign and malignant conditions. The benign sclerosing lesions of the thyroid include Riedel's disease and fibrosing Hashimoto's thyroiditis. Although these conditions usually occur separately, rarely can they occur simultaneously. In malignant lesions, papillary thyroid carcinoma and anaplastic carcinoma of the thyroid can be associated with extensive sclerosis leading to partial or total effacement of the tumor. We report on three cases that showed simultaneous occurrence of Riedel's disease and fibrosing Hashimoto's thyroiditis. Two of these cases also showed papillary carcinoma (one case of Warthin's-like papillary carcinoma and one case of classic type). All patients were females (age range 32-67 yr) and presented with elevated antithyroglobulin antibodies. Two patients presented with a solitary thyroid mass, and from these one had multiple bilateral neck nodes and a paravertebral mass. The third patient presented with a multinodular gland adherent to neck structures. All patients underwent total thyroidectomy. Histologic sections showed extensive replacement of the thyroid parenchyma with dense keloidal fibrosis, intermixed well-developed lymphoid follicles, and scattered lymphocytes and plasma cells. In all cases the fibrotic process extended beyond thyroid capsule with involvement of the perithyroidal soft tissues and skeletal muscle consistent with Riedel's disease. One case showed a classic papillary carcinoma with bilateral lymph node metastases, and the other showed a Warthin's-like papillary carcinoma. In both cases the papillary cancers were surrounded by dense sclerosis. Immunohistochemical stains for B- and T-markers and immunoglobulin light chains showed a polyclonal population of the lymphoid cells. The simultaneous occurrence of Riedel's disease and fibrosing Hashimoto's thyroiditis is rare and most likely represents a coincidental phenomenon, because both of these conditions are distinct clinicopathologic entities.

Simultaneous involvement of thyroid by Riedel's [correction of Reidel's] disease and fibrosing Hashimoto's thyroiditis: a case report

We report an unusual thyroid lesion showing histologic features of both Riedel's [corrected] disease and fibrosing Hashimoto's thyroiditis in a 57-year-old white female. The clinical presentation was hypothyroidism associated with a solitary firm to hard cold nodule replacing the entire right lobe of thyroid gland. Pathological examination demonstrated extensive replacement of the thyroid parenchyma with dense keloidal fibrosis, intermixed well-developed lymphoid follicles, scattered lymphocytes, and plasma cells. The fibrotic process extended into the perithyroidal soft tissues and skeletal muscle with complete obliteration of the thyroid capsule. These findings were consistent with Riedel's [corrected] disease. However, the immunohistochemical stains for B and T markers and immunoglobulin light chains showed an immunoprofile consistent with Hashimoto's thyroiditis. This combination of Riedel's [corrected] disease and fibrosing Hashimoto's thyroiditis is rare and coincidental, as both represent two distinct clinicopathological entities.

Hashimoto's thyroiditis associated with Riedel's thyroiditis and retroperitoneal fibrosis

This article describe the case of a 38-year-old woman with simultaneous involvement of the thyroid by Hashimoto's thyroiditis and Riedels's disease, associated with retroperitoneal fibrosis and lipidic endarteritis. According to a large review of the literature on the occurrence of this rare condition the difficulty in sharply defining the two thyroid processes is discussed. The chronology of the events is analyzed, and etiopathogenic hypotheses are listed with emphasis on the relationship between the vascular lesions and the onset of the fibrosing process.

Riedel's thyroiditis associated with high titers of antimicrosomal and antithyroglobulin antibodies and hypothyroidism

Riedel's thyroiditis is a rare, chronic inflammatory disease of the thyroid gland. The aggressive fibrosis with extension beyond the thyroid into adjacent tissues contrasts with the diffuse, but intracapsular fibrosis of Hashimoto's thyroiditis. Most current studies refute the possibility of progression from a highly fibrosing form of Hashimoto's thyroiditis to a Riedel's thyroiditis based on the distinct clinical and laboratory data, although an unknown immunological basis is suggested for both diseases. The authors describe a patient with Riedel's thyroiditis, probably associated with Hashimoto's thyroiditis, sent to surgery because her cytological examination suggested thyroid malignancy. This patient had clinical and laboratory features of hypothyroidism and very high titers of antimicrosomal and antithyroglobulin antibodies, which decreased after surgery. Pathology studies disclosed Riedel's thyroiditis with intense lymphocytic infiltration suggestive of Hashimoto's thyroiditis. Quantitative immunohistochemical studies were not able to distinguish between both diseases.

Riedel's thyroiditis associated with Hashimoto's thyroiditis, hypoparathyroidism, and retroperitoneal fibrosis

A patient with Riedel's struma (invasive fibrous thyroiditis) with hypothyroidism, hypoparathyroidism, and retroperitoneal fibrosis is reported. This disorder appeared to emanate from Hashimoto's thyroiditis in this case. The possible relationship of the two entities is discussed.

Test for recovery from hypothyroidism during thyroxine therapy in Hashimoto's thyroiditis

Hypothyroid patients with Hashimoto's thyroiditis usually receive lifelong thyroxine therapy. Some are known to recover thyroid function, but identification of these patients during continued thyroxine therapy has been impossible. 92 patients with hypothyroidism after Hashimoto's thyroiditis and 70 normal controls were studied. All controls but not patient before thyroxine was started had a normal thyroid response to thyroid stimulating hormone (TSH), circulating concentrations of which were increased by administration of 500 micrograms thyrotropin releasing hormone (TRH). During treatment with thyroxine, 22 patients recovered thyroid responsiveness to TSH, and when treatment was stopped these patients have remained euthyroid for 1-8 years, whereas all 70 who did not recover thyroid TSH responsiveness became hypothyroid within 3 months. Over 20% of patients with hypothyroidism after Hashimoto's thyroiditis may recover satisfactory thyroid function, and can be identified during thyroxine treatment by their thyroid response to TSH in a TRH test.

Ultrastructural pathology in Hashimoto's thyroiditis

Ultrastructural studies of the thyroid tissue in two cases of Hashimoto's thyroiditis demonstrated that the inflammatory cells do not pass through the follicular cells. Indeed these cells travelled between the epithelial cells in a manner similar to the neutrophil emigration (diapedesis) through the vessel wall in acute inflammation. Inflammatory infiltrates were composed of lymphocytes, plasma cells, or transformed lymphocytes that showed features intermediate between those of lymphocytes and plasma cells. These inflammatory cells were observed to travel from the stroma to the follicular lumen in a vectorial manner - similar to neutrophilic chemotaxis in acute inflammation. The basement membrane around the thyroid follicles remained intact around some follicles whereas it was reduplicated or focally increased in thickness around others. The basement membrane material seemed to have been secreted by the follicular cells, and strands of early collagen fiber formation were seen within the excess basement membrane material. The follicular cells showed evidence fo sublethal injury characterized by prominent defects of the rough endoplasmic reticulum or the mitochondria. Cells from areas that appeared as foci of squamous metaplasia by light microscopy showed an increased number of cytoplasmic filaments (120 to 160 A), bundles of tonofilaments, large desmosomes, an increased number of desmosomes, and intracellular desmosomes. The colloid content of the follicles was diminished, and it seemed that instead of secreting the protein colloid, the follicular cells in Hashimoto's thyroiditis were producing either excessive proteinaceous material similar to colloid or other types of proteins such as basement membrane material or keratin.

Delayed healing of mandibular fracture in idiopathic myxedema

Lack of adequate amount of thyroid hormone may interfere with healing. A patient in whom a fracture of the mandible failed to heal in the 2 years following surgical treatment is presented. When thyroid hormone supplementation was introduced, the fracture progressed to union. The physical findings of hypothyroidism and the role of thyroid hormone in healing are discussed.

Monozygous twins with hypothyroidism and diabetes mellitus

Monozygous twins with diabetes mellitus and autoimmune hypothyroidism are described. The onset of the hypothyroidism was simultaneous, but one twin had had insulin-dependent diabetes mellitus for 9 years while the other twin developed insulin-independent diabetes concurrently with the hypothyroidism. Two other siblings had diabetes mellitus and one of them had a goitre, possibly lymphadenoid. The aetiology of autoimmune hypothyroidism is discussed, and evidence is presented which supports suggestions that diabetes mellitus may be an autoimmune disease.

Congenital hypothyroidism and hyperthyroidism in monozygotic twin girls

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