Riedel Thyroiditis Diagnosis and Causes

Riedel Thyroiditis

• Presents as hypothyroidism with a "stone-like, hard-as-wood" nontender thyroid gland
• Diagnostic criteria:
  • Extra-thyroidal extension of the inflammatory process
  • Presence of occlusive phlebitis
  • Absence of granulomas, giant cells, lymphoid follicles, or oncocytes
  • Absence of thyroid malignancy
• Causes:
  • Intense fibrosis of the thyroid and surrounding structures (including mediastinal and retroperitoneal fibrosis)
• Treatment:
  • Symptomatic with propranolol
  • Glucocorticoids as the mainstay of medical treatment
  • Tamoxifen as a selective estrogen receptor modulator (SERM)
  • Mycophenolate mofetil as an immunosuppressive agent with antifibrotic properties

Thyroid Disease Approach

• Evaluation of a thyroid nodule:
  • Initial step: TSH level (most sensitive test) for the diagnosis of suspected hyperthyroidism

Graves Ophthalmopathy

• Initial therapy: Steroids
• Radiation therapy for those not responding to steroids
• Severe cases may require decompressive surgery

Symptoms

• Thyroid enlargement without pain or tenderness
• Early symptoms of hyperthyroidism:
  • Heart palpitations
  • Nervousness
  • Weight loss
  • Heat intolerance
  • Diarrhea
  • Increased appetite
• Late symptoms of hypothyroidism:
  • Cold intolerance
  • Weight gain
  • Constipation
  • Fatigue

Prognosis

• Subacute thyroiditis: may recur every couple of years in some individuals
• Chronic lymphocytic thyroiditis: a lifelong condition
• With appropriate treatment, thyroid levels can return to normal, and symptoms may completely subside

Chronic Lymphocytic Thyroiditis

• Symptoms:
  • Fatigue
  • Weight gain
  • Cold intolerance
  • Loss of appetite
  • Constipation
  • Depression
  • Joint stiffness
  • Muscle pain
  • Miscarriage
  • Changes in the menstrual cycle
  • Dry skin
  • Hair loss
  • Slow heart rate
  • Difficulty concentrating
  • Poor memory
  • Reduced exercise tolerance
  • Goiter (enlarged thyroid)
• Diagnosis:
  • Physical exam including palpating the thyroid for enlargement or goiter
  • Blood tests: thyroid hormone levels (T3, T4, TSH) and thyroid peroxidase (TPO) level
  • Ultrasound or medical imaging may be ordered to evaluate the size of the goiter and determine if treatment such as surgery is warranted
• Treatment: Levothyroxine is the treatment of choice for managing hypothyroidism due to chronic lymphocytic thyroiditis.

Test your knowledge about Riedel thyroiditis, a rare condition that presents as hypothyroidism with a unique set of symptoms and characteristics. Learn about the diagnostic criteria, causes, and effects of this condition. Evaluate your understanding of this topic with this quiz!