Study note
Surgery
The thyroid gland
Riedel’s thyroiditis: invasive fibrosis of the thyroid
THE CONTEXT
Riedel’s thyroiditis
is very rare, accounting for 0.5% of goitres, and produces a very hard, fixed thyroid enlargement.
Pathology and associations
•
Cellular fibrous tissue replaces thyroid tissue and
extends through the capsule into muscles and adjacent structures.
•
Structures involved
may include the parathyroids, recurrent nerves and carotid sheath.
•
The condition
may accompany retroperitoneal and mediastinal fibrosis and is considered most probably a collagen disease.
Presentation and diagnosis
•
The goitre may be unilateral or bilateral and
is very hard and fixed.
•
Only biopsy
can distinguish the condition with certainty from anaplastic carcinoma. A wedge of the isthmus should also be removed to free the trachea.
•
When initially unilateral, the other lobe is usually involved later; subsequent hypothyroidism is common.
Treatment and response
•
Treatment consists of high-dose steroids, tamoxifen and thyroxine replacement.
•
Early treatment
is expected to reduce goitre size and provide long-term symptomatic improvement.
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