239 results on '"riedel’s thyroiditis"'
Search Results
2. Reshaping the Concept of Riedel's Thyroiditis into the Larger Frame of IgG4-Related Disease (Spectrum of IgG4-Related Thyroid Disease).
- Author
-
Carsote, Mara and Nistor, Claudiu
- Subjects
THYROID diseases ,THYROIDITIS ,AUTOIMMUNE thyroiditis ,CORE needle biopsy ,GRAVES' disease ,PLASMA cells - Abstract
Recently, Riedel's thyroiditis (RT) was assimilated into the larger spectrum of immunoglobulin IgG4-related disease (IgG4-RD) in addition to a particular frame of IgG4-related thyroid disease (IgG4-RTD), underlying IgG4-RT, IgG4-associated Hashimoto's thyroiditis (and its fibrotic variant), and IgG4-related Graves's disease. Our objective was to overview recent data on RT, particularly IgG4-RD and IgG4-RTD. The case and study– sample analysis (2019–2023) included 293 articles and selected 18 original studies: nine single case reports (N = 9, female/male = 2/1, aged: 34–79 years, 5/9 patients with serum IgG4 available data, 2/5 with high serum IgG4) and four case series (N = 21; 4/5 series provided data on IgG4 profile, 3/21 had serum IgG4 assays, and 2/3 had abnormally high values). IgG4-RD and thyroid findings were analyzed in three cohorts (N = 25). Another two studies (N = 11) specifically addressed IgG4-RTD components. On presentation, the patients may have hypothyroidism, transitory thyrotoxicosis, goiter, long-term history of positive anti-thyroid antibodies, and hypoechoic ultrasound thyroid pattern. The 5-year analysis (N = 66) showed the rate of serum IgG4 evaluation remained low; normal values do not exclude RT. Mandatory histological and immunohistochemistry reports point out a high content of IgG4-carrying plasma cells and IgG4/IgG ratio. Unless clinically evident, histological confirmation provides a prompt indication of starting corticoid therapy since this is the first-line option. Surgery, if feasible, is selective (non-responders to medical therapy, emergency tracheal intervention, and open/core needle biopsy). Current open issues are identifying the role of serum IgG4 assays in patients with IgG4-RD, finding out if all cases of RT are IgG4-mediated, applying IgG4-RTD criteria of differentiation among four entities, and providing an RT/IgG4-RTD guideline from diagnosis to therapy. It remains that the central aim of approaching RT in daily practice is the early index of suspicion in order to select patients referred for further procedures that provide enough histological/immunohistochemistry material to confirm RT and its high IgG4 burden. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
3. Tamoxifen Treatment for Riedel's Thyroiditis: A Case Report.
- Author
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Karakılıç, Ersen, Saygılı, Emre Sedar, Yıldız, Özlem, and Kuyucu, Aslı
- Subjects
- *
AUTOIMMUNE thyroiditis , *GLUCOCORTICOIDS , *THYROTROPIN , *METHYLPREDNISOLONE , *COMBINATION drug therapy , *IMMUNOGLOBULINS , *BIOPSY , *HYPOTHYROIDISM , *THYROXINE , *PEROXIDASE , *TAMOXIFEN , *NECK , *TRIIODOTHYRONINE , *COMPUTED tomography , *IMMUNOSUPPRESSIVE agents , *THYROID gland , *RARE diseases ,NECK radiography - Abstract
Riedel's thyroiditis is a rare variant of thyroiditis, and treatment recommendations are based on case reports. This thyroiditis form is considered among immunoglobulin G4-related diseases. Intense fibrosis of the thyroid gland can cause compression of the surrounding tissues and hypothyroidism. Glucocorticoids are recommended as first-line therapy, and tamoxifen is second-line therapy. Other immunosuppressive agents have also been used in some resistant cases. Our case was presented with a palpable firm mass in the neck, shortness of breath, and hypothyroidism. The exact diagnosis of Riedel's thyroiditis was made after a pathological examination of a true-cut biopsy. We present the successful management of this case with glucocorticoid and tamoxifen combination treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
4. A case of reversible hypoparathyroidism in a patient with Riedel's thyroiditis treated with glucocorticoids.
- Author
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Salhi, Salma, Oueslati, Ibtissem, Ayari, Sabrina, Kamoun, Elyes, Yazidi, Meriem, and Chihaoui, Melika
- Subjects
- *
THYROIDITIS , *GLUCOCORTICOIDS , *HYPOPARATHYROIDISM , *SYMPTOMS , *ASYMPTOMATIC patients , *THYROID gland - Abstract
A 48‐year‐old woman with a history of primary hypothyroidism, presented with compressive symptoms secondary to a rapid enlargement of a preexisting goiter. She had no clinical signs of hypocalcemia. Biological tests revealed hypoparathyroidism. Cervicothoracic computed tomography scan showed a heterogeneous compressive goiter. The patient was treated with levothyroxine, calcium, and alfacalcidol. A total thyroidectomy was not performed because of the hard adhesion to neighboring structures. Histopathological examination of the thyroid biopsy was consistent with the diagnosis of Riedel's thyroiditis (RT). The patient was treated with glucocorticoids. The outcome was marked by the resolution of compressive symptoms and the decrease of the thyroid gland volume. Serum calcium and parathyroid hormone levels reached normal ranges after the discontinuation of vitaminocalcic supplementation. Hypoparathyroidism may be clinically asymptomatic in a patient with RT as in our case. Early administration of glucocorticoids may be effective in reducing the fibrosclerotic process and lead to the recovery of parathyroid dysfunction. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
5. A case of reversible hypoparathyroidism in a patient with Riedel's thyroiditis treated with glucocorticoids
- Author
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Salma Salhi, Ibtissem Oueslati, Sabrina Ayari, Elyes Kamoun, Meriem Yazidi, and Melika Chihaoui
- Subjects
glucocorticoids ,hypocalcemia ,hypoparathyroidism ,Riedel's thyroiditis ,Medicine ,Medicine (General) ,R5-920 - Abstract
Abstract A 48‐year‐old woman with a history of primary hypothyroidism, presented with compressive symptoms secondary to a rapid enlargement of a preexisting goiter. She had no clinical signs of hypocalcemia. Biological tests revealed hypoparathyroidism. Cervicothoracic computed tomography scan showed a heterogeneous compressive goiter. The patient was treated with levothyroxine, calcium, and alfacalcidol. A total thyroidectomy was not performed because of the hard adhesion to neighboring structures. Histopathological examination of the thyroid biopsy was consistent with the diagnosis of Riedel's thyroiditis (RT). The patient was treated with glucocorticoids. The outcome was marked by the resolution of compressive symptoms and the decrease of the thyroid gland volume. Serum calcium and parathyroid hormone levels reached normal ranges after the discontinuation of vitaminocalcic supplementation. Hypoparathyroidism may be clinically asymptomatic in a patient with RT as in our case. Early administration of glucocorticoids may be effective in reducing the fibrosclerotic process and lead to the recovery of parathyroid dysfunction.
- Published
- 2023
- Full Text
- View/download PDF
6. Fine Needle Aspiration of Benign Thyroid Nodules
- Author
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Hoda, Rana S., Austin, Elizabeth, Hoda, Rana S., editor, Rao, Rema, editor, and Scognamiglio, Theresa, editor
- Published
- 2020
- Full Text
- View/download PDF
7. G4-immunglobulinnal társult endokrin betegségek.
- Author
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Erdei, Annamária
- Abstract
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- Published
- 2022
- Full Text
- View/download PDF
8. Riedel's thyroiditis: diagnostic difficulties (clinical case and brief review)
- Author
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A. A. Rybakova, N. M. Platonova, T. V. Soldatova, N. V. Tarbaeva, T. S. Panevin, and E. A. Troshina
- Subjects
riedel's thyroiditis ,thyroid gland ,glucocorticoids ,fibrous thyroiditis ,compression syndrome ,Medicine - Abstract
Riedel's thyroiditis is a rare disease characterized by chronic fibrosis. Clinical performance of this disease is dense stony goiter, which can poorly be displaced during palpation. The overgrowth of the goiter can lead to the development of compression syndrome. To diagnose we need to made fine needle biopsy and made the final diagnose according to its results or according to the morphological description of the postoperative material. An important step in the diagnosis of Riedel's thyroiditis is the determination of serum IgG and IgG4 to exclude an IgG4-associated disease. Treatment of this disease includes drug therapy, which is based on glucocorticosteroids administration or surgical treatment when develops compression syndrome. This article presents a clinical case of a patient with Riedel's thyroiditis; the main complaints were associated with the growth of goiter and the development of compression syndrome. In this regard, patient underwent surgery on the thyroid gland, and after this we get final diagnose. Due to feeling unwell, drug therapy with glucocorticosteroids was prescribed, against the background of which we noted a positive trend.
- Published
- 2021
- Full Text
- View/download PDF
9. Reshaping the Concept of Riedel’s Thyroiditis into the Larger Frame of IgG4-Related Disease (Spectrum of IgG4-Related Thyroid Disease)
- Author
-
Mara Carsote and Claudiu Nistor
- Subjects
Riedel’s thyroiditis ,IgG4-related disease ,thyroidectomy ,thyroid ,autoimmune ,immunoglobulin ,Biology (General) ,QH301-705.5 - Abstract
Recently, Riedel’s thyroiditis (RT) was assimilated into the larger spectrum of immunoglobulin IgG4-related disease (IgG4-RD) in addition to a particular frame of IgG4-related thyroid disease (IgG4-RTD), underlying IgG4-RT, IgG4-associated Hashimoto’s thyroiditis (and its fibrotic variant), and IgG4-related Graves’s disease. Our objective was to overview recent data on RT, particularly IgG4-RD and IgG4-RTD. The case and study– sample analysis (2019–2023) included 293 articles and selected 18 original studies: nine single case reports (N = 9, female/male = 2/1, aged: 34–79 years, 5/9 patients with serum IgG4 available data, 2/5 with high serum IgG4) and four case series (N = 21; 4/5 series provided data on IgG4 profile, 3/21 had serum IgG4 assays, and 2/3 had abnormally high values). IgG4-RD and thyroid findings were analyzed in three cohorts (N = 25). Another two studies (N = 11) specifically addressed IgG4-RTD components. On presentation, the patients may have hypothyroidism, transitory thyrotoxicosis, goiter, long-term history of positive anti-thyroid antibodies, and hypoechoic ultrasound thyroid pattern. The 5-year analysis (N = 66) showed the rate of serum IgG4 evaluation remained low; normal values do not exclude RT. Mandatory histological and immunohistochemistry reports point out a high content of IgG4-carrying plasma cells and IgG4/IgG ratio. Unless clinically evident, histological confirmation provides a prompt indication of starting corticoid therapy since this is the first-line option. Surgery, if feasible, is selective (non-responders to medical therapy, emergency tracheal intervention, and open/core needle biopsy). Current open issues are identifying the role of serum IgG4 assays in patients with IgG4-RD, finding out if all cases of RT are IgG4-mediated, applying IgG4-RTD criteria of differentiation among four entities, and providing an RT/IgG4-RTD guideline from diagnosis to therapy. It remains that the central aim of approaching RT in daily practice is the early index of suspicion in order to select patients referred for further procedures that provide enough histological/immunohistochemistry material to confirm RT and its high IgG4 burden.
- Published
- 2023
- Full Text
- View/download PDF
10. Riedel's Thyroiditis. A Clinical Review.
- Author
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Elena V. Pokrovskaya, Dmitriy G. Beltsevich, Aleksandr Yu. Abrosimov, Sergey V. Lishchuk, Valeriy V. Voskoboynikov, and Anastassia Chevais
- Subjects
riedel’s thyroiditis ,low-grade fever ,thyroidectomy ,morphological study ,case report ,Surgery ,RD1-811 - Abstract
Riedel`s thyroiditis is a rare disease with an unknown etiology, which is characterized by replacement of the thyroid gland tissue with a fibrous connective tissue, the main characteristic sign is the stony-hard texture of the gland, extending to the surrounding structures (trachea, esophagus, blood vessels and nerves). Dense adhesion causes clinical symptoms of tracheal compression, such as shortness of breath, hoarseness, coughing and dyspnoea. Regarding functional activity, both euthyroidism and thyrotoxicosis with the subsequent development of hypothyroidism can be observed. A difficult preoperative diagnosis allows only to suspect this disease, as well as differentiate it with some aggressive forms of cancer, and therefore the final diagnosis is possible only after histological and immunohistochemical examinations of postoperative material. The conservative treatment (mainly glucocorticoid drugs) and surgical intervention can be applied. It is necessary to be meticulous about the choice of a treatment method, taking into account the firmly adhesion with surrounding structures and a high risk of complications of surgical treatment of the thyroid gland. This case report describes a patient with a confirmed morphological diagnosis of Riedelapos;s thyroiditis after thyroidectomy. The peculiarity of this case is a clear positive correlation of the occurrence of subfebrile fever with the onset of the disease and its resolution after surgical treatment and a 11-month follow-up period.
- Published
- 2020
- Full Text
- View/download PDF
11. IgG4 immunohistochemistry in Riedel's thyroiditis and the recommended criteria for diagnosis: A case series and literature review.
- Author
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Yu, Yang, Liu, Jumei, Yu, Nan, Zhang, Yang, Zhang, Shuang, Li, Ting, Gao, Ying, Lu, Guizhi, Zhang, Junqing, and Guo, Xiaohui
- Subjects
- *
DIAGNOSIS , *LITERATURE reviews , *PLASMA cells , *IMMUNOHISTOCHEMISTRY , *THYROIDITIS , *DATABASE searching - Abstract
Objective: Riedel's thyroiditis (RT) is a very rare chronic fibrosing thyroiditis that is often associated with multifocal fibrosclerosis. Although the relationship of RT and IgG4‐related disease (IgG4‐RD) has been suggested, the expression of IgG and IgG4 in thyroid tissues of patients with RT has seldom been studied. Design: A case series and literature review. Patients and Measurements: We searched our hospital's pathology database and identified five cases of RT between 2000 and 2019. The expression levels of IgG4 and IgG in thyroid tissues were detected by immunohistochemistry. We also performed a literature search of the electronic databases PubMed/MEDLINE, Web of Science and China National Knowledge Internet (CNKI). Eight papers were included in this study. Results: According to immunohistochemistry, the numbers of IgG4+ plasma cells per high‐power field (HPF) of the five RT patients at our hospital were 80, 8, 50, 10 and 22, and the respective IgG4+/IgG+ ratios were 76%, 80%, 43%, 19% and 28%. In the literature, 15 RT patients with confirmed IgG4 and IgG immunohistochemical findings were identified. Only seven of them fulfilled the IgG4‐RD diagnostic criteria in terms of immunohistochemistry (IgG4+ > 10/HPF, IgG4+/IgG+ > 40%). In order to ensure that most RT cases can meet the IgG4 immunohistochemical criteria, an organ‐specific cut‐off value (≥10 IgG4+ plasma cells/HPF and ≥ an IgG4+/IgG ratio of 20%) was finally selected in our study. Conclusion: Our findings of IgG4 expression in patients with RT suggest that a cut‐off of 10 IgG4+ plasma cells/HPF and an IgG4+/IgG ratio of 20% are more suitable diagnostic criteria for RT in IgG4‐RD. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
12. IgG4-related disease in endocrine practice
- Author
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Agata Rzepecka, Anna Babińska, and Krzysztof Sworczak
- Subjects
hashimoto’s thyroiditis ,igg4 related disease ,riedel’s thyroiditis ,hypophysitis ,graves ophthalmopathy ,igg4-related disease ,graves’ ophthalmopathy ,Medicine - Abstract
IgG4-related disease is a set of symptoms resulting from a chronic, usually multiple organ inflammatory condition which affects various organs. It consists of lymphoplasmacytic infiltrations with attendant fibrosis and deep vein thrombosis. Frequently observed tissue lesions are accompanied by elevated IgG4 levels in serum. The etiopathogenesis of the lesions is of multifactor character and the clinical manifestation of the disease is highly diverse. The diagnostic process is based on the patient’s medical history, clinical examination and additional tests, including a histopathological examination of the infected organ’s tissues. Almost forty different locations of the disease have been reported, including disorders of the endocrine system. IgG4-related endocrinopathies are quite rare. However, it is likely that the diagnosis is under-reported due to lack of awareness of this clinical entity. Despite increasing interest in the subject, there are not enough reliable studies evaluating the link between IgG4-RD and endocrine disorders.
- Published
- 2018
- Full Text
- View/download PDF
13. Coexistent presentation of Graves' disease and a Riedel's thyroiditis - Diagnostic dilemma.
- Author
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T., Gvianishvili and L., Gogiashvili
- Subjects
GRAVES' disease ,THYROIDITIS diagnosis ,AUTOIMMUNE thyroiditis ,IODINE deficiency ,THYROID diseases - Abstract
Background: The coexistence of Riedel's thyroiditis and Graves' disease is quite rare, presents a diagnostic dilemma and requires a particular clinical approach. Case report: We describe a 69-year-old man who had two autoimmune processes - Riedel's thyroiditis and Graves' disease, which develop at the same time in different lobes of the thyroid with contradictory manifestations. The diagnosis was confirmed by histological examination. Conclusions: Present case is unique by development and management, especially, it should be noted that iodine deficient thyroid diseases are endemic to the Caucasus region (Georgia), although the present case is the only one in our observation period (2016- 2019). [ABSTRACT FROM AUTHOR]
- Published
- 2020
14. Rare Causes of Acquired Hypoparathyroidism
- Author
-
Wémeau, Jean-Louis, Brandi, Maria Luisa, editor, and Brown, Edward Meigs, editor
- Published
- 2015
- Full Text
- View/download PDF
15. Enfermedad relacionada con IgG4.
- Author
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Lendechy-Velázquez, Marysol and Hernández-Delgado, Alejandra
- Abstract
This paper reports the case of two patients of 67 and 68 years old, both had a history of smoking and they started suffering with organomegaly and elevated serum globulins. The first patient presented parotidomegaly, xerostomia, xerophthalmia, recurrent uveitis and interstitial pneumonitis; a minor salivary gland biopsy was performed, which confirmed the diagnosis of systemic disease related to IgG4. The second patient presented a stony thyroid tumor, thyroidectomy was performed and the result of biopsy was Riedel's thyroditis (organ-specific thyroid disease related to IgG4). The initial presentation of the disease by IgG4 can be very nonspecific. The manifestations presented by the patients can be confused with Sjögren's syndrome or sarcoidosis (case 1) and with malignancy (case 2). [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
16. IgG4-related disease in endocrine practice.
- Author
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Rzepecka, Agata, Babińska, Anna, and Sworczak, Krzysztof
- Subjects
- *
VENOUS thrombosis , *ENDOCRINE diseases , *ENDOCRINE system - Abstract
IgG4-related disease is a set of symptoms resulting from a chronic, usually multiple organ inflammatory condition which affects various organs. It consists of lymphoplasmacytic infiltrations with attendant fibrosis and deep vein thrombosis. Frequently observed tissue lesions are accompanied by elevated IgG4 levels in serum. The etiopathogenesis of the lesions is of multifactor character and the clinical manifestation of the disease is highly diverse. The diagnostic process is based on the patient's medical history, clinical examination and additional tests, including a histopathological examination of the infected organ's tissues. Almost forty different locations of the disease have been reported, including disorders of the endocrine system. IgG4-related endocrinopathies are quite rare. However, it is likely that the diagnosis is under-reported due to lack of awareness of this clinical entity. Despite increasing interest in the subject, there are not enough reliable studies evaluating the link between IgG4-RD and endocrine disorders. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
17. Vasovagal reflex emergency caused by Riedel's thyroiditis: A case report and review of the literature
- Author
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Wei Cai, Hua Kang, and Tao Hai
- Subjects
Riedel's thyroiditis ,vasovagal reflex ,diagnosis ,Surgery ,RD1-811 - Abstract
Riedel's thyroiditis is a rare type of chronic thyroiditis, associated with fibroinflammatory process and invasion into surrounding tissues, leading to compressive symptoms. A 45-year-old man had a left thyroid mass, presenting with hypotension and bradycardia many times. He was diagnosed with vasovagal reflex caused by cervical vessel compression due to a thyroid lesion. We performed the emergency operation, and most of the left thyroid was removed to relieve the compression on cervical vessels. The result of pathology proved to be Riedel's thyroiditis. The vasovagal reflex did not occur any more during the 28-month follow up, except on the 3rd day after the surgery. Six months after the thyroidectomy, the patient was found to have retroperitoneal fibrosis, diagnosed by biopsy during a laparotomy for biliary disease. Riedel's thyroiditis can lead to a vasovagal episode and might not be a primary thyroid disease but rather a manifestation of the systemic disorder, multifocal fibrosclerosis.
- Published
- 2016
- Full Text
- View/download PDF
18. Riedel's thyroiditis
- Author
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Mohammed Darouichi, MD and Paul Eugène Constanthin
- Subjects
Riedel's Thyroiditis ,Radiology ,Histology ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
This article describes an unusual case of Riedel's thyroiditis and discusses its imagery, pathology, and treatment.
- Published
- 2016
- Full Text
- View/download PDF
19. Riedel's thyroiditis: diagnostic difficulties (clinical case and brief review)
- Author
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T. V. Soldatova, N. V. Tarbaeva, N. M. Platonova, T. S. Panevin, E. A. Troshina, and A. A. Rybakova
- Subjects
medicine.medical_specialty ,endocrine system ,Riedel's thyroiditis ,endocrine system diseases ,thyroid gland ,glucocorticoids ,business.industry ,030209 endocrinology & metabolism ,General Medicine ,Dermatology ,fibrous thyroiditis ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,Medicine ,Clinical case ,medicine.symptom ,business ,riedel's thyroiditis ,compression syndrome - Abstract
Riedel's thyroiditis is a rare disease characterized by chronic fibrosis. Clinical performance of this disease is dense stony goiter, which can poorly be displaced during palpation. The overgrowth of the goiter can lead to the development of compression syndrome. To diagnose we need to made fine needle biopsy and made the final diagnose according to its results or according to the morphological description of the postoperative material. An important step in the diagnosis of Riedel's thyroiditis is the determination of serum IgG and IgG4 to exclude an IgG4-associated disease. Treatment of this disease includes drug therapy, which is based on glucocorticosteroids administration or surgical treatment when develops compression syndrome. This article presents a clinical case of a patient with Riedel's thyroiditis; the main complaints were associated with the growth of goiter and the development of compression syndrome. In this regard, patient underwent surgery on the thyroid gland, and after this we get final diagnose. Due to feeling unwell, drug therapy with glucocorticosteroids was prescribed, against the background of which we noted a positive trend.
- Published
- 2021
20. Proposal of diagnostic criteria for IgG4-related thyroid disease
- Author
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Eijun Nishihara, Mitsuyoshi Hirokawa, Kennichi Kakudo, Akira Shimatsu, Yutaka Takahashi, Yaqiong Li, Ken Takeshima, and Takashi Akamizu
- Subjects
Thyroiditis ,endocrine system ,Pediatrics ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Thyroid Gland ,030209 endocrinology & metabolism ,Hashimoto Disease ,Disease ,Diagnostic Techniques, Endocrine ,Elevated serum ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Japan ,parasitic diseases ,medicine ,Humans ,Endocrine system ,skin and connective tissue diseases ,integumentary system ,Riedel's thyroiditis ,business.industry ,Thyroid disease ,fungi ,Thyroid ,medicine.disease ,Graves Disease ,medicine.anatomical_structure ,Immunoglobulin G ,030220 oncology & carcinogenesis ,Christian ministry ,Immunoglobulin G4-Related Disease ,medicine.symptom ,business - Abstract
Patients with IgG4-related disease (IgG4-RD) are diagnosed in Japan by comprehensive or organ-specific diagnostic criteria. To date, organ-specific criteria have been established for several organs, but not for the thyroid. We attempted to establish diagnostic criteria for IgG4-related thyroid disease (IgG4-RTD) based on IgG4-RD research by The Research Program on Intractable Diseases from the Ministry of Health, Labour and Welfare of Japan. These criteria have been publicly reported to members of both the Japan Endocrine Society and the Japan Thyroid Association. Thyroid diseases associated with IgG4 include Hashimoto's thyroiditis, Graves' disease and Riedel's thyroiditis. As a comprehensive definition that includes both systematic and organ-specific forms, we use the broad term 'IgG4-related thyroid disease'. Diagnostic criteria for IgG4-RTD comprise the following five items: I) enlargement of the thyroid, II) hypoechoic lesions in the thyroid by ultrasonography, III) elevated serum IgG4 levels, IV) histopathological findings in the thyroid lesion (IgG4+ plasma cells >20/HPF and IgG4+/IgG+ plasma cell ratio >30%) and V) involvement of other organs. "Definitive" diagnosis of IgG4-RTD is made when I, II, III and IV are all fulfilled, while "probable" diagnosis of IgG4-RTD is when I, II, and IV or V are fulfilled. Patients who fulfill I, II and III criteria are considered as "possible" IgG4-RTD. We believe that the proposed diagnostic criteria contribute to more accurate diagnosis of IgG4-RTD as well as exclusion of mimicry. Furthermore, they may lead to better understanding of the clinical implications and underlying pathogenesis of IgG4-RTD.
- Published
- 2021
- Full Text
- View/download PDF
21. IgG4 immunohistochemistry in Riedel's thyroiditis and the recommended criteria for diagnosis: A case series and literature review
- Author
-
Nan Yu, Shuang Zhang, Ying Gao, Jumei Liu, Yang Zhang, Guizhi Lu, Junqing Zhang, Yang Yu, Xiaohui Guo, and Ting Li
- Subjects
Thyroiditis ,medicine.medical_specialty ,Web of science ,Endocrinology, Diabetes and Metabolism ,Plasma Cells ,030209 endocrinology & metabolism ,Hashimoto Disease ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Multifocal fibrosclerosis ,Internal medicine ,parasitic diseases ,medicine ,Humans ,In patient ,skin and connective tissue diseases ,integumentary system ,Riedel's thyroiditis ,business.industry ,fungi ,Thyroid ,medicine.disease ,Immunohistochemistry ,medicine.anatomical_structure ,Immunoglobulin G ,030220 oncology & carcinogenesis ,IgG4-related disease ,medicine.symptom ,business - Abstract
Objective Riedel's thyroiditis (RT) is a very rare chronic fibrosing thyroiditis that is often associated with multifocal fibrosclerosis. Although the relationship of RT and IgG4-related disease (IgG4-RD) has been suggested, the expression of IgG and IgG4 in thyroid tissues of patients with RT has seldom been studied. Design A case series and literature review. Patients and measurements We searched our hospital's pathology database and identified five cases of RT between 2000 and 2019. The expression levels of IgG4 and IgG in thyroid tissues were detected by immunohistochemistry. We also performed a literature search of the electronic databases PubMed/MEDLINE, Web of Science and China National Knowledge Internet (CNKI). Eight papers were included in this study. Results According to immunohistochemistry, the numbers of IgG4+ plasma cells per high-power field (HPF) of the five RT patients at our hospital were 80, 8, 50, 10 and 22, and the respective IgG4+/IgG+ ratios were 76%, 80%, 43%, 19% and 28%. In the literature, 15 RT patients with confirmed IgG4 and IgG immunohistochemical findings were identified. Only seven of them fulfilled the IgG4-RD diagnostic criteria in terms of immunohistochemistry (IgG4+ > 10/HPF, IgG4+/IgG+ > 40%). In order to ensure that most RT cases can meet the IgG4 immunohistochemical criteria, an organ-specific cut-off value (≥10 IgG4+ plasma cells/HPF and ≥ an IgG4+/IgG ratio of 20%) was finally selected in our study. Conclusion Our findings of IgG4 expression in patients with RT suggest that a cut-off of 10 IgG4+ plasma cells/HPF and an IgG4+/IgG ratio of 20% are more suitable diagnostic criteria for RT in IgG4-RD.
- Published
- 2020
- Full Text
- View/download PDF
22. Riedel's Thyroiditis: A Diagnosis to Remember
- Author
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Elatiq H, Elalami Mn, Bamine H, Taleuan A, and Oudidi A
- Subjects
medicine.medical_specialty ,Riedel's thyroiditis ,Philosophy ,General Engineering ,medicine ,medicine.symptom ,Dermatology - Published
- 2020
- Full Text
- View/download PDF
23. Riedel's thyroiditis as a diagnostic dilemma - A case report and review of the literature
- Author
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Nourah Bin Saad, Bandar N Alharthi, and Alam Ara Shafi
- Subjects
medicine.medical_specialty ,Anaplastic carcinoma ,Case Report ,Malignancy ,Thyroiditis ,03 medical and health sciences ,0302 clinical medicine ,Thyroid lymphoma ,medicine ,Riedel's thyroiditis ,Intensive care medicine ,Thyroid mass ,business.industry ,Thyroid ,General Medicine ,medicine.disease ,Diagnostic challenges ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Etiology ,030211 gastroenterology & hepatology ,Surgery ,Rituximab ,medicine.symptom ,business ,Tamoxifen ,medicine.drug - Abstract
Riedel's thyroiditis is a rare inflammatory process which not only involves thyroid gland but also the surrounding vital structures. It may also be associated with various forms of systemic fibrotic disorders. The exact etiology is not known, but currently, the most favored view is that of a localized form of the systemic fibrotic process. We report a case of Riedel's thyroiditis in a male patient, highlighting diagnostic challenges and a rare presentation of hypocalcemia and mimicking thyroid lymphoma. Clinical knowledge of such a presentation of Riedel's thyroiditis would enhance our ability to make a speedy diagnosis. Apart from avoiding aggressive surgical intervention, awareness of such a clinical entity may avoid complications and hence morbidity. Our case also highlights the difficulty in histological diagnosis which is vital to rule out malignancy and avoiding any major surgical intervention fraught with complications. Although the patient had a poor tolerance to Tamoxifen and Rituximab, however, his response to high dose steroids is the currently accepted treatment of choice. This case adds to the sparse literature available on the cytological diagnosis of RT and highlights the diagnostic challenge due to suspicious radiology findings., Highlights • Riedel's thyroiditis, a rare form of chronic thyroiditis is associated with a fibrotic process involving the thyroid gland, leading to anatomical and physiological consequences. • Riedel's thyroiditis is part of the spectrum of IgG4-related systemic disorders (IgG4-RSD). • Clinicians should be aware of RT to differentiate this condition from other thyroid disorders, especially malignant lesions. • Thyroidectomy is indicated for patients with compressive symptoms, suspicion of malignancy and failure of medical management.
- Published
- 2020
24. Our Uncommon Experience with 6 Cases of Riedel’s Thyroiditis (Woody Thyroiditis)
- Author
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Shriraam Mahadevan, Dhalapathy Sadacharan, R. Vimala, Hemchand Prasad, S. Smitha, and Althaf Ahmed
- Subjects
medicine.medical_specialty ,education.field_of_study ,Riedel's thyroiditis ,Decompression ,business.industry ,medicine.medical_treatment ,Population ,Thyroidectomy ,medicine.disease ,Dysphagia ,Thyroiditis ,Surgery ,Otorhinolaryngology ,Hypoparathyroidism ,medicine ,medicine.symptom ,business ,education - Abstract
Riedel's thyroiditis is a rare form of thyroiditis. Estimated prevalence is 1.06/100,000 population and is reported in 0.05% of thyroidectomy specimens. It has 38% association with systemic fibrotic conditions. We retrospectively reviewed 6 cases of Riedel's thyroiditis at a tertiary care centre in south India, from 2011 through 2019 with special emphasis on demography, clinical presentation, workup, management, intraoperative findings, postoperative outcomes and follow up. There were 4 females and 2 males of which we reported a rare presentation in paediatric age group which was probably never reported before. Presenting symptoms included dysphagia and compressive symptoms in neck. 5 out of 6 cases underwent surgical management- 4 total thyroidectomy and 1 hemithyroidectomy. Postoperative complications noted were temporary hypoparathyroidism, unilateral vocal cord palsy and temporary bilateral vocal cord palsy One case was medically managed with oral corticosteroids. There was no evidence of extra cervical fibrosis on follow up in all patients. There was no cause-specific mortality, and the fibrotic process stabilized or resolved in all patients. Riedel's thyroiditis is a fibroinflammatory disorder presenting with compressive symptoms mandating surgical intervention mainly decompression in the form of isthmectomy. However since extensive interventions are associated with complications it is less favoured approach. Long term follow up of these cases are necessary for detecting evidence of extra cervical fibrosis.
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- 2020
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25. A misdiagnosed Riedel's thyroiditis successfully treated by thyroidectomy and tamoxifen
- Author
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Chih-Jung Wang, Ta-Jen Wu, Chung-Ta Lee, and Shih-Ming Huang
- Subjects
chronic thyroiditis ,invasive fibrous thyroiditis ,Riedel's thyroiditis ,Medicine (General) ,R5-920 - Abstract
Riedel's thyroiditis, known as invasive fibrous thyroiditis, is a very rare form of chronic thyroiditis. It is hard to make the diagnosis without surgical biopsy. We present a case of Riedel's thyroiditis in a 52-year-old female with past history of Hashimoto's thyroiditis. She suffered from bilateral neck pain, which radiated to both lower jaws. The erythrocyte sedimentation rate was 125 mm/hour. Subacute thyroiditis superimposed on Hashimoto's thyroiditis was diagnosed and treated with steroid. However the response was poor and she had a history of severe peptic ulcer. To avoid inducing the peptic ulcer by steroid, she received bilateral subtotal thyroidectomy. During surgery, the thyroid had severe adhesion to surrounding soft tissue and the pathology showed Riedel's thyroiditis. The neck pain improved after thyroidectomy. Tamoxifen has been given for 8 months and the size of remnant thyroid decreased to 8 mm. We concluded that combined thyroidectomy and tamoxifen successfully cured a patient with Riedel's thyroiditis.
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- 2012
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26. Riedel's Thyroiditis Mimicking as Anaplastic Thyroid Carcinoma: Unusual Presentation.
- Author
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hakeem, Arsheed, Chandramathyamma, Sreerenjini, Hakeem, Imtiyaz, Wani, Fozia, and Gomez, Ramesh
- Abstract
Riedel's thyroiditis is a rare inflammatory process which not only involves thyroid gland but also the surrounding vital structures. It may also be associated with various forms of systemic fibrotic disorders. The exact etiology is not known, but currently most favored view is that of a localized form of systemic fibrotic process. We report a case of Riedel's thyroiditis in a patient, highlighting a rare presentation mimicking anaplastic carcinoma. Clinical awareness of such presentation of Riedel's thyroiditis would enhance our ability to make this diagnosis promptly. Apart from avoiding or minimizing aggressive surgical intervention, awareness of such clinical entity may avoid complications and hence morbidity. Our case also highlights the difficulty in histological diagnosis which is very important to rule out malignancy and avoiding any major surgical intervention fraught with complications. Good response to high dose steroids as seen in our case is the current accepted treatment of choice. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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27. Entzündungen der Schilddrüse.
- Author
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Synoracki, S., Ting, S., and Schmid, K.
- Abstract
Copyright of Der Pathologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2016
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28. A small subgroup of Hashimoto's thyroiditis is associated with IgG4-related disease.
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Jokisch, Friedrich, Kleinlein, Irene, Haller, Bernhard, Seehaus, Tanja, Fuerst, Heinrich, and Kremer, Marcus
- Abstract
IgG4-related disease is a newly identified syndrome characterized by high serum IgG4 levels and increased IgG4-positive plasma cells in involved organs. The incidence of IgG4-related thyroiditis in the Caucasian population of Europe is unknown. We investigated formalin-fixed thyroid gland samples of 216 patients (191 Hashimoto's thyroiditis, 5 Riedel's thyroiditis, and 20 goiters, as controls), morphologically, and immunohistochemically. Cases were divided into two groups: IgG4-related Hashimoto's thyroiditis (24 cases) together with Riedel thyroiditis (1 case) and 171 non-IgG4-related thyroiditis. Compared to the non-IgG4-related cases, IgG4-related thyroiditis showed a higher IgG4/IgG ratio (0.6 vs. 0.1, p < 0.0001), a higher median IgG4 count (45.2 vs. 6.2, p < 0.0001), an association with younger age (42.1 vs. 48.1 years, p = 0.036), and a lower female-to-male ratio (11:1 vs. 17.5:1). Fibrous variant of Hashimoto's thyroiditis was diagnosed in 23 of the 24 IgG4-related cases (96 %) and in 13 of 167 (18 %, p > 0.001) non-IgG4-related cases. The single case of IgG4-related Riedel's thyroiditis also showed a higher median IgG4 plasma cell count (56.3 vs. 14.3) and a higher IgG4/IgG ratio (0.5 vs. 0.2) than the four cases of non-IgG4-related Riedel's thyroiditis. Our data suggests the incidence of IgG4-related disease (IgG4-RD) of the thyroid gland in Europe is considerably lower than that observed in other studies. A significant elevation of IgG4-positive plasma cells was only found in a small group of Hashimoto's thyroiditis and then accompanied by intense fibrosis, indicating an association with IgG4-RD. Morphologically, IgG4-RD of the thyroid gland differs from that in other organ systems, exhibiting a dense fibrosis without intense eosinophilia or obliterative phlebitis. [ABSTRACT FROM AUTHOR]
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- 2016
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29. Vasovagal reflex emergency caused by Riedel's thyroiditis: A case report and review of the literature.
- Author
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Cai, Wei, Kang, Hua, and Hai, Tao
- Abstract
Summary Riedel's thyroiditis is a rare type of chronic thyroiditis, associated with fibroinflammatory process and invasion into surrounding tissues, leading to compressive symptoms. A 45-year-old man had a left thyroid mass, presenting with hypotension and bradycardia many times. He was diagnosed with vasovagal reflex caused by cervical vessel compression due to a thyroid lesion. We performed the emergency operation, and most of the left thyroid was removed to relieve the compression on cervical vessels. The result of pathology proved to be Riedel's thyroiditis. The vasovagal reflex did not occur any more during the 28-month follow up, except on the 3 rd day after the surgery. Six months after the thyroidectomy, the patient was found to have retroperitoneal fibrosis, diagnosed by biopsy during a laparotomy for biliary disease. Riedel's thyroiditis can lead to a vasovagal episode and might not be a primary thyroid disease but rather a manifestation of the systemic disorder, multifocal fibrosclerosis. [ABSTRACT FROM AUTHOR]
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- 2016
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30. Riedel’s Thyroiditis: Report of Two Cases and Literature Review
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Juliana Escobar, Ana María Arrunategui, Guillermo Guzmán, Luis Guillermo Arango, Camilo Andrés Páez, Veline Martínez, Angela María Victoria, and Victor Manuel Blanco
- Subjects
030203 arthritis & rheumatology ,Pathology ,medicine.medical_specialty ,lcsh:RC648-665 ,Riedel's thyroiditis ,business.industry ,Endocrinology, Diabetes and Metabolism ,Thyroid ,Rare entity ,Case Report ,030209 endocrinology & metabolism ,Disease ,Airway obstruction ,medicine.disease ,lcsh:Diseases of the endocrine glands. Clinical endocrinology ,Thyroiditis ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,medicine ,medicine.symptom ,business - Abstract
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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- 2019
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31. Riedel's Thyroiditis: A Case Report
- Author
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Rumi Sekine, Yohei Morishita, Hiromi Kojima, Takara Nakazawa, Kentaro Matsuura, Kota Wada, Hiroto Ohto, and Yoichi Seino
- Subjects
medicine.medical_specialty ,Riedel's thyroiditis ,business.industry ,Medicine ,medicine.symptom ,business ,Dermatology - Published
- 2019
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32. Riedel's Thyroiditis Within an Elderly Patient Revealed by Tracheal Compression: a Case Report
- Author
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Ibrahiman Toure, Zie Cheick Traore, Justin Kouame N’dah, Kouadio Donatien Koffi, Nguiessan Alphonse Aman, Mohamed Kouyate, and Zana Ismael Coulibaly
- Subjects
medicine.medical_specialty ,Riedel's thyroiditis ,business.industry ,medicine ,Radiology ,TRACHEAL COMPRESSION ,medicine.symptom ,business ,Elderly patient - Abstract
Background : Riedel's thyroiditis (RT) is a rare fibrosclerotic disease that affects the thyroid gland and surrounding tissues. The etiology is unknown, and it rarely affects the elderly.Case Presentation : A 56-year-old man, with no particular medical history, was seen in consultation at the Surgery Department of the Treichville Teaching University Hospital for a painless swelling of the anterior base of the neck. Physical examination showed a patient with inspiratory dyspnea probably due to tracheal compression. The patient underwent a subtotal thyroidectomy because of the clinical symptomatology and the persistence of dyspnea. Macroscopically, the thyroid mass was well-encapsulated, weighed 80g, and measured 10 cm x 5 cm x 2 cm. After section, we observed whitish fibrous nodules associated with pinkish-brownish band. Histologically, the architecture of thyroid tissue was restructured by dense and diffuse collagenous fibrosis in which rare atrophic thyroid vesicles were found. The fibrous areas were infiltrated by inflammatory elements, including lymphocytes, plasmocytes, and eosinophilic polynuclear cells. No malignant cells were found. Masson's trichrome staining confirmed the fibrous nature of the thyroid tissue, which is essential for the certain diagnosis of Riedel's thyroiditis. There was no postoperative complication Conclusion : Riedel's thyroiditis is a rare disease that is difficult to diagnose preoperatively despite advances in imaging and fine needle cytology screening methods. Histological examination of the sample confirms the diagnosis of Riedel's thyroiditis. Thyroidectomy is indicated in patients with compression symptoms. Clinicians should suspect Riedel's thyroiditis in patients with a hard thyroid mass with compressive symptoms, despite its rarity.
- Published
- 2021
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33. Riedel's thyroiditis - difficulties in differentiating from thyroid cancer
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Marcin Żach, Magdalena Góralska, and Marta Podlewska
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Pathology ,medicine.medical_specialty ,Neck pain ,Thyroiditis ,Riedel's thyroiditis ,business.industry ,Endocrinology, Diabetes and Metabolism ,fungi ,Thyroid ,Soft tissue ,Hashimoto Disease ,medicine.disease ,Dysphagia ,Endocrinology ,medicine.anatomical_structure ,medicine ,Humans ,IgG4-related disease ,Thyroid Neoplasms ,medicine.symptom ,business ,Thyroid cancer - Abstract
A hard, palpable mass localized in the perithyroidal soft tissue is often suposed of having a cancerous process. Along with dysphagia or neck pain, it causes patient and physician concern. It is important for a correct diagnosis to differentiate the disease with another with an identical clinical manifestation - a Riedel's thyroiditis. In Riedel's thyroiditis fibrosclerotic organ manifestations can either be a part of IgG4-related disease or solely be located in the thyroid and adjacent tissues and elevation of serum IgG4 can be found.
- Published
- 2021
34. [Clinical practice guidelines for acute and chronic thyroiditis (excluding autoimmune thyroiditis)]
- Author
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B M Shifman, Marina S. Sheremeta, P O Rumyanstsev, Elena A. Panfilova, N S Kuznetzov, Galina A. Melnichenko, E S Senyushkina, A A Larina, M S Mikhina, Ivan Ivanovich Dedov, A A Glibka, Mikhail V. Degtyarev, Ekaterina Troshina, and I V Kim
- Subjects
Nosology ,medicine.medical_specialty ,Thyroiditis ,Endocrinology, Diabetes and Metabolism ,MEDLINE ,Specialty ,030209 endocrinology & metabolism ,Hashimoto Disease ,030204 cardiovascular system & hematology ,Autoimmune thyroiditis ,03 medical and health sciences ,0302 clinical medicine ,Health care ,medicine ,Humans ,Intensive care medicine ,Chronic thyroiditis ,Subacute thyroiditis ,Evidence-Based Medicine ,Riedel's thyroiditis ,business.industry ,Thyroiditis, Autoimmune ,medicine.disease ,Chronic Disease ,Practice Guidelines as Topic ,medicine.symptom ,business - Abstract
Acute and chronic thyroid diseases are the most frequently detected disorders being second only to diabetes mellitus.The World Health Organization points out that thyroid diseases’ incidence tends to grow every year. The present paper consists of clinical practice guidelines that consider etiology, clinical course, diagnostics and treatment of acute and chronic inflammatory thyroid diseases (except those of autoimmune type).The clinical practice guidelines provide an important working tool for clinicians including specialty physicians and medical experts. Containing structured and concise information on the specific nosology, diagnostic methods and treatment tips these guidelines allow medical specialists to quickly resolve difficulties and choose the most efficient and personalized treatment (following strict principles of evidence-based medicine at the same time).The clinical practice guidelines were drawn up by highly-skilled professional team of specialty physicians approved by the Expert Council of Russian Federation’s Health Department. These guidelines contain the most complete and up-to-date information required to diagnose acute and chronic thyroiditis, provide patient care and treatment.The working group publishes the present paper in the professional journal dealing with endocrinology topics to improve healthcare quality and refine treatment of acute and chronic thyroiditis (autoimmune thyroiditis excluded). It is advisable to acquaint as many endocrinology and general (family) medicine specialists as possible with the full text of these clinical guidelines.
- Published
- 2021
35. IgG4-Related Retroperitoneal Fibrosis: A Rare Association With Riedel’s Thyroiditis
- Author
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Jonathan Pacella, David Newman, and Soamsiri Niwattisaiwong
- Subjects
Pathology ,medicine.medical_specialty ,retroperitoneal fibrosis ,igg4-related disease ,030204 cardiovascular system & hematology ,Retroperitoneal fibrosis ,Thyroiditis ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Fibrosis ,Biopsy ,parasitic diseases ,medicine ,Internal Medicine ,Idiopathic Retroperitoneal Fibrosis ,Obstructive uropathy ,Riedel's thyroiditis ,medicine.diagnostic_test ,integumentary system ,business.industry ,fungi ,General Engineering ,Endocrinology/Diabetes/Metabolism ,medicine.disease ,IgG4-related disease ,medicine.symptom ,business ,riedel's thyroiditis ,030217 neurology & neurosurgery - Abstract
Idiopathic retroperitoneal fibrosis is a rare fibro-inflammatory disease that can be associated with other IgG4-related diseases (IgG4-RDs). It is exceedingly uncommon to encounter this condition in a patient with Riedel's thyroiditis (RT), another disease in the IgG4-RD family. We present the case of a 53-year-old man with a history of RT who presented for severe localized lower abdominal and suprapubic pain due to obstructive uropathy from extensive retroperitoneal fibrosis. The biopsy of the mass demonstrated fibro-inflammatory tissue, and its immunohistochemistry was notable for IgG4-positive plasma cells. This case highlights the challenge associated with the diagnosis and management of this rare manifestation of IgG4-RD. In a patient with a history of any form of IgG4-RDs, providers should be vigilant for any signs or symptoms that suggest the development of fibrosis in other organs.
- Published
- 2021
36. IgG4-Related Fibrous Thyroiditis (Riedel’s Thyroiditis): A Case Report
- Author
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Luis Antonio Marín-Castañeda, Cecilia A Gallegos, Oscar Quiroz, Valeria Navarro-Sánchez, and Miguel Ahumada-Ayala
- Subjects
Thyroiditis ,endocrine system ,medicine.medical_specialty ,Goiter ,endocrine system diseases ,medicine.medical_treatment ,Levothyroxine ,Gastroenterology ,Internal medicine ,medicine ,Humans ,Aged ,Riedel's thyroiditis ,business.industry ,Thyroid ,Primary hypothyroidism ,Thyroidectomy ,Articles ,General Medicine ,medicine.disease ,Fibrosis ,medicine.anatomical_structure ,Immunoglobulin G ,Female ,Differential diagnosis ,medicine.symptom ,business ,medicine.drug - Abstract
Patient: Female, 69-year-old Final Diagnosis: Riedel thyroiditis Symptoms: Dysphagia • goiter Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Rare disease Background: Riedel’s thyroiditis is a rare form of immunoglobulin G (IgG) 4-related invasive fibrosis of the thyroid gland; given its scarce incidence, standardized therapeutic guidelines are unavailable. Although complications are unusual, obstructive symptoms produced by the stony-hard goiter may put patients’ lives at risk. The diagnosis must be biopsy-proven, and treatment consists of thyroid hormone replacement and anti-inflammatory drugs, although sometimes thyroidectomy may be required. Case Report: A 69-year-old woman presented with a 7-month history of progressive hypothyroidism and obstructive dysphagia. On physical examination, she had a large, stony-hard goiter. A Doppler ultrasound study revealed a massive, avascular enlargement of the thyroid gland. A computed tomography scan failed to demonstrate any extrathyroidal extension of the abnormal tissue. A Tru-Cut biopsy of the thyroid was performed. Extensive replacement of thyroid follicles by prominent bands of fibrous tissue was observed, with follicular obliteration and mild focal occlusive phlebitis. A lymphoplasmacytic infiltrate was clearly identified; no oxyphilic nor giant cells were found. On immunohistochemistry, the immunoglobulin G (IgG) 4/IgG ratio in the plasma cell infiltrate was 40%; increased serum IgG4 levels were also found, supporting the diagnosis of Riedel’s thyroiditis. The patient was successfully treated with levothyroxine replacement and tamoxifen with prompt resolution of obstructive symptoms. Conclusions: Fibrous thyroiditis should be considered in the differential diagnosis of primary hypothyroidism in a patient with a stony-hard goiter. Although steroids are often used as a therapeutic strategy for this disease, our patient had an excellent therapeutic response to tamoxifen, avoiding adverse effects associated with steroid therapy, the higher cost of monoclonal antibody therapy, and surgery-associated risks.
- Published
- 2020
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37. SUN-LB84 Riedel’s Thyroiditis: A Diagnostic and Therapeutic Challenge
- Author
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Aleksandra Sliwinska, Carl D. Malchoff, Danielle Millar, and Fatima Jalil
- Subjects
Thyroid ,medicine.medical_specialty ,endocrine system ,Riedel's thyroiditis ,endocrine system diseases ,Thyroid Disorders Case Reports IV ,business.industry ,Endocrinology, Diabetes and Metabolism ,medicine ,medicine.symptom ,business ,Dermatology ,AcademicSubjects/MED00250 - Abstract
Background: Riedel’s thyroiditis is a rare thyroid pathology which presents a challenge for clinicians to diagnose and treat. Etiology remains largely unknown, although data suggests an association with Hashimoto thyroiditis, systemic fibrosis, and IgG-4 related systemic disease. Presentation of Riedel’s thyroiditis can mimic malignant thyroid neoplasm, lymphoma, or a fibrous variant of Hashimoto thyroiditis. Due to its rarity, there is no consensus on the treatment. Clinical case: A 36-year old woman presented with a two-month history of gradually progressing neck swelling. She developed associated neck pain, decreased range of motion, hoarseness, and dysphagia, without difficulty breathing. One year prior to presentation, she had been diagnosed with hypothyroidism. She did not have a family or personal history of thyroid malignancy, however, she lived near Chernobyl during her childhood. On exam, the anterior and lateral neck was hard and enlarged, but nontender. The neck range of motion was diminished. The initial ultrasound of the thyroid demonstrated asymmetrically enlarged heterogenous diffusely nodular right thyroid and isthmus measuring 1.9cm. A CT of the chest with contrast showed diffusely enlarged thyroid extending superiorly beyond the image with mild tracheal displacement. Initial laboratory results included TSH of 17.40 uU/ml (ref: 0.35-4.94 uU/ml), free T4 of 1.06 ng/dl (ref: 0.61-1.82 ng/dl). She had a significantly increased thyroid autoantibodies (Anti-TPO >700 IU/ml with ref: 0.0-9.0 IU/ml, Anti-TG >2000 IU/ml with ref: 0.0-4.0 IU/ml). PTH and calcium were normal, and calcitonin was low. In the interim, the patient was evaluated by ENT without evidence of airway compromise. She underwent a core biopsy of the right thyroid lobe which demonstrated dense fibrous connective tissue mixed with mature lymphocytes. Pathology and immunostaining results were suggestive of Riedel’s thyroiditis. The patient was started on prednisone 60mg daily, which she tolerated for 6 weeks. Due to side effects, prednisone dose was titrated down and tamoxifen was added. Over the following 6 months, compressive symptoms resolved, and the ultrasound showed a significant decrease in the thyroid size. TSH normalized with thyroid hormone replacement. To date, she is asymptomatic and continues on tamoxifen and low dose prednisone without evidence of progression. Conclusion: Riedel’s thyroiditis is a rare condition that can progress into a medical emergency and should be suspected in patients presenting with a thyroid mass. Clinical awareness of Riedel’s symptomatology and laboratory findings should enhance our ability to distinguish and make the diagnosis. Instituting effective treatment that results in the improvement of symptoms and reduction in thyroid size can be challenging due to possible poor response or development of side effects.
- Published
- 2020
38. [IGG4-related diseases in endocrinology]
- Author
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Evgenia A Kolpakova, Pavel O. Rumyantsev, Elena U Ulanova, Andrei G. Goncharov, Ivan G Kozlov, Sergey V. Korenev, and Olga S. Chukhacheva
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Thyroid Gland ,Disease ,Lacrimal gland ,Autoimmune Diseases ,Pathogenesis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Pathological ,Autoimmune pancreatitis ,030203 arthritis & rheumatology ,Inflammation ,Riedel's thyroiditis ,business.industry ,Thyroid ,medicine.disease ,030104 developmental biology ,medicine.anatomical_structure ,Endocrinology ,Immunoglobulin G ,Etiology ,Immunoglobulin G4-Related Disease ,medicine.symptom ,business - Abstract
Immunoglobulin-G4-related disease (IgG4-RD) is a chronic immunomediated pathology of different organs of local or systemic nature, which has been established as a separate clinical entity in the early 2000s and is characterized by storiform fibroid inflammation of the affected tissues, their increase, and elevated serum immunoglobulin-G4 (IgG4) levels. The most common manifestations of the disease are major salivary and lacrimal gland enlargement, lymphadenopathy and type 1 autoimmune pancreatitis (AIP1), however, other organs may be also involved (the thyroid, eyes, meninges, heart, lungs, kidneys, aorta, upper airways, mesentery, etc.). The effectiveness of treatment of IgG4-RD, as well as other pathological conditions, is also determined by the timely diagnosis. However, the latter is complicated due to the variety of clinical manifestations and rather variable diagnostic criteria. It is necessary to constantly update the evidence-based knowledge and diagnostic algorithms within this pathology in order to overcome the difficulties, and involve immunologists, endocrinologists, pathologists and specialists in other spheres. This review provides information about the etiology, pathogenesis, and current methods of diagnosis and treatment of IgG4-related diseases, as well as examples of some manifestations of IgG4-RD that an endocrinologist may face in practice.
- Published
- 2020
39. Mucosa-associated lymphoid tissue lymphoma of the thyroid with abundant IgG4-positive plasma cells.
- Author
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Miki, Kentaro, Orita, Yorihisa, Sato, Yasuharu, Sugitani, Iwao, Noyama, Misato, Fuji, Sayaka, Domae, Shuhei, Nose, Soichiro, Hamaya, Kazuo, Yoshino, Tadashi, and Nishizaki, Kazunori
- Subjects
- *
LYMPHOID tissue , *LYMPHOMAS , *IMMUNOGLOBULIN G , *PLASMA cells , *MUCOUS membranes , *NECK diseases - Abstract
Abstract: A case of thyroidal mucosa-associated lymphoid tissue (MALT) lymphoma mimicking IgG4-related disease is described. A 54-year-old male presented with acute swelling of the anterior neck. Anaplastic thyroid carcinoma (ATC), malignant lymphoma (ML), or acute deterioration of Hashimoto's thyroiditis were initially suspected, and an emergent tracheostomy was required for progressive airway obstruction; a simultaneous biopsy from the thyroid tissue was performed. Histopathologically, the lesion consisted of sclerotic fibrosis and diffuse and dense infiltration by small lymphoid cells without atypia and plasma cells, many of which were IgG4-positive. Blood examination also revealed high serum IgG4 levels. Riedel's thyroiditis was suspected. However, despite medical treatments, a firm swelling of the thyroid still remained. In an in situ hybridization study, IgG4-negative plasma cells showed immunoglobulin light-chain restriction (κ-monotype), and immunoglobulin heavy (IgH) chain gene monoclonal re-arrangement was detected by polymerase chain reaction. The lesion was finally diagnosed as MALT lymphoma. When IgG4-related disease is suspected, it is important to thoroughly exclude other possibilities. [Copyright &y& Elsevier]
- Published
- 2013
- Full Text
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40. Immunoglobulin G4-related endocrine diseases
- Author
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Erdei A
- Subjects
- Humans, Immunoglobulin G, Hashimoto Disease diagnosis, Hashimoto Disease drug therapy, Thyroiditis pathology
- Abstract
Immunoglobulin G4-related disease has become the focus of interest in recent years. The disease is characterized by inflammation of the organs involved, often with a macroscopic appearance suggestive of a tumor, elevated immuno-globulin G4 levels, immunoglobulin G4-positive plasma cell infiltration on histological examination, fibrosis, oblit-erative phlebitis, and typically a rapid therapeutic response to corticosteroids. The disease can show a variety of organ manifestations, with frequent involvement of exocrine glands. Among the endocrine organs, symptoms may appear in the thyroid gland and the pituitary gland. The criteria for immunoglobulin G4-related hypophysitis were formu-lated in 2011. Until a few years ago, a condition formerly known as Riedel's thyroiditis was identified as immuno-globulin G4-related thyroiditis. Based on the criteria system for immunoglobulin G4-related thyroid diseases pub-lished in 2021, some patients with Hashimoto's thyroiditis and Graves' disease can also be classified as immunoglobulin G4-related thyroid disease. The identification of immunoglobulin G4-related endocrine diseases and the establishment of an accurate diagnosis can modify the treatment of the patient and determine the course of the disease. Other organ manifestations should be sought in patients with immunoglobulin G4-related endocrine disease and lifelong immunological follow-up is warranted.
- Published
- 2022
- Full Text
- View/download PDF
41. A misdiagnosed Riedel's thyroiditis successfully treated by thyroidectomy and tamoxifen.
- Author
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Wang, Chih-Jung, Wu, Ta-Jen, Lee, Chung-Ta, and Huang, Shih-Ming
- Subjects
THYROIDITIS diagnosis ,THYROIDECTOMY ,TAMOXIFEN ,BLOOD sedimentation ,AUTOIMMUNE thyroiditis ,SOFT tissue infections - Abstract
Riedel''s thyroiditis, known as invasive fibrous thyroiditis, is a very rare form of chronic thyroiditis. It is hard to make the diagnosis without surgical biopsy. We present a case of Riedel''s thyroiditis in a 52-year-old female with past history of Hashimoto''s thyroiditis. She suffered from bilateral neck pain, which radiated to both lower jaws. The erythrocyte sedimentation rate was 125 mm/hour. Subacute thyroiditis superimposed on Hashimoto''s thyroiditis was diagnosed and treated with steroid. However the response was poor and she had a history of severe peptic ulcer. To avoid inducing the peptic ulcer by steroid, she received bilateral subtotal thyroidectomy. During surgery, the thyroid had severe adhesion to surrounding soft tissue and the pathology showed Riedel''s thyroiditis. The neck pain improved after thyroidectomy. Tamoxifen has been given for 8 months and the size of remnant thyroid decreased to 8 mm. We concluded that combined thyroidectomy and tamoxifen successfully cured a patient with Riedel''s thyroiditis. [Copyright &y& Elsevier]
- Published
- 2012
- Full Text
- View/download PDF
42. The Clinical and Pathological Features of IgG-Related Disease.
- Author
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Khosroshahi, Arezou, Deshpande, Vikram, and Stone, John
- Abstract
The rapidly emerging disorder now known as IgG-related disease (IgG-RD) includes a variety of clinical entities once regarded as being entirely separate diseases. Manifestations of IgG-RD have now been reported in essentially all organ systems. Regardless of which organ is involved, tissue biopsies reveal striking histopathological similarities. The hallmark pathology findings are diffuse lymphoplasmacytic infiltrates, abundant IgG-positive plasma cells, modest tissue eosinophilia, and extensive fibrosis. Tumorous swelling and obliterative phlebitis are other frequently observed features. Polyclonal elevations of serum IgG are found in approximately 70% of patients. Many questions pertaining to the etiology, pathophysiology, epidemiology, clinical features, therapy, disease monitoring, and long-term outcomes remain to be addressed. This paper focuses on the clinical and pathological features of IgG-RD. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
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43. Unusual presentations of thyroid malignancies - a case series.
- Author
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Raju, G. and Kameswaran, Mohan
- Subjects
- *
CANCER , *TUMORS , *THYROID diseases , *MANAGEMENT - Abstract
Unusual presentations of thyroid neoplasms have been reported from time to time. Four such cases of bizarre presentations of thyroid malignancies seen in the ENT Department of ESIC Hospital, K.K. Nagar, Chennai, India are presented. These cases highlight certain important issues concerning the diagnosis and management. A review of the literature on the subject is discussed. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
44. Riedel’s thyroiditis: impact and strategy of a challenging surgery.
- Author
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Lorenz, Kerstin, Gimm, Oliver, Holzhausen, Hans Jürgen, Kittel, Stephan, Ukkat, Jörg, Phuong Nguyen Thanh, Brauckhoff, Michael, and Dralle, Henning
- Subjects
- *
THYROIDITIS , *SURGERY , *CANCER , *SYMPTOMS , *DISEASE complications , *STEROIDS - Abstract
No surgical standard for Riedel’s thyroiditis (RT) is established. Salvage surgery follows severe cervical and compressive airway symptoms or strong suspicion of malignancy. Obscured planes and multi-infiltrative extension prevent sufficient surgery with considerate complications. No alternative definitive treatment is available. In failing conservative treatment, the role of surgery in RT remains unclear. Clinical manifestation, treatment, outcome and follow-up in a unique series of eight consecutive patients with RT are presented. Seven female patients and one male patient with cervical tumor growth or thyroiditis underwent four total and three sub-total thyroidectomies, respectively, one patient declined remedial surgery. Complications were one bilateral laryngeal nerve palsy and one transient hypoparathyroidism. Histology confirmed RT with perithyroidal extension and excluded malignancy in all. Symptomatic relief of cervical and airway obstruction was achieved in all. Follow-up revealed two extensive mediastinal RT recurrences 1 and 6 years after surgery. Favourable symptomatic outcome and alleviation of steroids in the majority render surgery for RT valuable when conservative treatment fails. However, more radical procedures show no advantages and recurrences are not prevented. The demanding technique in RT requires special surgical expertise and highly recommends intra-operative neuromonitoring. [ABSTRACT FROM AUTHOR]
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- 2007
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45. Riedel’s thyroiditis in a 78 year old male: a rare experience
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Krishna Maharjan, Anju Pradhan, Shyam Thapa Chettri, Niharika Shah, and P Paudyal
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endocrine system ,Pathology ,medicine.medical_specialty ,endocrine system diseases ,Riedel's thyroiditis ,business.industry ,medicine.medical_treatment ,Thyroid ,Thyroidectomy ,Normal thyroid ,medicine.disease ,Thyroiditis ,Gross examination ,medicine.anatomical_structure ,Fibrosis ,Parenchyma ,medicine ,General Earth and Planetary Sciences ,medicine.symptom ,business ,General Environmental Science - Abstract
We present a rare case of Riedel’s thyroiditis in a 78-year-old male, native of hilly region of Nepal who presented with chief complaint of long standing swelling of the thyroid with discharging sinus. Right hemithyroidectomy with excision of sinus was done. Gross examination showed asymmetrically enlarged right lobe of thyroid with adherent fibroadipose and muscular tissue. Microscopy revealed diffuse hyalinised fibrosis of the thyroid parenchyma with presence of variable number of atrophic to few normal thyroid follicles in between. The stroma showed dense lymphoplasmacytic infiltration with foci of calcifications and hemorrhage. There was extension of fibrosis beyond the thyroid capsule, encasing the skeletal muscle bundles at many places. Diagnosis of Riedel’s thyroiditis was made.Riedel’s thyroiditis is a rare entity but can occasionally be encountered. Various imaging modalities may not be helpful for the definite diagnosis. Diagnostic thyroidectomy should be performed for the accurate diagnosis and further management. DOI: 10.21276/APALM.1392
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- 2017
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46. Differential diagnosis and management of airway obstruction in Riedel's thyroiditis: A case report
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Sato, Katsuro, Hanazawa, Hideyuki, Watanabe, Jun, and Takahashi, Sugata
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DIFFERENTIAL diagnosis , *DEGLUTITION disorders , *AUTOIMMUNE diseases ,THYROID disease diagnosis - Abstract
Abstract: A case of Riedel''s thyroiditis, which required differential diagnosis from malignant tumor of the thyroid gland, and the strategy of surgical treatment is reported. Differential diagnosis prior to the treatment was difficult, but the diagnosis was decided by the histopathological findings of an open biopsy specimen obtained simultaneously in an emergent tracheostomy required for progressive airway stenosis. First-choice treatment for Riedel''s thyroiditis has been reported to be steroid administration, however, this treatment was difficult for the present case due to continuous steroid treatment for complicated neuro-Behçet''s disease. Therefore, vaporization of the lesion using KTP-LASER and T-tube placement was chosen for the surgical treatment strategy of this patient. After 1 year of follow-up since the operation, the T-tube was removed and the tracheostoma was closed, and the patient has remained symptom free for years. Careful long-term follow-up is still needed for this patient to prevent recurrence of the disease, subsequent complications of autoimmune diseases, and thyroid malignancies. [Copyright &y& Elsevier]
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- 2005
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47. Positron emission tomography as an aid in the diagnosis and follow-up of Riedel's thyroiditis
- Author
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Kotilainen, Pirkko, Airas, Laura, Kojo, Tiina, Kurki, Timo, Kataja, Kaisa, Minn, Heikki, and Nuutila, Pirjo
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- *
POSITRON emission tomography , *THYROID gland , *ADRENOCORTICAL hormones , *THYROIDITIS - Abstract
We describe the usage of positron emission tomography (PET) as an aid in the initial diagnosis and follow-up of Riedel''s thyroiditis. A 41-year-old patient was admitted for an enlarged and tender thyroid gland in association with severe systemic symptoms of inflammation. Imaging with fluorine-18 fluorodeoxyglucose (FDG) and PET demonstrated an intensive uptake of FDG in both lobes of the thyroid gland as an indication of severe inflammation. The diagnosis of Riedel''s thyroiditis was confirmed by the histological findings of biopsy specimens taken during a palliative thyroid resection. The inflammatory symptoms and local pain dramatically disappeared after commencement of high-dose corticosteroid therapy. A follow-up PET scan after 2 weeks of corticosteroid treatment showed a 60% decrease in the uptake of FDG in the thyroid. This indicates that FDG metabolic activity can also be used to assess a patient''s response to therapy in Riedel''s thyroiditis. [Copyright &y& Elsevier]
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- 2004
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48. Steroid responsiveness in a case of Riedel's thyroiditis and retroperitoneal fibrosis.
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Moulik, P.K., Al-Jafari, M.S., and Khaleeli, A.A.
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RETROPERITONEAL fibrosis ,THYROIDITIS ,STEROID drugs ,THYROID diseases ,STEROIDS ,RETROPERITONEUM diseases - Abstract
Riedel's thyroiditis is a rare chronic inflammatory disease of the thyroid characterised by an invasive fibrotic process. We present a lady with newly diagnosed hypothyroidism, rapidly enlarging hard, fixed goitre, strongly positive thyroid antibodies and raised erythrocyte sedimentation rate (ESR). A tru-cut biopsy confirmed Riedel's struma. Regression of the goitre and reduction of antibody titres occurred after starting prednisolone, which was stopped after 10 months. Six months later, she presented with renal failure due to retroperitoneal fibrosis that was successfully treated by reinstitution of steroids and ureteric stenting. Very high titres of thyroid antibodies and hypothyroidism predating development of goitre suggest coexistence of Hashimoto's thyroiditis and Riedel's thyroiditis. Tru-cut biopsy obviated the need for open thyroidectomy. A predominantly inflammatory as opposed to fibrotic thyroid histology may predict good response to steroids. Relapse following steroid withdrawal may not only be in the thyroid but also at other sites. [ABSTRACT FROM AUTHOR]
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- 2004
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49. Comprehensive research on thyroid diseases associated with autoimmunity: autoimmune thyroid diseases, thyroid diseases during immune-checkpoint inhibitors therapy, and immunoglobulin-G4-associated thyroid diseases
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Hiroshi Iwakura, Takashi Akamizu, Hidefumi Inaba, Hiroyuki Ariyasu, and Ken Takeshima
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endocrine system ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,Graves' disease ,030209 endocrinology & metabolism ,Autoimmunity ,Disease ,Hashimoto Disease ,medicine.disease_cause ,Autoantigens ,Thyroiditis ,Thyrotropin receptor ,Autoimmune Diseases ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Th2 Cells ,medicine ,Animals ,Humans ,Riedel's thyroiditis ,business.industry ,Immunogenicity ,Thyroid ,Thyroiditis, Autoimmune ,Receptors, Thyrotropin ,HLA-DR Antigens ,Th1 Cells ,medicine.disease ,Thyroid Diseases ,Graves Disease ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Immunoglobulin G ,Immunology ,Immunotherapy ,medicine.symptom ,business - Abstract
Various thyroid diseases are associated with autoimmunity. Major autoimmune thyroid diseases are Graves' disease (GD) and Hashimoto's thyroiditis (HT). Thyrotropin receptor is an autoantigen in GD, and its immunogenicity has been examined. Immune-checkpoint inhibitor (ICI) is recently widely used for treatment of malignant tumors, but cases of thyroid diseases during ICI treatment have been increasing. Thyroid diseases during ICI therapy have been investigated in immunological and clinical aspects, and their Japanese official diagnostic guidelines were established. In addition, serum and tissue immunoglobulin-G4 levels have been examined in association with clinicopathological characteristics in GD, HT, and Riedel's thyroiditis. We review these diseases associated with thyroid autoimmunity and comprehensively discuss their potential application in future research and therapeutic options.
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- 2019
50. SAT-597 Diagnostic and Therapeutic Challenges of Riedel's Thyroiditis
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Vafa Tabatabaie, Karen McCloskey, and MaryAnne Bhojwani
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Thyroid ,medicine.medical_specialty ,Riedel's thyroiditis ,business.industry ,Endocrinology, Diabetes and Metabolism ,medicine ,medicine.symptom ,Thyroid Case Reports: Hypothyroidism, Hyperthyroidism, Goiter and Laboratory Assessment ,business ,Dermatology - Abstract
Background: Riedel’s thyroiditis is an extremely rare condition characterized by an overgrowth of inflammatory fibrosis that destroys the thyroid follicular architecture. The presentation can mimic malignancy, and due to its rarity, the diagnosis can be delayed. Experience with treatment of this condition is limited, but glucocorticoids and tamoxifen have both been shown in case reports to be effective. Clinical Case: A 68 year old woman presented with dyspnea and weakness. Her exam showed a diffusely enlarged thyroid with a hard texture. Labs showed hypothyroidism for which she was started on levothyroxine, and imaging revealed a goiter with a dominant 3.1cm left thyroid nodule causing tracheal narrowing. Laryngoscopy showed R vocal fold paralysis. FNA of this nodule was non-diagnostic; therefore a core biopsy was attempted which showed no thyroid tissue but skeletal muscle and sclerotic fibro-connective tissue infiltrated by chronic inflammatory cells. Neck CT done 1 month after initial presentation showed a diffusely enlarged and heterogeneous thyroid gland encasing the R carotid artery, infiltrating the peri-thyroidal fat, and causing tracheal narrowing. Given ongoing concern for malignancy, she had open incisional thyroid biopsy showing dense fibrous tissue with chronic inflammation and entrapped skeletal muscle, but again no thyroid tissue was identified. Pathology was believed to be consistent with Riedel’s thyroiditis. She was started on prednisone 60mg daily with improvement in her symptoms, and the steroids were gradually tapered off after 9 months of treatment given stable imaging. The patient remained off steroids and without new symptoms for 1.5 years. She was then admitted for syncope and had further evidence of disease progression on CT scan, with continued growth of the mediastinal component as well as encasement of the bilateral internal carotid arteries, right brachiocephalic trunk, trachea, and upper esophagus. Repeat biopsy again showed dense fibrous tissue with scattered small lymphocytes and plasma cells. She was started back on prednisone 60 mg daily, and imaging done after 3 months of treatment showed shrinkage of the size of the neck and mediastinal mass. However, the patient was noted to have Cushingoid features, including moon facies and weight gain. Therefore, tamoxifen 10mg twice a day was started, and the glucocorticoids were successfully tapered off. To date, she remains asymptomatic without evidence of disease progression while on tamoxifen 10mg twice a day. Conclusion: Riedel’s thyroiditis is a rare chronic inflammatory disease characterized by an invasive fibrotic process that can mimic malignancy. Treatment with glucocorticoids and/or tamoxifen can result in improvement in symptoms and reduction of the size of the mass.
- Published
- 2019
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