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Riedel's thyroiditis masquerading as anaplastic thyroid carcinoma: a case report.

Shahi N, Abdelhamid MF, Jindall M, Awad RW - J Med Case Rep (2010)

Bottom Line: We discuss the presentation, investigation and management of this very rare condition.This was successfully treated with very high dose steroids, with no relapse in the symptoms.In addition, our case demonstrates that this condition should be treated with very high dose steroids to prevent relapse.

View Article: PubMed Central - HTML - PubMed

Affiliation: Warwick Hospital, Lakin house, Lakin Road, CV34 5BW, UK.

ABSTRACT

Introduction: Riedel's thyroiditis is a rare thyroid disease characterized by dense fibrous tissues that replace the thyroid gland and invade the adjacent structures that can mimic thyroid malignancy. We discuss the presentation, investigation and management of this very rare condition.

Case presentation: We present a case of a 59-year-old African-Caribbean man who presented with a rapidly growing hard neck mass, a hoarse voice, dysphagia and breathing difficulty that clinically suggested thyroid malignancy. Biopsy, however, revealed dense fibrous tissues suggestive of Riedel's thyroiditis. This was successfully treated with very high dose steroids, with no relapse in the symptoms.

Conclusion: It is important for clinicians to be aware of this diagnosis when managing patients with thyroid disease, because Riedel's thyroiditis can mimic malignancy. In addition, our case demonstrates that this condition should be treated with very high dose steroids to prevent relapse.

No MeSH data available.


Related in: MedlinePlus

Computed tomography (CT) scan of the neck and thoracic outlet. Repeat CT scanning after ten months of steroid therapy confirms reduction in size of the goitre and with return of the trachea to midline position.
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Figure 2: Computed tomography (CT) scan of the neck and thoracic outlet. Repeat CT scanning after ten months of steroid therapy confirms reduction in size of the goitre and with return of the trachea to midline position.

Mentions: During surgery this thyroid mass was found invading all the surrounding structures, including the carotid arteries, internal jugular vein and the right recurrent laryngeal nerve. The trachea was significantly deviated to the left side by this mass and no tissue planes could be identified for dissection. Anaplastic carcinoma of the thyroid was suspected, though unlikely due to the age of the patient. As surgical resection was impossible, a wedge biopsy was taken to establish histological diagnosis. Histopathology showed an admixture of fibrous tissue with focal collagen hyalinization and inflammatory infiltrate rich in lymphocytes and plasma cells. Occasional giant cells were present with atrophic thyroid follicles. At this stage, the diagnosis was confirmed as Riedel's thyroiditis, based on the histology results. The patient was subsequently started on 80 mg/day of prednisolone. After four weeks, there was marked improvement in the voice and swallowing of the patient with reduction in the size of the goitre. Within two weeks of starting steroids, the ESR was noted to have fallen to 10 mm/hr. Prednisolone was gradually tapered over 10 months to a dose of 5 mg on alternate days. Repeat CT scan confirmed reduction in the size of the goitre with minimal shift in the trachea (Figure 2).


Riedel's thyroiditis masquerading as anaplastic thyroid carcinoma: a case report.

Shahi N, Abdelhamid MF, Jindall M, Awad RW - J Med Case Rep (2010)

Computed tomography (CT) scan of the neck and thoracic outlet. Repeat CT scanning after ten months of steroid therapy confirms reduction in size of the goitre and with return of the trachea to midline position.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2821392&req=5

Figure 2: Computed tomography (CT) scan of the neck and thoracic outlet. Repeat CT scanning after ten months of steroid therapy confirms reduction in size of the goitre and with return of the trachea to midline position.
Mentions: During surgery this thyroid mass was found invading all the surrounding structures, including the carotid arteries, internal jugular vein and the right recurrent laryngeal nerve. The trachea was significantly deviated to the left side by this mass and no tissue planes could be identified for dissection. Anaplastic carcinoma of the thyroid was suspected, though unlikely due to the age of the patient. As surgical resection was impossible, a wedge biopsy was taken to establish histological diagnosis. Histopathology showed an admixture of fibrous tissue with focal collagen hyalinization and inflammatory infiltrate rich in lymphocytes and plasma cells. Occasional giant cells were present with atrophic thyroid follicles. At this stage, the diagnosis was confirmed as Riedel's thyroiditis, based on the histology results. The patient was subsequently started on 80 mg/day of prednisolone. After four weeks, there was marked improvement in the voice and swallowing of the patient with reduction in the size of the goitre. Within two weeks of starting steroids, the ESR was noted to have fallen to 10 mm/hr. Prednisolone was gradually tapered over 10 months to a dose of 5 mg on alternate days. Repeat CT scan confirmed reduction in the size of the goitre with minimal shift in the trachea (Figure 2).

Bottom Line: We discuss the presentation, investigation and management of this very rare condition.This was successfully treated with very high dose steroids, with no relapse in the symptoms.In addition, our case demonstrates that this condition should be treated with very high dose steroids to prevent relapse.

View Article: PubMed Central - HTML - PubMed

Affiliation: Warwick Hospital, Lakin house, Lakin Road, CV34 5BW, UK.

ABSTRACT

Introduction: Riedel's thyroiditis is a rare thyroid disease characterized by dense fibrous tissues that replace the thyroid gland and invade the adjacent structures that can mimic thyroid malignancy. We discuss the presentation, investigation and management of this very rare condition.

Case presentation: We present a case of a 59-year-old African-Caribbean man who presented with a rapidly growing hard neck mass, a hoarse voice, dysphagia and breathing difficulty that clinically suggested thyroid malignancy. Biopsy, however, revealed dense fibrous tissues suggestive of Riedel's thyroiditis. This was successfully treated with very high dose steroids, with no relapse in the symptoms.

Conclusion: It is important for clinicians to be aware of this diagnosis when managing patients with thyroid disease, because Riedel's thyroiditis can mimic malignancy. In addition, our case demonstrates that this condition should be treated with very high dose steroids to prevent relapse.

No MeSH data available.


Related in: MedlinePlus