Riedel’s thyroiditis

Introduction 

Riedel’s thyroiditis is a chronic inflammatory disease associated with fibrosis or woody enlargement of all or part of the thyroid gland 

-it is now considered a IgG4-related systemic disease 

-Women in midlife are most often affected 

Symptoms & Signs 

-Symptoms of hypothyroidism when enough thyroid tissue is replaced by fibrous tissue; compressive symptoms of the esophagus, trachea such as dysphagia, dyspnea, hoarseness; a hard, ‘woody’ thyroid gland

Diagnosis 

Gross exam: hard, fixed, ‘woody’ thyroid gland 

Labs: normal or low thyroid hormones, normal or elevated TSH, normal or elevated IgG4 levels 

Open thyroid biopsy: a dense lymphoplasmacytic infiltrate rich in IgG4 plasma cells, storiform fibrosis, and obliterative phlebitis

Treatment 

Surgery: decompression through thyroidectomy Hypothyroidism: thyroid hormone replacement

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