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
Highlights
Riedel’s thyroiditis (RT) is a chronic thyroiditis characterized by an inflammatory proliferative fibrosing process that partially destroys the thyroid gland and extends into the surrounding tissues beyond the thyroid capsule
T3 and T4 levels were within the normal range while thyroid stimulating hormone (TSH) was raised (10.7 μIU/mL)
The true incidence is unknown, but in a 1985 review of 56,700 thyroidectomies performed at Mayo Clinic, only 37 cases of Riedel’s thyroiditis were identified.[6]Due to extensive fibrosis of the thyroid tissue along with surrounding soft tissue, it generally presents as a firm mass in the thyroid, with compressive symptoms.[5,7]
Summary
Riedel’s thyroiditis (RT) is a chronic thyroiditis characterized by an inflammatory proliferative fibrosing process that partially destroys the thyroid gland and extends into the surrounding tissues beyond the thyroid capsule. [1] It is an uncommon disease found in about 0.05% of all thyroidectomies.[2]. Neck Ultrasound showed enlarged right lobe of thyroid with multiple nodules and coarse calcifications. The gland was found to be asymmetrically enlarged with adherent fibroadipose and muscular tissue on the right. The attached soft tissue showed presence of a sinus tract which was not reaching up to the thyroid. Microscopic examination revealed diffuse hyalinised fibrosis of the thyroid parenchyma with presence of variable number of atrophic to few normal thyroid follicles in between (Figure 2 & 3). The tract was not extending into the thyroid parenchyma microscopically as well. There was absence of hürthle cells, lymphoid follicles, multinucleated giant cells or granulomas. Based on these findings a diagnosis of Riedel’s thyroiditis was considered
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