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invasive fibrous thyroiditis; Riedel's fibrous thyroiditis; Riedel's struma
The rarest form of thyroiditis.
Etiology: unknown
Epidemiology:
1) woman affected more frequently than men (3:1)
2) most frequently occurs in women 30-60 years of age
Pathology:
- Morphology:
a) glandular atrophy
b) fibrous replacement of thyroid
c) adhesion to surrounding structures
- May be misconstrued as malignancy.
- Sometimes associated with fibrosis at other sites, especially retroperitoneal or multifocal fibrosis.
Clinical manifestations:
1) enlargement of a pre-existing goiter
2) generally painless
3) enlargement of thyroid may cause symptoms
4) thyroid hard, woody thyroid mass
5) fixation to surrounding structure
6) vocal cord paralysis may occur
7) associated with other focal sclerosing syndromes (1/3)
a) retroperitoneal
b) cholangitis
c) orbital
d) mediastinal
Laboratory:
1) T4 generally normal, but may decline with fibrous replacement of thyroid
2) biopsy to establish diagnosis & rule-out carcinoma
Management:
1) no medications of benefit
2) surgery is to relieve symptoms of compression
General
chronic thyroiditis (Riedel's thyroiditis, Hashimoto's thyroiditis)
References
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 646-650
- Cotran et al Robbins Pathologic Basis of Disease,
5th ed. W.B. Saunders Co, Philadelphia, PA 1994 pg 1125-26