Riedel's goiter (fibro-invasive thyroiditis)

Riedel's goiter (fibro-invasive thyroiditis) - a very rare form of thyroiditis - 0.98% of cases - was first described in 1986 by Riedel, distinguished by focal or diffuse enlargement of the gland with extreme density and propensity to invasive growth, as a result of which paresis and compression symptoms develop vessels of the neck and trachea.

[1], [2], [3]

Causes of the fibrous-invasive thyroiditis (hoba ridela)

The cause and pathogenesis of fibro-invasive thyroiditis (Riedel's goiter) are not clear. Antithyroid antibodies are rarely found, have low titers and pathogenetic values do not have.

Gland asymmetrically or symmetrically enlarged, woody density, intimately soldered to surrounding organs and tissues. It is almost total replacement of the parenchyma hyalinized fibrous tissue with a small infiltration of lymphocytes and plasma cells, less often with neutrophils and eosinophils. Riedel's thyroiditis can be combined with retroperitoneal, mediastinal, orbital and pulmonary fibrosclerosis, being part of multifocal fibrosclerosis or a manifestation of fibrosing disease.

This form of thyroiditis progresses over the years, leading to hypothyroidism. When scanning, areas of fibrosis are defined as “cold”. Changes are more often multilocular, sometimes only one lobe is affected, and then the patient remains euthyroid.

[4], [5], [6], [7]

Forms

[8], [9], [10], [11], [12]

Chronic specific thyroiditis

These forms of thyroiditis arise against tuberculosis, Hodgkin's disease,  amyloidosis,  sarcoidosis,  actinomycosis. Causing destruction of the gland, specific changes lead to hypothyroidism, defined on the scangram as "cold" areas. The most informative is a puncture biopsy with histological changes characteristic of a particular disease.

As a rule, the treatment of the underlying disease leads to the cure of specific thyroiditis. In rare cases, in the presence of tubercle, gum and fistula with actinomycosis, it is necessary to remove the affected lobe. The ability to work is restored completely.

[13], [14]

Diagnostics of the fibrous-invasive thyroiditis (hoba ridela)

The diagnosis of fibro-invasive thyroiditis (Riedel's goiter) is made on the basis of palpatory data (ligneous density, cohesion with surrounding tissues, poor displacement of the gland), low titer of antithyroid antibodies, and puncture biopsy.

Differential diagnosis is carried out with thyroid cancer. The disease can be combined with parotid salivary gland fibrosis, retrobulbar retroperitoneal fibrosis (Ormond syndrome).

[15], [16]

Differential diagnosis

Differential diagnosis is done with thyroid cancer. Disease may be combined with fibrosis of parotid gland, optic RPF syndrome (Ormond syndrome).

Treatment of the fibrous-invasive thyroiditis (hoba ridela)

Treatment of fibro-invasive thyroiditis (Riedel's goiter) is surgical.

Forecast

The prognosis is favorable. The work capacity depends on the compensation of hypothyroidism.

[17], [18]