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Riedel's goiter (fibrotic invasive thyroiditis).
Last reviewed: 04.07.2025
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Riedel's goiter (fibroinvasive thyroiditis) is a very rare form of thyroiditis - 0.98% of cases - first described in 1986 by Riedel, characterized by focal or diffuse enlargement of the gland with extreme density and a tendency to invasive growth, resulting in the development of paresis and symptoms of compression of the vessels of the neck and trachea.
Causes fibrotic invasive thyroiditis (Riedel's goiter).
The cause and pathogenesis of fibro-invasive thyroiditis (Riedel's goiter) are unclear. Antithyroid antibodies are rarely detected, in low titers, and have no pathogenetic significance.
The gland is asymmetrically or symmetrically enlarged, woody in density, intimately fused with surrounding organs and tissues. Almost total replacement of the parenchyma with hyalinized fibrous tissue with a small infiltration of lymphocytes and plasma cells, less often - neutrophils and eosinophils, occurs in it. 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 years, leading to hypothyroidism. When scanning, areas of fibrosis are defined as "cold". Changes are often multilocular, sometimes only one lobe is affected, and then the patient remains euthyroid.
Forms
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Chronic specific thyroiditis
These forms of thyroiditis occur against the background of tuberculosis, lymphogranulomatosis, amyloidosis, sarcoidosis, actinomycosis. Causing destruction of the gland, specific changes lead to hypothyroidism, being determined on the scanogram as "cold" areas. The most informative is a puncture biopsy with histological changes characteristic of a particular disease.
As a rule, treatment of the underlying disease leads to the cure of specific thyroiditis. In rare cases, in the presence of tuberculomas, gums and fistulas in actinomycosis, it is necessary to remove the affected lobe. Working capacity is restored completely.
Diagnostics fibrotic invasive thyroiditis (Riedel's goiter).
The diagnosis of fibro-invasive thyroiditis (Riedel's goiter) is made on the basis of palpation data (woody density, adhesion to surrounding tissues, poor mobility of the gland), low titer of antithyroid antibodies, and puncture biopsy.
Differential diagnostics are performed with thyroid cancer. The disease may be combined with fibrosis of the parotid salivary gland, retrobulbar retroperitoneal fibrosis (Ormond syndrome).
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Treatment fibrotic invasive thyroiditis (Riedel's goiter).
Treatment of fibro-invasive thyroiditis (Riedel's goiter) is surgical.