Skip to main content

Advertisement

SpringerLink
Log in

Riedel’s thyroiditis: impact and strategy of a challenging surgery

  • Current Concepts in Endocrine Surgery
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

No surgical standard for Riedel’s thyroiditis (RT) is established. Salvage surgery follows severe cervical and compressive airway symptoms or strong suspicion of malignancy. Obscured planes and multi-infiltrative extension prevent sufficient surgery with considerate complications. No alternative definitive treatment is available. In failing conservative treatment, the role of surgery in RT remains unclear.

Materials and methods

Clinical manifestation, treatment, outcome and follow-up in a unique series of eight consecutive patients with RT are presented.

Results

Seven female patients and one male patient with cervical tumor growth or thyroiditis underwent four total and three sub-total thyroidectomies, respectively, one patient declined remedial surgery. Complications were one bilateral laryngeal nerve palsy and one transient hypoparathyroidism. Histology confirmed RT with perithyroidal extension and excluded malignancy in all. Symptomatic relief of cervical and airway obstruction was achieved in all. Follow-up revealed two extensive mediastinal RT recurrences 1 and 6 years after surgery.

Conclusion

Favourable symptomatic outcome and alleviation of steroids in the majority render surgery for RT valuable when conservative treatment fails. However, more radical procedures show no advantages and recurrences are not prevented. The demanding technique in RT requires special surgical expertise and highly recommends intra-operative neuromonitoring.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Woolner LB, Mc Conahey WM, Bears OB (1957) Invasive fibrous thyroiditis (Riedel’s struma). JCEM 17:201–220

    PubMed  Google Scholar 

  2. Hay ID (1985) Thyroiditis: a clinical update. Mayo Clin Proc 60:836–843

    PubMed  CAS  Google Scholar 

  3. Riedel BM (1896) Die chronische, zur BIldung eisenharter Tumoren führende Entzündung der Schilddrüse. Verh Dtsch Ges Chir 25:101–105

    Google Scholar 

  4. Martin Schwaegerle S, Bauer TW, Esselstyn (1988) Single case reports. Riedel’s thyroiditis. Am J Clin Pathol 90:715–722

    Google Scholar 

  5. Harigopal M, Sahoo S, Recant WM, DeMay RM (2004) Fine needle aspiration of Riedel’s disease: report of a case and review of the literature. Diagn Cytopathol 30:193–197

    Article  PubMed  Google Scholar 

  6. Papi G, Corrado S, Carapezzi C, De Gaetani C, Carani C (2003) Riedel’s thyroiditis and fibrous variant of Hashimoto’s thyroiditis: a clinicopathological and immunohistochemical study. J Endocrinol Invest 26:444–449

    PubMed  CAS  Google Scholar 

  7. Nazal EM, Belmatoug N, De Roquancourt A, Lefort A, Fantin B (2003) Hypoparathyroidism preceding Riedel’s thyroiditis. Eur J Intern Med 14:202–204

    Article  PubMed  Google Scholar 

  8. Emch TM, Miller MA (2005) Case report. Retroperitoneal fibrosis involving the left kidney in a patient with a remote history of Riedel’s thyroiditis. AJR Am J Roentgenol 184:97–98

    Google Scholar 

  9. Kotilainen P, Airas L, Kojo T, Kurki T, Kataja K, Minn H, Nuutila P (2005) Riedel’s thyroiditis in a patient with multiple sclerosis. Neuroendocrinol Lett 26:67–68

    PubMed  Google Scholar 

  10. Armiagliato M, Paolini R, Bianchini E, Monesi G, Zamboni S, D’Andrea E (2002) Hashimoto’s thyroiditis and Grave’s disease associated with retroperitoneal fibrosis. Thyroid 12:829–831

    Article  Google Scholar 

  11. Drieskens O, Blockmans D, Van den Bruel A, Mortelmans L (2002) Riedel’s thyroiditis and retroperitoeneal fibrosis in multifocal fibrosclerosis. Positron emission tomographic findings. Clin Nucl Med 27:413–415

    Article  PubMed  Google Scholar 

  12. Fontaine S, Gaches F, Lamant L, Uzan M, Bennet A, Caron Ph (2005) An unusual form of Riedel’s thyroiditis: a case report and review of the literature. Thyroid 15:85–88

    Article  PubMed  CAS  Google Scholar 

  13. Tütüncü NB, Erbas T, Bayraktar M, Özgen A, Gedik O (2000) Multifocal idiopathic fibrosclerosis manifesting with Riedel’s thyroiditis. Endocr Pract 6:447–449

    PubMed  Google Scholar 

  14. Hostalet F, Hellin D, Ruitz JA (2003) Tumefactive fibroinflammatory lesion of the head and neck treated with steroids: a case report. Eur Arch Otorhinolaryngol 260:229–231

    PubMed  CAS  Google Scholar 

  15. Moore SE, Suvarna SK, Harrison BJ (2001) Management of complicated intrathoracic Riedel’s thyroiditis. ANZ Journal of Surgery 71:559–560

    Article  PubMed  CAS  Google Scholar 

  16. Pritchyk K, Newkirk K, Garlich P, Deeb Z (2004) Tamoxifen therapy for Riedel’s thyroiditis. Laryngoscope 114:1758–1760

    Article  PubMed  Google Scholar 

  17. Few J, Thompson NW, Angelos P, Simeone D, Giordano T, Reeve T (1996) Riedel’s thyroiditis: treatment with tamoxifen. Surgery 120:993–999

    Article  PubMed  CAS  Google Scholar 

  18. Lo JC, Loh KC, Rubin AL, Cha I, Greenspan FS (1998) Riedel’s thyroiditis presenting with hypothyroidism and hypoparathyroidism: dramatic response to glucocorticoid and thyroxine therapy. Clin Endocrinol 48:815–818

    Article  CAS  Google Scholar 

  19. Jung YJ, Schaub CR, Rhodes R, Rich FA, Muehlenbein SJ (2004) A case of Riedel’s thyroiditis treated with tamoxifen. Another successful outcome. Endocr Pract 10:483–486

    PubMed  Google Scholar 

  20. Meijer S, Hausman R (1978) Occlusive phlebitis, a diagnostic feature in Riedel’s thyroiditis. Virchow’s Arch A 337:339–349

    Google Scholar 

  21. Kojima M, Nakamura S, Yamane Y, Shimizu K, Sugihara S, Masawe N (2003) Riedel’s thyroiditis containing cytologically atypically appearing B-cells: a case report. Pathol Res Pract 199:497–501

    Article  PubMed  Google Scholar 

  22. Heufelder AE, Goellner JR, Bahn RS, Gleich GJ, Hay ID (1996) Tissue eosinophilis and eosinophil degranulation in Riedel’s invasive fibrous thyroiditis. J Clin Endocrinol Metab 81:977–984

    Article  PubMed  CAS  Google Scholar 

  23. Rodriguez I, Ayala E, Caballero C, De Miguel C, Matia-Guiu X, Cubilla AL, Rosai J (2001) Solitary fibrous tumor of the thyroid gland. Am J Surg Pathol 25:1424–1428

    Article  PubMed  CAS  Google Scholar 

  24. Sato K, Hanazawa H, Watanabe J, Takahashi S (2005) Differential diagnosis and management of airway obstruction in Riedel’s thyroiditis: a case report. Auris Nasus Larynx 32:439–443

    Article  PubMed  Google Scholar 

  25. Kotilainen P, Airas L, Kojo T, Kurki T, Kataja K, Minn H, Nuutila P (2004) Positron emission tomography as an aid in the diagnosis and follow-up of Riedel’s thyroiditis. Eur J Intern Med 15:186–189

    Article  PubMed  Google Scholar 

  26. Papi G, Corrado S, Cesinaro AM, Novelli L, Smerieri A, Carapezzi C (2002) Riedel’s thyroiditis: clinical, pathological and imaging features. Int J Clin Pract 56:65–67

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General, Visceral and Vascular Surgery, Martin-Luther University of Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle/Saale, Germany

    Kerstin Lorenz, Oliver Gimm, Stephan Kittel, Jörg Ukkat, Phuong Nguyen Thanh, Michael Brauckhoff & Henning Dralle

  2. Department of Pathology, Martin-Luther University of Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle/Saale, Germany

    Hans Jürgen Holzhausen

Authors
  1. Kerstin Lorenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Oliver Gimm
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hans Jürgen Holzhausen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephan Kittel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jörg Ukkat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Phuong Nguyen Thanh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael Brauckhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Henning Dralle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kerstin Lorenz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lorenz, K., Gimm, O., Holzhausen, H.J. et al. Riedel’s thyroiditis: impact and strategy of a challenging surgery. Langenbecks Arch Surg 392, 405–412 (2007). https://doi.org/10.1007/s00423-007-0147-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-007-0147-8

Keywords

Search

Navigation