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Langenbeck's Archives of Surgery

, Volume 392, Issue 4, pp 405–412 | Cite as

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

  • Kerstin LorenzEmail author
  • Oliver Gimm
  • Hans Jürgen Holzhausen
  • Stephan Kittel
  • Jörg Ukkat
  • Phuong Nguyen Thanh
  • Michael Brauckhoff
  • Henning Dralle
Current Concepts in Endocrine Surgery

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.

Keywords

Riedel’s thyroiditis Surgery Outcome Neuromonitoring 

References

  1. 1.
    Woolner LB, Mc Conahey WM, Bears OB (1957) Invasive fibrous thyroiditis (Riedel’s struma). JCEM 17:201–220PubMedGoogle Scholar
  2. 2.
    Hay ID (1985) Thyroiditis: a clinical update. Mayo Clin Proc 60:836–843PubMedGoogle Scholar
  3. 3.
    Riedel BM (1896) Die chronische, zur BIldung eisenharter Tumoren führende Entzündung der Schilddrüse. Verh Dtsch Ges Chir 25:101–105Google Scholar
  4. 4.
    Martin Schwaegerle S, Bauer TW, Esselstyn (1988) Single case reports. Riedel’s thyroiditis. Am J Clin Pathol 90:715–722Google Scholar
  5. 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 30:193–197PubMedCrossRefGoogle Scholar
  6. 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 26:444–449PubMedGoogle Scholar
  7. 7.
    Nazal EM, Belmatoug N, De Roquancourt A, Lefort A, Fantin B (2003) Hypoparathyroidism preceding Riedel’s thyroiditis. Eur J Intern Med 14:202–204PubMedCrossRefGoogle Scholar
  8. 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 184:97–98Google Scholar
  9. 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 26:67–68PubMedGoogle Scholar
  10. 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 12:829–831CrossRefGoogle Scholar
  11. 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 27:413–415PubMedCrossRefGoogle Scholar
  12. 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 15:85–88PubMedCrossRefGoogle Scholar
  13. 13.
    Tütüncü NB, Erbas T, Bayraktar M, Özgen A, Gedik O (2000) Multifocal idiopathic fibrosclerosis manifesting with Riedel’s thyroiditis. Endocr Pract 6:447–449PubMedGoogle Scholar
  14. 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 260:229–231PubMedGoogle Scholar
  15. 15.
    Moore SE, Suvarna SK, Harrison BJ (2001) Management of complicated intrathoracic Riedel’s thyroiditis. ANZ Journal of Surgery 71:559–560PubMedCrossRefGoogle Scholar
  16. 16.
    Pritchyk K, Newkirk K, Garlich P, Deeb Z (2004) Tamoxifen therapy for Riedel’s thyroiditis. Laryngoscope 114:1758–1760PubMedCrossRefGoogle Scholar
  17. 17.
    Few J, Thompson NW, Angelos P, Simeone D, Giordano T, Reeve T (1996) Riedel’s thyroiditis: treatment with tamoxifen. Surgery 120:993–999PubMedCrossRefGoogle Scholar
  18. 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 48:815–818CrossRefGoogle Scholar
  19. 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 10:483–486PubMedGoogle Scholar
  20. 20.
    Meijer S, Hausman R (1978) Occlusive phlebitis, a diagnostic feature in Riedel’s thyroiditis. Virchow’s Arch A 337:339–349Google Scholar
  21. 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 199:497–501PubMedCrossRefGoogle Scholar
  22. 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 81:977–984PubMedCrossRefGoogle Scholar
  23. 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 25:1424–1428PubMedCrossRefGoogle Scholar
  24. 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 32:439–443PubMedCrossRefGoogle Scholar
  25. 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 15:186–189PubMedCrossRefGoogle Scholar
  26. 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 56:65–67PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Kerstin Lorenz
    • 1
    Email author
  • Oliver Gimm
    • 1
  • Hans Jürgen Holzhausen
    • 2
  • Stephan Kittel
    • 1
  • Jörg Ukkat
    • 1
  • Phuong Nguyen Thanh
    • 1
  • Michael Brauckhoff
    • 1
  • Henning Dralle
    • 1
  1. 1.Department of General, Visceral and Vascular SurgeryMartin-Luther University of Halle-WittenbergHalle/SaaleGermany
  2. 2.Department of PathologyMartin-Luther University of Halle-WittenbergHalle/SaaleGermany

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