Riedel thyroiditis is an uncommon form of chronic thyroiditis in which the thyroid gland is replaced by fibrous tissue. The etiological mechanism underlying RT are unclear. The prevailing view is that it is part of a generalized fibro-inflammatory process also involving other organs. Therapeutic options are not standardized (surgery, corticosteroids, and more recently tamoxifene). The aim of this work is to present three new cases, and the favourable evolution observed in one of them with cyclosporine. All three patients were female, aged 48 to 61 years old. Patients 1 and 2 complained of rapidly growing compressive stony cervical nodule, that was diagnosed in the follow-up of an oropharyngeal epidermoïd cancer treated by radiotherapy and electrocoagulation 10 years before in case 2. Case 3 was first diagnosed Hashimoto thyroiditis in reason of the presence of antithyroperoxidase auto-antibodies, and of cytodiagnostic. Two years later, the patient presented with stony compressive infiltrative neck enlargement. At the time of diagnosis, patients 1 and 3 complained of dysphagia and dyspnea and patient 2 had vocal cord paralysis. The three patients had hypothyroidism, and lack of uptake on I123 thyroid scintigraphy. Ultrasonography showed hypoechoic lesion, infiltrating perithyroid organs, inducing carotid sheathing, with adenopathies. Riedel thyroiditis was diagnosed in these 3 women on surgical biopsy. Cases 1 and 3 were treated with tamoxifene and the result was favourable in patient 1 with overt decrease of compressive symptoms one year later. The results of patient 3 are awaited. Patient 2 was first treated with steroids without any results. Cyclosporine, introduced because of severe psoriasis, induced a dramatic decrease of her thyroid volume. To conclude, Riedel thyroiditis is a rare thyroid disease, often resembling malignancy more often encountered in women in the second part of life. Steroids and tamoxifene may improve symptoms. Cyclosporine was found efficient in one of our cases.
01 - 05 Apr 2006
European Society of Endocrinology