RIEDEL’S THYROIDITIS: A RARE DIAGNOSIS THAT RARELY REQUIRES THYROID SURGERY
Riedel’s thyroiditis is a fibrous invasive type of chronic thyroiditis with a benign pattern which is characterized by a dense fibrotic and inflammatory process that invades the thyroid gland and adjacent structures of the neck Our purpose is to introduce such a rare case with challenges of rapid diagnosis associating severe local complications which required thyroid surgery. A 71-year-old female patient was admitted because of developing a neck mass in association with dysphagia and weight loss. Thyroid enlargement, especially of the right lobe, had a woody consistency. Ultrasound showed an asymmetric enlargement, with absent vascular flow. Normal thyroid function associated positive anti-thyroperoxidase antibodies. The diagnosis of Hashimoto’s thyroiditis was confirmed but the clinical evaluation (a large compressive goiter) raised the suspicion of a thyroid malignancy. Fine needle aspiration provided unsatisfactory tissue sample because of the fibrous consistency. Due to the persistent aggravating compressive symptoms emergency thyroidectomy was performed. The pathologic report showed: chronic Hashimoto thyroiditis with an extensive fibrous tissue transformation of the right lobe, chronic inflammatory and sclerosing pattern suggestive for Riedel’s thyroiditis. The postoperative evolution had no complications, levothyroxine substitution was initiated, and the pain and dysphagia completely disappeared. Clinical presentation of Riedel’s thyroiditis, a rare thyroid condition, mimics practically any other thyroid pathologies, especially sub-acute thyroiditis and malignancy. The differential diagnosis is essential for the treatment plan since missing the diagnosis may be fatal. Atypical cases which rapidly developing compressive symptoms require lifesaving surgery.