Riedel Thyroiditis

By | June 8, 2022

A rare inflammation of the thyroid gland is called Riedel thyroiditis. This leads to the destruction of the thyroid tissue.

What is Riedel thyroiditis?

Riedel ‘s thyroiditis is also known as Riedel’s goiter. This means inflammation of the thyroid gland. The disease was named after the German surgeon Bernhard Riedel (1846-1916). The physician first described the thyroiditis variant in a book in 1896.

Riedel’s thyroiditis is a form of autoimmune thyroiditis. Its typical features include hard fibrous thyroid tissue remodeling. Riedel’s goiter occurs only rarely. It only shows up once or twice in every 100,000 people. People between the ages of 40 and 60 are particularly affected. Four out of five patients are women.¬†For leukocytosis guide, please visit deluxesurveillance.com.

Causes

What triggers Riedel’s thyroiditis has not yet been determined. The disease is one of the chronic inflammations of the thyroid gland. During the course of the disease, healthy thyroid tissue is increasingly displaced by dense fibrotic tissue.

Because this remodeling is not limited to the thyroid alone, it spreads to neighboring tissue. For this reason, an iron-hard goiter forms. Thyroid autoantibodies are found in around two-thirds of all patients. Therefore, some doctors suspect that there is a connection between Riedel’s thyroiditis and Graves’ disease and Hashimoto’s thyroiditis.

According to new studies, Riedel’s goiter is the organic manifestation of a systemic IgG4-associated disease. IgG4 is a subclass of the immunoglobulins G. The fibrotic-sclerotic remodeling of multiple organs and tissues is typical of an IgG4-associated disease.

Symptoms, Ailments & Signs

The characteristic feature of Riedel thyroiditis is the increasing enlargement of the thyroid gland. This in turn causes narrowing of the trachea, which can cause breathing difficulties. In addition, the affected persons suffer from paralysis of their vocal cords, hoarseness and difficulties in swallowing.

Because the thyroid grows together with the neighboring neck tissue, there is also a risk of restricted movement. Some patients are no longer able to move their head in all directions as usual. Furthermore, those affected have the feeling of having a foreign body in their throat or suffer from nerve lesions.

Due to the increasing destruction of the healthy thyroid tissue, as the Riedel thyroiditis progresses, the thyroid gland becomes underactive (hypothyroidism), which is accompanied by the corresponding symptoms. These include but are not limited to a hoarse voice, constipation, sensitivity to cold, dry skin, loss of appetite, weight gain, and fatigue.

Diagnosis & course of disease

If you suspect an inflamed thyroid gland, you should consult a doctor. After the medical history (anamnesis) has been recorded, the doctor carries out a physical examination, during which an iron-hard enlargement of the thyroid gland can be felt. Typical indications are local problems caused by the goiter, such as narrowing of the vessels in the neck and the trachea.

In addition, the cervical nerves can become so crowded that this leads to paresis of the laryngeal nerve. In addition, the thyroid gland can no longer be moved when swallowing, which gives the doctor an indication of adhesions. Sensitivity to pain, on the other hand, is rare.

The further examination consists of a sonography (ultrasound examination) with which infiltrated neck tissue and nodular changes can be determined. Furthermore, the doctor can perform a scintigraphy to examine the thyroid functions and the position of certain organ areas. Within the scope of the scintigraphy, a lower technetium uptake is usually detected.

If cold nodules can be identified during the examination, there is a suspicion of thyroid carcinoma. For this reason, surgical removal is done to either rule out or confirm cancer. Histologically, the definitive diagnosis can also be made by removing tissue (biopsy).

The differential diagnosis also plays an important role in distinguishing Riedel’s thyroiditis from Hashimoto’s thyroiditis and thyroid cancer. In most cases, the functional status of the thyroid gland is not restricted by Riedel goiter. However, every third patient suffers from hypothyroidism as the disease progresses.

Complications

Riedel’s thyroiditis is a very rare autoimmune thyroid inflammation that can lead to various serious complications if left untreated. Due to connective tissue remodeling, the thyroid tissue hardens and enlarges, so that other organs that are nearby are crowded out.

This often leads to narrowing of the trachea, paralysis of the vocal cords and difficulty swallowing. If left untreated, the thyroid will continue to be damaged to the point of its complete destruction. In one third of the cases, an underactive thyroid gland (hypothyroidism) can develop. Hypothyroidism is characterized by insufficient release of thyroid hormones.

In addition to tiredness, listlessness and weight gain, there are also frequent infections, poor concentration, constipation and cramps. Since the disease is triggered by an autoimmune reaction of the body’s own immune system to the thyroid gland, the course of the disease can be delayed but not cured by using immunosuppressants such as glucocorticoids.

In order to preserve as much thyroid tissue as possible, an operation should therefore be carried out at an early stage, especially since treatment with immunosuppressants also leads to a weakening of the immune system. During drug treatment, the symptoms of what is known as Cushing’s syndrome can develop with obesity, a full moon face and increased susceptibility to infections. After the operation, however, no or too few thyroid hormones are produced. Replacement therapy with thyroid hormones is therefore always necessary.

When should you go to the doctor?

Riedel thyroiditis must always be examined and treated by a doctor. This condition cannot heal on its own, and the symptoms usually get worse if the patient does not initiate treatment. Early diagnosis and treatment of Riedel thyroiditis always have a positive effect on the further course of this disease.

A doctor should be consulted if the patient suffers from severe breathing difficulties. This can also lead to hoarseness or a persistent cough, although some sufferers can also lose consciousness in severe cases. Difficulty swallowing can also indicate Riedel’s thyroiditis and should be examined if they occur for no particular reason and, above all, are permanent and make life difficult for the person affected. Dry skin or permanent constipation can also indicate Riedel thyroiditis and should also be examined.

The first examination can be done by a general practitioner. For further treatment, however, a visit to a specialist is usually necessary.

Treatment & Therapy

Riedel’s thyroiditis is one of the chronic inflammations of the thyroid gland that rarely heal spontaneously. Due to the autoimmune processes that have been unclear up to now, the therapy of Riedel goiter can be difficult. So far there is no causal treatment of Riedel’s thyroiditis.

Since the disease can take on life-threatening proportions due to increasing hardening, early surgical removal of the goiter is the most sensible option. Glucocorticoids can also be administered to slow down the fibrotic transformation, but this usually only results in a delay. In addition, there is no reliable evidence of successful conservative treatment of Riedel thyroiditis.

A surgical intervention on a Riedel goiter is classified as difficult. Patients often suffer from complications such as hypofunction of the parathyroid glands (hypoparathyroidism). The thyroid gland is removed as part of a thyroidectomy. The surgeon makes a cross section between five and seven centimeters in length over the jugular groove (jugulum).

After removing the skin and fatty tissue, the neck muscles are divided and shifted. The thyroid is then freely accessible and can be removed by the surgeon. After inserting a wound drainage, the skin can be closed with an intracutaneous suture technique. With the thyroid gland removed, the affected person will need to take thyroid hormones for the rest of their life.

Prevention

The causes of Riedel’s thyroiditis have not yet been determined. Measures that serve to prevent thyroid inflammation are therefore not known.

Aftercare

After the successful treatment of Riedel thyroiditis, extensive follow-up care is required. If the thyroid gland has been completely removed, thyroid hormone replacement must be taken for life. In addition, regular endocrinological examinations of the other hormone levels in the body should be carried out in order to identify any hormone problems caused by the lack of the thyroid gland in good time.

In addition to this, regular ultrasound examinations of the neck should be carried out in order to detect possible new inflammations in the area where the thyroid gland was removed at an early stage. If the thyroid gland has not (yet) been removed, the thyroid levels in the blood should also be checked regularly in order to document the progress of the disease and to be able to adjust the medication.

In addition, after treatment of Riedel thyroiditis, the trachea and neck vessels should be examined intensively for remaining narrowing or malformations. If a narrowing or permanent deformity remains, further surgical procedures may be necessary to correct it.

In addition, it may be necessary to take blood-thinning medication (Macumar) to ensure blood flow to the brain and head and to prevent blood clots from forming in narrowed areas. If the large nerves in the neck have been permanently damaged, neurological treatment may also be necessary to combat the associated symptoms. Voice training can also be useful in the case of residual and permanent vocal cord paralysis.

You can do that yourself

Since Riedel’s thyroiditis is a chronic disease, those affected often have a long treatment path ahead of them. Currently there are only symptomatic therapies, since the underlying autoimmune processes are not yet clear. In addition to medical treatments, measures can also be taken that are carried out yourself.

One such can be learning physical exercises. Doctors and physiotherapists can give instructions on which movements will help delay the hardening of the affected muscles. Light massage techniques and relaxation exercises can reduce symptomatic pain. It is important that these are used regularly to ensure mobility is maintained.

In addition to physiological successes, mental relaxation can also be achieved through such exercises. The probability of suffering from an accompanying depression is thus reduced. Also and especially in view of the large number of strenuous operations that the patient has to undergo, it is important to keep an eye on the psychosocial balance. An intact social environment can help to survive the strain of such operations, to gain new perspectives despite the illness and not to lose touch with others.

Riedel Thyroiditis