Endocrine Abstracts

Introduction: Riedel’s thyroiditis is a rare disorder of unknown aetiology and may be seen isolated or as a part of multifocal fibrosclerosis. Multifocal fibrosclerosis involves two or more fibrotic disorders including Riedel’s thyroiditis, retroperitoneal fibrosis, sclerosing mediastinitis, retro-orbital pseudotumour and sclerosing cholangitis. We report a case of recurrent Riedel’s thyroiditis as part of multifocal fibrosclerosis presenting with a woody neck swelling and dysphagia.

Case report: A 64-year-old man with a 4 months history of painful neck swelling, dysphagia, weight loss, bilateral diplopia and conjuctival congestion was referred to the endocrine clinic. He had a past medical history of Riedel’s thyroiditis and retroperitoneal fibrosis confirmed by tissue biopsy, both settled with oral prednisolone eleven years previously. He had a 13 years history of IgG kappa paraproteinaemia without Bence Jones proteinuria, which has remained stable.

The laboratory profile revealed a normocytic anaemia with normal renal, liver and bone profiles. Thyroid function test (TFT) has persistently remained normal, his last TFT showed fT4 17.0 pmol/l fT3 (4.0 pmol/l) and TSH (0.82 μ/l) with normal thyroid peroxidase antibody levels. His PTH level was 3.8 pmol/l and serum calcium was 2.4 mmol. His gonadotrophin showed raised follicle stimulating hormone (25 IU/l), with normal lutinizing hormone (5.2 IU/l) and low testosterone levels (5.8 nmol/l). Testicular ultrasound and MRI pituitary was normal. CT thorax showed thickening of the soft tissues of the anterior neck, sclerosing mediastinitis, and concentric oesophageal thickening throughout its length.

Oesophagogastroduodenoscopy and biopsy was normal. A diagnosis of recurrent Riedel’s thyroiditis as part of multifocal fibrosclerosis was made. Four weeks after commencing high dose oral prednisolone therapy, the neck swelling, dysphagia and diplopia had significantly reduced.

Conclusion: In patients presenting with neck swelling and bilateral eye signs it is essential to consider rare causes. This is a rare case of Riedel’s thyroiditis presented with history of dysphagia due to thickening of the entire length of the oesophagus as part of multifocal fibrosclerosis.