Endocrine Abstracts

Riedel thyroiditis (RT) is a rare kind of chronic thyroiditis which may be a part of a multifocal systemic fibrosis syndrome. When it is generally accepted as a thyroid manifestation of IgG4 related systemic disease. We hereby present a 54 year old woman who was suffering from shortness of breath because of a mass lesion originating from thyroid and invading neck and upper mediastinal structures, leading to dyspnea and dysphagia, as shown by CT, 15 years ago. After an isthmectomy and decompression surgery she was diagnosed as RT. Corticosteroid therapy was given as the firstline agent and she responded well to the therapy, the dose was tapered off in about 6 months. However she was readmitted with severe dyspnea and chest pain with no large mass lesion at neck. Investigations revealed an exudative pleural and pericardial effusion and mediastinal enlargement. The detailed evaluation of pleuropericardial effusion, did not point out any spesific etiology. Glucocorticoid theraphy was restarted along with colchicines and azathioprine. Alleviation of the symptoms were achieved. She was followed by tamoxifene and colchicines on the long term. She is now symptom-free with loss of the soft tissue mass and effusions for more than 15 years. This case is interesting because of reporting pleuropericardial involvement and the success of being in remission for more than 15 years. Although the etiology and definite treatment of the IgG4 related thyroid diseases are unclear; expanding knowledge about IgG4 related diseases will further clarify the optimal approach to RT.