Endocrine Abstracts

Riedel Thyroiditis is a rare form of infiltrative and fibrotic disease of the thyroid that is characterized by compressive symptoms resulting from a rapidly enlarging goiter. The association with Graves Thyroiditis and autoimmune diseases is very rare. The aim of this presentation is to report a patient with asymptomatic Riedel Thyroiditis associated with Thyroid Storm and Polyglandular Autoimmune Disease. A 54-year-old female patient with recent diagnosis of Grave’s Disease was admitted to our hospital with congestive heart failure, abdominal pain, vomiting and diarrhea. Her medical history was remarkable for dilated myocardiopathy, cholecystectomy and precocious ovarian failure. At physical examination ascites, bilateral pleural effusion and a 50 g goiter with a 19 mm nodule were present. Thyroid Storm was diagnosed according to Burch-Wartofsky Score. A 10 miCu I131 dose was administrated given the impossibility to prescribe antithyroid drugs because of severe liver disease associated. Due to persistent hyperthyroidism a second dose of 12 miCu I131 was administrated. After achieving euthyrodism on L-thyroxine treatment a hepatic biopsy was indicated due to chronic intrahepatic cholestasis with negative antibodies and confirmed a stage 2 Primary Biliary Cirrhosis. Later on the patient presented impaired fasting glycaemia. A pancreatic, adrenal and ovary autoimmune panel was asked and only GADA resulted positive. Histocompatibility study showed HLA DQ9 and DQ4. Three fine needle aspirations (FNA) were performed during follow up due to changes in the vascular flow of the nodule. After a negative first result the second FNA leads to III Bethesda diagnosis. Given the insufficient material obtained during the third a total thyroidectomy was indicated. Histopathological examination revealed a 1.5 cm Follicular Adenoma surrounded by Riedel Thyroiditis. To our knowledge asymptomatic Riedel Thyroiditis associated with Thyroid Storm and Polyglandular Autoimmune Disease has not been described.