Endocrine Abstracts

Riedel thyroiditis (RT) is a rarest form of thyroiditis, and characterized by dense fibrosis of the throid gland and infiltration into surrounding tissues. RT generally presents with local symptoms association with compression and also fibrotic process can impact thyroid and parathyroid functions. We report a case with RT which presents with compression findings and also hypoparathyroidism and hypothyroidism. 30 year old women visited our outpatient clinic with a complaint of neck mass and hoarseness. The symptoms had begun 20 days ago and had been followed by dyspnea. This patient had previously diagnosed with hypothyroidism and after hypoparathyroidizm approximately 6 mounths before and she had underwent treatment. She had been taking L- thyroxine, vitamin D3 and calcium preparat. Thyroid examination revealed a diffuse thyroid enlargement with very firm tissue. She had also stridor in rest. Thyroid function tests revealed thyroid stimulation hormone of 13.22 mIU/l (normal range, 0.4–3.7), showed hypothyroidism. Levels of thyroid antibodies were negative. Blood calcium was 7.8 mg/dl (normal range:8.8–10.6 mg/dl). Her parathyroid hormone level was12.7 ng/l(normal range:15–65). Other biochemical tests were normal. Thyroid ultrasound demonstrated asymetrically enlarged thyroid gland with decreased vascularity, and showed a 4 cm mass in the left lobe and 3 cm mass in the right lobe. There was right shift of the trachea. There were no enlarged pathologic lymph nodes in the neck. Computerized tomography (CT) scan suggested that multinoduler guatr with a largest mass in the left lobe of the thyroid which push the trachea and caused tracheal stenosis. USG-guided tru-cut biopsy was performed on the nodule of greatest size. Histopathology exam showed that the thyroid gland was destroyed and extensively replaced by dense kollogen fibrous tissue with mononuclear cells infiltration. There was no evidence of malignancy and resultly riedel thyroiditis was confirmed as a diagnose. Prednisolon 40 mg/day was started and has been tapered during six months. After six month of treatment the symptoms improved and neck mass size decreased, and in ultrasound examination trachea was normal. After 6 months of follow up, now the patient is euthyroid with levothyroxine replacement (her needs reduced with time), and pth level was increased. In conclusion the appearance of hypoparathyroidism in Riedel’s thyroiditis is a rare situation. Clinicians should be aware of RT, which presents as stony hard thyroid with hypothyroidism and unexpected hypoparathyroidism. The response to treatment was good with prednisolon.