Endocrine Abstracts

Introduction: Riedl thyroiditis is a rare thyroid disorder of unknown etiology (autoimmune assumed), in which the gland is invaded by dense fibrous tissue, that extends in the vicinity. Goiter is usually painless and can be accompanied by other fibrous affections (retroperitoneal fibrosis, sclerosing cholangitis, mediastinal fibrosis).

Case presentation: Patient, 39 years old, smoker, from nonendemic area, initially presents in 2011 with voluminous polynodular goiter, spontaneously painful associated with primary myxedema. The painful symptomatology was responsive to glucocorticoids, but relapses severely when trying to stop the administration. In this context, it was performed total thyroidectomy and postoperative histopathological examination revealed thyroiditis scleroatrophic Riedl. Postoperative, she developed severe hypoparathyroidism, corrected with calcitriol(alphacalcidol later) and calcium. Early postoperative cervical ultrasound showed hypodense area of 6 mm in bilateral thyroid box. 5 years later, the patient returns accusing anterior neck pain, anorexia and growth of the thyroid lodge. Investigations carried out show euthyroidism (under substitution therapy), severe persistent hypoparathyroidism, corrected with treatment. A cervico-thoracic CT scan reveals replacement process of the thyroid space bilaterally extended to the posterior vertebral bodies adjacent, that displaces the esophagus posteriorly and the internal carotid arteries and internal jugular veins laterally. Due to the extension of the fibrotic process in the upper mediastinum it was decided to temporize the surgical reintervention and corticosteroid therapy was initiated. The therapy was maintained for 8 months and stopped by patient’s initiative, accusing depression and lack of appetite. Thus, hormonal therapy was recommended, with selective estrogen receptor modulator (SERM)- that has shown partial efficiency in Riedl disease. The therapy is relatively better tolerated, but with no signs of improvement. Moreover, she presents in 2019 with recurrence of the disease locally.

Conclusion: Riedl thyroiditis may present with atypical forms, dominated by intense pain in the neck region. Severe recurrence of the disease is present even after the initial quasi-total excision of the affected thyroid tissue and the patient’s life quality is gravely affected.