Riedel's goiter

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Classification according to ICD-10
E06.5 Other chronic thyroiditis
- Riedel's goiter
ICD-10 online (WHO version 2019)

The Riedel goiter ( Riedel thyroiditis , "iron-hard goiter"; named after Bernhard Riedel) ) is a very rare invasive sclerosing thyroid inflammation ( thyroiditis ) that mostly occurs in middle-aged women.

  • Invasive means here: growing into the environment.
  • Sclerosing means: scarring.

The cause of the disease is unknown. The thyroid tissue is completely destroyed by fibrosing proliferation (remodeling of connective tissue). Often the thyroid capsule is exceeded with infiltration of the surrounding neck tissue.

Diagnosis

The clinical examination reveals a palpable and "iron-hard" thyroid enlargement goiter . This can lead to local problems with constriction of the trachea and neck vessels, but also to a displacement of large cervical nerves up to recurrent palsy . During the act of swallowing, the thyroid gland can no longer be moved as a sign of adhesion with the surrounding neck tissue, but it rarely shows any sensitivity to pain.

During the ultrasound examination of the thyroid gland, the volume can be determined and nodular changes and infiltration into the neck tissue can be detected. The sonography can be followed by a scintigraphy of the thyroid gland, which allows an assessment of the functional position of the entire thyroid gland and individual organ sections. Typically, the scintigram in Riedel's goiter shows an overall decreased uptake of technetium . If cold nodules are detected, a carcinoma is always suspected , which results in surgical removal.

You can also take a targeted tissue sample from the affected thyroid in order to make the diagnosis.

Differential diagnoses

The main distinctions are thyroid cancer and the fibrous variant of Hashimoto's thyroiditis .

therapy

Since Riedel's goiter only causes local problems on the neck, it should be surgically removed as early as possible. In the subsequent histological assessment of the removed tissue, cancer can also be excluded (or proven).

There is no reliable experience with conservative therapeutic approaches. After surgical removal of the thyroid gland ( thyroidectomy ), thyroid hormones must be taken in pill form for life.

literature

  • A. Beham et al .: Chronic invasive fibrous thyroiditis (Riedel struma). Case report with special reference to preoperative diagnosis. In: Wien Klin Wochenschr. 1988 Apr 1; ​​100 (7), pp. 210-215. (Article in German)

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