Riedel thyroiditis

Last updated: March 21, 2023

Riedel thyroiditis

ETP Endocrine System

ETP Endocrine System

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Anatomy of the thyroid and parathyroid glands
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Flashcards

Riedel thyroiditis

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USMLE® Step 1 style questions USMLE

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Start
A 68-year-old man is brought to the PA by his partner because of increasing forgetfulness over the last 5 weeks. The patient is unable to finish his daily crossword puzzles and often has to call his partner when he is at the grocery store to help remember the list. He has had an 8-lb weight gain over this same time period. The patient has chronic hypertension, which is well-controlled with lisinopril, and he has also recently started taking laxatives several times a week to relieve constipation. Temperature is 36.5°C (97.7°F), pulse is 57/min, blood pressure is 128/86 mm Hg, and BMI is 27 kg/m2. The patient is alert and oriented to time, place, and person. Physical examination shows dry skin and a slightly distended abdomen. There is no mucosal pallor and capillary refill is less than 2 seconds. Deep tendon reflexes are delayed in the upper and lower extremities. Further testing confirms the diagnosis and the patient is provided with a synthetic derivative of thyroxine. Which of the following medications was prescribed?  

Transcript

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With Riedel’s thyroiditis, thyroid- refers to the thyroid gland, and -itis means inflammation. So, Riedel’s thyroiditis is a condition where there is inflammation of the thyroid gland, which slowly causes fibrous tissue to replace the normal thyroid tissue. The condition is named after the German surgeon - Dr. Bernhard Moritz Carl Ludwig Riedel - who first described it.

Normally, the hypothalamus, which is located at the base of the brain, secretes thyrotropin-releasing hormone, known as ΤRH, into the hypophyseal portal system - which is a network of capillaries linking the hypothalamus to the anterior pituitary gland. The anterior pituitary then releases a hormone of its own, called thyroid-stimulating hormone, thyrotropin, or simply TSH.

TSH stimulates the thyroid gland, which is a gland located in the neck that looks like two thumbs hooked together in the shape of a “V”. If we zoom into the thyroid gland, we’ll find thousands of follicles, which are small, hollow spheres whose walls are lined with follicular cells and are separated by a small amount of connective tissue. Follicular cells convert thyroglobulin, a protein found in follicles into two iodine-containing hormones, triiodothyronine or T3, and thyroxine or T4.

Once released from the thyroid gland, these hormones enter the blood and bind to circulating plasma proteins, but only a small amount of T3 and T4 will travel unbound in the blood and these two hormones get picked up by nearly every cell in the body.

Once inside the cell, T4 is mostly converted into T3, and then it can exert its effect. T3 speeds up the basal metabolic rate. So as an example, they might produce more proteins and burn up more energy in the form of fats and sugars. It’s as if the cells are in a bit of a frenzy.

T3 increases cardiac output, stimulates bone resorption - thinning out the bones, and activates the sympathetic nervous system, the part of the nervous system responsible for our ‘fight-or-flight’ response.

Thyroid hormone is important - and the occasional increase can be really useful when you need a boost to get through the final rounds of a sporting competition or to stay warm during a snowstorm!

Meanwhile, Thyroid hormones are involved in a number of other things, such as normal functions of sebaceous and sweat glands, growth of hair follicles, and regulation of the synthesis of proteins and mucopolysaccharides by skin fibroblasts.

Key Takeaways

Riedel's thyroiditis (RT) is a form of chronic inflammation of the thyroid gland, characterized by fibrosis (scarring) and thickening of the thyroid gland, which can result in the gland becoming stone-hard and fixed to adjacent structures. This loss of normal thyroid tissue can eventually lead to hypothyroidism, with symptoms like cold intolerance, lack of energy, constipation, or dry skin. Treatment of Riedel's thyroiditis includes corticosteroids to suppress the immune system, and thyroid hormone replacement to correct hypothyroidism. Surgery may be done to remove a goiter, but it can be difficult if it's spread to nearby structures.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Harrison's Endocrinology, 4E" McGraw-Hill Education / Medical (2016)
  6. "Riedel’s thyroiditis: clinical presentation, treatment and outcomes" Endocrine (2018)
  7. "Riedel's thyroiditis" Radiology Case Reports (2016)
  8. "Rituximab: a novel treatment for refractory Riedel’s thyroiditis" Endocrinology, Diabetes & Metabolism Case Reports (2018)