Riedel’s thyroiditis: Diagnostic and therapeutic difficulties

Objective: We aimed to discuss the diagnostic and therapeutic difficulties of Riedel’s thyroiditis case which is a rarely seen disease of thyroid gland.
Case: A 43-year-old female patient who admitted to the hospital with a firm, painless midline mass, and shortness of breath. Diagnosis was made by radiographic imaging, fine needle aspiration biopsy, tru-cut biopsy and open biopsies. Surgical treatment was not planned due to extensive extrathyroidal spread of the disease. Systemic steroid treatment was decided to be initiated to the patient, who had tracheotomy due to tracheal compression, after examining the medical treatment protocols reported in the literature. A distinct decrease in the size of the thyroid mass was noticed at follow up.
Conclusion: Riedel thyroiditis is diagnosed in the presence of histopathological findings as well as radiological and physical examination findings. For diagnosis, primarily, it is important that the disease is suspected and that thyroid malignancies are excluded. Surgical treatment is not recommended because of the high morbidity except for the symptoms of compression, but there is also no standard medical treatment protocol. Therefore, reporting and discussion of the treatment choices of Riedel’s thyroiditis on an individual basis will be beneficial.

Riedel tiroiditi: Taný ve tedavide karþýlaþýlan güçlükler

Amaç: Tiroid bezinin nadir görülen bir hastalýðý olan Riedel tiroiditi tanýsý konulan bir olgunun taný ve tedavi seyri sýrasýnda karþýlaþýlan güçlüklerin tartýþýlmasý amaçlandý.
Olgu: Boyunda orta hatta aðrýsýz, sert kitle ve nefes darlýðý þikayeti ile baþvuran 43 yaþýnda kadýn hastaya yapýlan radyolojik görüntülemeler, ince iðne aspirasyon biyopsisi, tru-cut biyopsi ve açýk biyopsiler ile taný konuldu. Hastalýðýn yaygýn ekstratiroidal yayýlýmý nedeniyle cerrahi tedavi planlanmadý. Trakeal kompresyon nedeniyle trakeotomi açýlan hastaya, literatürde bildirilmiþ medikal tedavi protokolleri incelenerek, sistemik steroid tedavisi baþlanmasýna karar verildi. Takiplerinde tiroid kitlesi boyutlarýnda belirgin regresyon izlendi.
Sonuçlar: Riedel tiroiditi tanýsý histopatolojik bulgularýn yanýsýra, radyolojik ve fizik muayene bulgularý eþliðinde konulmaktadýr. Tanýda öncelikle, hastalýktan þüphelenilmesi ve tiroidin habis hastalýklarýnýn dýþlanmasý önemlidir. Cerrahi tedavi, basý semptomlarý dýþýnda, yüksek morbidite olasýlýðý nedeniyle önerilmezken standart bir medikal tedavi protokolü de bulunmamaktadýr. Bu nedenle olgu bazlý tedavi seçimlerinin bildirilmesi ve tartýþýlmasý yararlýdýr.