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Thyroiditis
Published in David S. Cooper, Jennifer A. Sipos, Medical Management of Thyroid Disease, 2018
Robert C. Smallridge, Victor Bernet
Riedel’s thyroiditis is an aggressive fibroinflammatory condition of uncertain etiology which involves the thyroid and tissues surrounding the thyroid gland. It should be distinguished from a fibrosing form of Hashimoto’s thyroiditis, which is limited to the thyroid gland.
Thyroid disease: Cytopathology and surgical pathology aspects
Published in Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner, Endocrine Surgery, 2017
Charvi A. Cassano, Arnold H. Szporn, G. Kenneth Haines
Undifferentiated or anaplastic thyroid carcinoma is a rare highly aggressive malignancy, accounting for less than 2% of thyroid carcinomas. Most patients present with sudden rapid growth of a pre-existing long-standing thyroid lesion, most often nodular hyperplasia. The bulky tumor often grossly extends into adjacent tissues and metastasizes to lymph nodes and distant sites. There are a number of histologic variants of anaplastic carcinoma, most consisting of pleomorphic, markedly atypical spindled, epithelioid, or giant cells [61] (Figure 6.13a–c). Frequent mitotic figures, abundant necrosis, and extensive lymphovascular and extrathyroidal extension are common. A hypocellular variant exists that may be mistaken for Riedel thyroiditis. This variant may be recognized based on the identification of rare cells with nuclear hyperchromasia. Foci of residual papillary, follicular, or medullary carcinoma may be seen. In such cases, similar mutations may be found in both differentiated and anaplastic portions of the tumor. Most cases of anaplastic thyroid carcinoma demonstrate nuclear staining for p53 and β-catenin.
Nonautoimmune thyroid disease
Published in Philip E. Harris, Pierre-Marc G. Bouloux, Endocrinology in Clinical Practice, 2014
Arie Berghout, Alex F. Muller, Philip E. Harris
The hallmark of thyroiditis is thyroid inflammation. Thyroid inflammation can be due to different causes: physical factors (palpation, radiation), pharmacotherapeutic agents, microorganisms, and autoimmunity. In this section, we focus on subacute granulomatous thyroiditis, subacute lymphocytic thyroiditis, and postpartum thy-roiditis. Riedel’s thyroiditis and infectious thyroiditis are discussed only briefly.
B cell targeted therapy for immunoglobulin G4-related disease
Published in Immunological Medicine, 2021
The efficacy of rituximab for IgG4-RD was first reported in 2008. Topazian et al. reported that the use of rituximab for autoimmune pancreatitis with sclerosing cholangitis that flared up after the use of glucocorticoids and immunosuppressants resulted in improvement of bile duct stenosis and the removal of a bile duct stent [32]. Subsequently, Khosroshahi et al. reported their experience with the treatment in 10 patients [33]. In patients refractory to glucocorticoid therapy, 1 g of rituximab was administered twice a day at 15 day-intervals, and the patients were evaluated using the IgG4-RD responder index [34]. All of the patients, except for one with Riedel’s thyroiditis, showed clinical improvement, and decreased serum IgG4 levels after taking rituximab. All patients were able to discontinue glucocorticoids and other immunosuppressants. Four of the patients experienced a relapse or increased serum IgG4 levels and were retreated with rituximab 6 months later [33]. A subsequent prospective open-label study of rituximab was conducted in 30 glucocorticoid-refractory patients (22 with prior glucocorticoid use), using the treatment protocol as described above. Twenty-six of the patients were treated with rituximab alone and were assessed using the IgG4-RD responder index and the examining physician’s general assessment. The treatment was judged effective at 6 months in 23 patients (77%), with 14 patients (47%) in complete remission at 12 months. Rituximab was shown to be effective even in the absence of glucocorticoids [35].
Supraphysiological doses of glucocorticoids induce remission in a patient with retroperitoneal fibrosis but no effect on the course of Hashimoto’s thyroiditis: a discordant mode of action
Published in Modern Rheumatology Case Reports, 2019
Mohamed K. M. Shakir, Thanh D. Hoang, Jeptha T. Johnson, Vinh Q. Mai
Although idiopathic RPF has been reported to occur in several autoimmune disorders, such as autoimmune pancreatitis and infundibulo-hypophysitis, there have been few reports of this disorder occurring in association with thyroiditis [1–3]. Most of the reported cases of thyroiditis involve Riedel’s thyroiditis in which the thyroid gland is replaced by fibrotic tissue [1–3]. It is interesting to note that 30% of patients with Riedel’s thyroiditis subsequently develop idiopathic RPF [1]. It is often difficult to distinguish Riedel’s thyroiditis from the fibrosing variant of HT [4,5,20]. Most patients with HT have high serum levels of TPO and Tg antibodies with or without hypothyroidism. Although elevated serum levels of the thyroid antibody have been observed in Riedel’s thyroiditis, usually the antibody titres are relatively low in these patients [4,5]. The high serum levels of TPO and Tg antibodies in association with ultrasound features and cytological confirmation confirmed the diagnosis of HT in our patient.