Riedel's thyroiditis medical therapy: Difference between revisions

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{{Riedel's thyroiditis}}
{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{MMF}}


==Overview==
==Overview==
[[Tamoxifen]] has been proposed as part of a treatment plan.<ref name="pmid12698518">{{cite journal |author=Dabelic N, Jukic T, Labar Z, Novosel SA, Matesa N, Kusic Z |title=Riedel's thyroiditis treated with tamoxifen |journal=Croat. Med. J. |volume=44 |issue=2 |pages=239–41 |year=2003 |month=April |pmid=12698518 |doi= |url=http://www.cmj.hr/2003/44/2/12698518.pdf|format=PDF}}</ref>
Pharmacologic medical therapies for Riedel's thyroiditis include [[corticosteroids]], [[tamoxifen]], and [[Mycophenolate sodium|mycophenolate mofetil]].
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
*The majority of cases of [disease name] are self-limited and require only supportive care.
 
*[Disease name] is a medical emergency and requires prompt treatment.
 
*The mainstay of treatment for [disease name] is [therapy].
 
*The optimal therapy for [malignancy name] depends on the stage at diagnosis.
* [Therapy] is recommended among all patients who develop [disease name].
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for Riedel's thyroiditis include [[corticosteroids]] and [[tamoxifen]].<ref name="pmid8120524">{{cite journal |vauthors=Zimmermann-Belsing T, Feldt-Rasmussen U |title=Riedel's thyroiditis: an autoimmune or primary fibrotic disease? |journal=J. Intern. Med. |volume=235 |issue=3 |pages=271–4 |year=1994 |pmid=8120524 |doi= |url=}}</ref><ref name="pmid9497955">{{cite journal |vauthors=Vaidya B, Harris PE, Barrett P, Kendall-Taylor P |title=Corticosteroid therapy in Riedel's thyroiditis |journal=Postgrad Med J |volume=73 |issue=866 |pages=817–9 |year=1997 |pmid=9497955 |pmc=2431527 |doi= |url=}}</ref><ref name="pmid263470">{{cite journal |vauthors=Chopra D, Wool MS, Crosson A, Sawin CT |title=Riedel's struma associated with subacute thyroiditis, hypothyroidism, and hypoparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=46 |issue=6 |pages=869–71 |year=1978 |pmid=263470 |doi=10.1210/jcem-46-6-869 |url=}}</ref><ref name="pmid7560814">{{cite journal |vauthors=Bagnasco M, Passalacqua G, Pronzato C, Albano M, Torre G, Scordamaglia A |title=Fibrous invasive (Riedel's) thyroiditis with critical response to steroid treatment |journal=J. Endocrinol. Invest. |volume=18 |issue=4 |pages=305–7 |year=1995 |pmid=7560814 |doi=10.1007/BF03347818 |url=}}</ref><ref name="pmid5694137">{{cite journal |vauthors=Thomson JA, Jackson IM, Duguid WP |title=The effect of steroid therapy on Riedel's thyroiditis |journal=Scott Med J |volume=13 |issue=1 |pages=13–6 |year=1968 |pmid=5694137 |doi=10.1177/003693306801300103 |url=}}</ref><ref name="pmid12698518">{{cite journal |author=Dabelic N, Jukic T, Labar Z, Novosel SA, Matesa N, Kusic Z |title=Riedel's thyroiditis treated with tamoxifen |journal=Croat. Med. J. |volume=44 |issue=2 |pages=239–41 |year=2003|pmid=12698518 |doi= |url=http://www.cmj.hr/2003/44/2/12698518.pdf|format=PDF}}</ref>
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*[[Mycophenolate sodium|Mycophenolate mofetil]] is also used in combination with [[corticosteroids]].<ref name="pmid20067381">{{cite journal |vauthors=Levy JM, Hasney CP, Friedlander PL, Kandil E, Occhipinti EA, Kahn MJ |title=Combined mycophenolate mofetil and prednisone therapy in tamoxifen- and prednisone-resistant Reidel's thyroiditis |journal=Thyroid |volume=20 |issue=1 |pages=105–7 |year=2010 |pmid=20067381 |doi=10.1089/thy.2009.0324 |url=}}</ref><ref name="pmid21568724">{{cite journal |vauthors=Fatourechi MM, Hay ID, McIver B, Sebo TJ, Fatourechi V |title=Invasive fibrous thyroiditis (Riedel thyroiditis): the Mayo Clinic experience, 1976-2008 |journal=Thyroid |volume=21 |issue=7 |pages=765–72 |year=2011 |pmid=21568724 |doi=10.1089/thy.2010.0453 |url=}}</ref>
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===


* '''1 Stage 1 - Name of stage'''
===Treatment regimens for Riedel's thyroiditis===
** 1.1 '''Specific Organ system involved 1'''
The effectiveness of therapy and dosages for Riedel's thyroiditis have not yet been assessed completely. As a result, the exact dosage regimens and duration of therapy cannot be defined. The current recommendations are based on the clinical manifestations, associated conditions, and the response to treatment.
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 2.1 '''Specific Organ system involved 2'''
*** 2.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 2.1.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)


* 2 '''Stage 2 - Name of stage'''
* Preferred regimen (1): [[Prednisone]] 15-60mg PO q24h for 6 months to 2 years   
** 2.1 '''Specific Organ system involved 1 '''
* Preferred regimen (2): [[Prednisone]] 500 mg PO q24h for 6 months to 2 years
**: '''Note (1):'''
* Alternative regimen (1): [[Tamoxifen]] 10-20 mg PO q24h for 6 months to 2 years
**: '''Note (2)''':
* Alternative regimen (1): [[Mycophenolate sodium|Mycophenolate mofetil]] 1 g PO q12h for 6 months to 2 years
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]

Overview

Pharmacologic medical therapies for Riedel's thyroiditis include corticosteroids, tamoxifen, and mycophenolate mofetil.

Medical Therapy

Treatment regimens for Riedel's thyroiditis

The effectiveness of therapy and dosages for Riedel's thyroiditis have not yet been assessed completely. As a result, the exact dosage regimens and duration of therapy cannot be defined. The current recommendations are based on the clinical manifestations, associated conditions, and the response to treatment.

  • Preferred regimen (1): Prednisone 15-60mg PO q24h for 6 months to 2 years
  • Preferred regimen (2): Prednisone 500 mg PO q24h for 6 months to 2 years
  • Alternative regimen (1): Tamoxifen 10-20 mg PO q24h for 6 months to 2 years
  • Alternative regimen (1): Mycophenolate mofetil 1 g PO q12h for 6 months to 2 years

References

  1. ↑ Zimmermann-Belsing T, Feldt-Rasmussen U (1994). "Riedel's thyroiditis: an autoimmune or primary fibrotic disease?". J. Intern. Med. 235 (3): 271–4. PMID 8120524.
  2. ↑ Vaidya B, Harris PE, Barrett P, Kendall-Taylor P (1997). "Corticosteroid therapy in Riedel's thyroiditis". Postgrad Med J. 73 (866): 817–9. PMC 2431527. PMID 9497955.
  3. ↑ Chopra D, Wool MS, Crosson A, Sawin CT (1978). "Riedel's struma associated with subacute thyroiditis, hypothyroidism, and hypoparathyroidism". J. Clin. Endocrinol. Metab. 46 (6): 869–71. doi:10.1210/jcem-46-6-869. PMID 263470.
  4. ↑ Bagnasco M, Passalacqua G, Pronzato C, Albano M, Torre G, Scordamaglia A (1995). "Fibrous invasive (Riedel's) thyroiditis with critical response to steroid treatment". J. Endocrinol. Invest. 18 (4): 305–7. doi:10.1007/BF03347818. PMID 7560814.
  5. ↑ Thomson JA, Jackson IM, Duguid WP (1968). "The effect of steroid therapy on Riedel's thyroiditis". Scott Med J. 13 (1): 13–6. doi:10.1177/003693306801300103. PMID 5694137.
  6. ↑ Dabelic N, Jukic T, Labar Z, Novosel SA, Matesa N, Kusic Z (2003). "Riedel's thyroiditis treated with tamoxifen" (PDF). Croat. Med. J. 44 (2): 239–41. PMID 12698518.
  7. ↑ Levy JM, Hasney CP, Friedlander PL, Kandil E, Occhipinti EA, Kahn MJ (2010). "Combined mycophenolate mofetil and prednisone therapy in tamoxifen- and prednisone-resistant Reidel's thyroiditis". Thyroid. 20 (1): 105–7. doi:10.1089/thy.2009.0324. PMID 20067381.
  8. ↑ Fatourechi MM, Hay ID, McIver B, Sebo TJ, Fatourechi V (2011). "Invasive fibrous thyroiditis (Riedel thyroiditis): the Mayo Clinic experience, 1976-2008". Thyroid. 21 (7): 765–72. doi:10.1089/thy.2010.0453. PMID 21568724.

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