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The exact pathogenesis of Riedel's thyroiditis is not fully understood. The presence of thyroid autoantibodies and lymphoid infiltration of the thyroid gland resembling that of Hashimoto's thyroiditis might indicate an autoimmune etiology. It is considered that the infiltrating lymphocytes release cytokines which are responsible for the activation of fibroblasts responsible for the fibrosis. Riedel's thyroiditis is characterized by a replacement of the normal thyroid parenchyma by a dense [[fibrosis]] that invades adjacent structures of the neck and extends beyond the thyroid capsule. This makes the thyroid gland stone-hard and fixed to adjacent structures. | The exact pathogenesis of Riedel's thyroiditis is not fully understood. The presence of thyroid [[autoantibodies]] and [[lymphoid]] infiltration of the thyroid gland resembling that of [[Hashimoto's thyroiditis]] might indicate an [[autoimmune]] etiology. It is considered that the infiltrating [[lymphocytes]] release [[cytokines]] which are responsible for the activation of [[fibroblasts]] responsible for the fibrosis. Riedel's thyroiditis is characterized by a replacement of the normal [[Parenchyma|thyroid parenchyma]] by a dense [[fibrosis]] that invades adjacent structures of the neck and extends beyond the thyroid capsule. This makes the thyroid gland stone-hard and fixed to adjacent structures. A shared mechanism with [[retroperitoneal fibrosis]] and [[sclerosing cholangitis]] has been suggested. | ||
A shared mechanism with [[retroperitoneal fibrosis]] and [[sclerosing cholangitis]] has been suggested. | |||
==Pathophysiology== | ==Pathophysiology== | ||
===Pathogenesis=== | ===Pathogenesis=== | ||
The exact pathogenesis of Riedel's thyroiditis is not fully understood. The presence of thyroid autoantibodies and lymphoid infiltration of the thyroid gland resembling that of Hashimoto's thyroiditis might indicate an autoimmune etiology. | The exact pathogenesis of Riedel's thyroiditis is not fully understood. The presence of thyroid [[autoantibodies]] and lymphoid infiltration of the thyroid gland resembling that of [[Hashimoto's thyroiditis]] might indicate an [[autoimmune]] etiology. | ||
*It is considered that the infiltrating lymphocytes release cytokines which are responsible for the activation of fibroblasts responsible for the fibrosis.<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> | *It is considered that the infiltrating [[lymphocytes]] release [[cytokines]] which are responsible for the activation of [[fibroblasts]] responsible for the fibrosis.<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> | ||
*Riedel's thyroiditis is characterized by a replacement of the normal thyroid parenchyma by a dense [[fibrosis]] that invades adjacent structures of the neck and extends beyond the thyroid capsule.This makes the thyroid gland stone-hard and fixed to adjacent structures.<ref name="pmid17603227">{{cite journal |author=Cho MH, Kim CS, Park JS, ''et al'' |title=Riedel's thyroiditis in a patient with recurrent subacute thyroiditis: a case report and review of the literature |journal=Endocr. J. |volume=54 |issue=4 |pages=559–62 |year=2007|pmid=17603227 |doi= |url=http://joi.jlc.jst.go.jp/JST.JSTAGE/endocrj/K06-186?from=PubMed}}</ref> | *Riedel's thyroiditis is characterized by a replacement of the normal thyroid parenchyma by a dense [[fibrosis]] that invades adjacent structures of the neck and extends beyond the thyroid capsule.This makes the thyroid gland stone-hard and fixed to adjacent structures.<ref name="pmid17603227">{{cite journal |author=Cho MH, Kim CS, Park JS, ''et al'' |title=Riedel's thyroiditis in a patient with recurrent subacute thyroiditis: a case report and review of the literature |journal=Endocr. J. |volume=54 |issue=4 |pages=559–62 |year=2007|pmid=17603227 |doi= |url=http://joi.jlc.jst.go.jp/JST.JSTAGE/endocrj/K06-186?from=PubMed}}</ref> | ||
*Tissue eosinophilia and Major basic protein (MBP) identified in the thyroid gland on the histopathological analysis are also thought to play a role in the proliferation of fibroblasts.<ref name="urlTissue eosinophilia and eosinophil degranulation in Riedels invasive fibrous thyroiditis | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic">{{cite web |url=https://doi.org/10.1210/jcem.81.3.8772560 |title=Tissue eosinophilia and eosinophil degranulation in Riedel's invasive fibrous thyroiditis | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic |format= |work= |accessdate=}}</ref> | *Tissue [[eosinophilia]] and [[Major basic protein]] (MBP) identified in the thyroid gland on the [[histopathological]] analysis are also thought to play a role in the proliferation of [[fibroblasts]].<ref name="urlTissue eosinophilia and eosinophil degranulation in Riedels invasive fibrous thyroiditis | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic">{{cite web |url=https://doi.org/10.1210/jcem.81.3.8772560 |title=Tissue eosinophilia and eosinophil degranulation in Riedel's invasive fibrous thyroiditis | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic |format= |work= |accessdate=}}</ref> | ||
*A shared mechanism with [[retroperitoneal fibrosis]] and [[sclerosing cholangitis]] is also suggested.<ref name="pmid8504980">{{cite journal |author=De Boer WA |title=Riedel's thyroiditis, retroperitoneal fibrosis, and sclerosing cholangitis: diseases with one pathogenesis? |journal=Gut |volume=34 |issue=5 |pages=714 |year=1993|pmid=8504980 |pmc=1374200 |doi= |url=http://gut.bmj.com/cgi/pmidlookup?view=long&pmid=8504980}}</ref> | *A shared mechanism with [[retroperitoneal fibrosis]] and [[sclerosing cholangitis]] is also suggested.<ref name="pmid8504980">{{cite journal |author=De Boer WA |title=Riedel's thyroiditis, retroperitoneal fibrosis, and sclerosing cholangitis: diseases with one pathogenesis? |journal=Gut |volume=34 |issue=5 |pages=714 |year=1993|pmid=8504980 |pmc=1374200 |doi= |url=http://gut.bmj.com/cgi/pmidlookup?view=long&pmid=8504980}}</ref> | ||
==Associated Conditions== | ==Associated Conditions== | ||
Riedel's thyroiditis is associated various other autoimmune conditions including:<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="pmid4413980">{{cite journal |vauthors=Drury MI, Sweeney EC, Heffernan SJ |title=Invasive fibrous (Riedel's) thyroiditis |journal=Ir Med J |volume=67 |issue=14 |pages=388–90 |year=1974 |pmid=4413980 |doi= |url=}}</ref><ref name="urlChronic thyroiditis: A case showing features of both riedels and hashimotos thyroiditis - Merrington - 1948 - British Journal of Surgery - Wiley Online Library">{{cite web |url=http://dx.doi.org/10.1002/bjs.18003514015 |title=Chronic thyroiditis: A case showing features of both riedel's and hashimoto's thyroiditis - Merrington - 1948 - British Journal of Surgery - Wiley Online Library |format= |work= |accessdate=}}</ref><ref name="Invasive Fibrous (Riedel's) Thyroiditis">{{cite journal |vauthors=Hines RC, Scheuermann HA, Royster HP |title=Invasive Fibrous (Riedel's) Thyroiditis With Bilateral Fibrous Parotitis.|journal=JAMA|pages=869-871 |year=1970 |doi=10.1001/jama.1970.03170310147054 |url=http://jamanetwork.com/journals/jama/article-abstract/355936}}</ref><ref name="urlRiedels Thyroiditis: A Clinical Review | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic">{{cite web |url=https://doi.org/10.1210/jc.2011-0617 |title=Riedel's Thyroiditis: A Clinical Review | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic |format= |work= |accessdate=}}</ref> | Riedel's thyroiditis is associated various other autoimmune conditions including:<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="pmid4413980">{{cite journal |vauthors=Drury MI, Sweeney EC, Heffernan SJ |title=Invasive fibrous (Riedel's) thyroiditis |journal=Ir Med J |volume=67 |issue=14 |pages=388–90 |year=1974 |pmid=4413980 |doi= |url=}}</ref><ref name="urlChronic thyroiditis: A case showing features of both riedels and hashimotos thyroiditis - Merrington - 1948 - British Journal of Surgery - Wiley Online Library">{{cite web |url=http://dx.doi.org/10.1002/bjs.18003514015 |title=Chronic thyroiditis: A case showing features of both riedel's and hashimoto's thyroiditis - Merrington - 1948 - British Journal of Surgery - Wiley Online Library |format= |work= |accessdate=}}</ref><ref name="Invasive Fibrous (Riedel's) Thyroiditis">{{cite journal |vauthors=Hines RC, Scheuermann HA, Royster HP |title=Invasive Fibrous (Riedel's) Thyroiditis With Bilateral Fibrous Parotitis.|journal=JAMA|pages=869-871 |year=1970 |doi=10.1001/jama.1970.03170310147054 |url=http://jamanetwork.com/journals/jama/article-abstract/355936}}</ref><ref name="urlRiedels Thyroiditis: A Clinical Review | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic">{{cite web |url=https://doi.org/10.1210/jc.2011-0617 |title=Riedel's Thyroiditis: A Clinical Review | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic |format= |work= |accessdate=}}</ref> | ||
*Graves’ disease | *[[Graves’ disease]] | ||
*Hashimoto’s thyroiditis | *[[Hashimoto's thyroiditis|Hashimoto’s thyroiditis]] | ||
*Multifocal idiopathic fibrosclerosis | *Multifocal idiopathic fibrosclerosis | ||
*Addison’s disease | *[[Addison's disease|Addison’s disease]] | ||
*Pernicious anemia | *[[Pernicious anemia]] | ||
*Type 1 diabetes | *[[Diabetes mellitus type 1|Type 1 diabetes]] | ||
==Gross Pathology== | ==Gross Pathology== | ||
*On gross pathology, dense, avascular white fibrous tissue, absence of capsule, and no normal thyroid tissue are characteristic findings of Riedel's thyroiditis.<ref name="urlRiedel’s Thyroiditis | American Journal of Clinical Pathology | Oxford Academic">{{cite web |url=https://doi.org/10.1093/ajcp/90.6.715 |title=Riedel’s Thyroiditis | American Journal of Clinical Pathology | Oxford Academic |format= |work= |accessdate=}}</ref> | *On gross pathology, dense, [[avascular]] white fibrous tissue, the absence of a capsule, and no normal thyroid tissue are characteristic findings of Riedel's thyroiditis.<ref name="urlRiedel’s Thyroiditis | American Journal of Clinical Pathology | Oxford Academic">{{cite web |url=https://doi.org/10.1093/ajcp/90.6.715 |title=Riedel’s Thyroiditis | American Journal of Clinical Pathology | Oxford Academic |format= |work= |accessdate=}}</ref> | ||
==Microscopic Pathology== | ==Microscopic Pathology== | ||
*On microscopic histopathological analysis, destruction of thyroid follicle by inflammatory cells and fibrous tissues and invasion of surrounding structures are characteristic findings of Riedel's thyroiditis.The inflammatory cells including lymphocytes, plasma cells and eosinophils are present in a dense matrix of hyalinized connective tissue.<ref name="urlRedirecting">{{cite web |url=https://doi.org/10.1016/S1001-9294(10)60036-3 |title=Redirecting |format= |work= |accessdate=}}</ref><ref name="pmid15298150">{{cite journal |vauthors=Papi G, LiVolsi VA |title=Current concepts on Riedel thyroiditis |journal=Am. J. Clin. Pathol. |volume=121 Suppl |issue= |pages=S50–63 |year=2004 |pmid=15298150 |doi= |url=}}</ref> | *On microscopic [[histopathological]] analysis, destruction of thyroid follicle by inflammatory cells and fibrous tissues and invasion of surrounding structures are characteristic findings of Riedel's thyroiditis.The inflammatory cells including [[lymphocytes]], [[plasma cells]], and [[eosinophils]] are present in a dense matrix of hyalinized [[connective tissue]].<ref name="urlRedirecting">{{cite web |url=https://doi.org/10.1016/S1001-9294(10)60036-3 |title=Redirecting |format= |work= |accessdate=}}</ref><ref name="pmid15298150">{{cite journal |vauthors=Papi G, LiVolsi VA |title=Current concepts on Riedel thyroiditis |journal=Am. J. Clin. Pathol. |volume=121 Suppl |issue= |pages=S50–63 |year=2004 |pmid=15298150 |doi= |url=}}</ref> | ||
==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
The exact pathogenesis of Riedel's thyroiditis is not fully understood. The presence of thyroid autoantibodies and lymphoid infiltration of the thyroid gland resembling that of Hashimoto's thyroiditis might indicate an autoimmune etiology. It is considered that the infiltrating lymphocytes release cytokines which are responsible for the activation of fibroblasts responsible for the fibrosis. Riedel's thyroiditis is characterized by a replacement of the normal thyroid parenchyma by a dense fibrosis that invades adjacent structures of the neck and extends beyond the thyroid capsule. This makes the thyroid gland stone-hard and fixed to adjacent structures. A shared mechanism with retroperitoneal fibrosis and sclerosing cholangitis has been suggested.
Pathophysiology
Pathogenesis
The exact pathogenesis of Riedel's thyroiditis is not fully understood. The presence of thyroid autoantibodies and lymphoid infiltration of the thyroid gland resembling that of Hashimoto's thyroiditis might indicate an autoimmune etiology.
- It is considered that the infiltrating lymphocytes release cytokines which are responsible for the activation of fibroblasts responsible for the fibrosis.[1]
- Riedel's thyroiditis is characterized by a replacement of the normal thyroid parenchyma by a dense fibrosis that invades adjacent structures of the neck and extends beyond the thyroid capsule.This makes the thyroid gland stone-hard and fixed to adjacent structures.[2]
- Tissue eosinophilia and Major basic protein (MBP) identified in the thyroid gland on the histopathological analysis are also thought to play a role in the proliferation of fibroblasts.[3]
- A shared mechanism with retroperitoneal fibrosis and sclerosing cholangitis is also suggested.[4]
Associated Conditions
Riedel's thyroiditis is associated various other autoimmune conditions including:[1][5][6][7][8]
- Graves’ disease
- Hashimoto’s thyroiditis
- Multifocal idiopathic fibrosclerosis
- Addison’s disease
- Pernicious anemia
- Type 1 diabetes
Gross Pathology
- On gross pathology, dense, avascular white fibrous tissue, the absence of a capsule, and no normal thyroid tissue are characteristic findings of Riedel's thyroiditis.[9]
Microscopic Pathology
- On microscopic histopathological analysis, destruction of thyroid follicle by inflammatory cells and fibrous tissues and invasion of surrounding structures are characteristic findings of Riedel's thyroiditis.The inflammatory cells including lymphocytes, plasma cells, and eosinophils are present in a dense matrix of hyalinized connective tissue.[10][11]
References
- ↑ 1.0 1.1 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.
- ↑ Cho MH, Kim CS, Park JS; et al. (2007). "Riedel's thyroiditis in a patient with recurrent subacute thyroiditis: a case report and review of the literature". Endocr. J. 54 (4): 559–62. PMID 17603227.
- ↑ "Tissue eosinophilia and eosinophil degranulation in Riedel's invasive fibrous thyroiditis | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic".
- ↑ De Boer WA (1993). "Riedel's thyroiditis, retroperitoneal fibrosis, and sclerosing cholangitis: diseases with one pathogenesis?". Gut. 34 (5): 714. PMC 1374200. PMID 8504980.
- ↑ Drury MI, Sweeney EC, Heffernan SJ (1974). "Invasive fibrous (Riedel's) thyroiditis". Ir Med J. 67 (14): 388–90. PMID 4413980.
- ↑ "Chronic thyroiditis: A case showing features of both riedel's and hashimoto's thyroiditis - Merrington - 1948 - British Journal of Surgery - Wiley Online Library".
- ↑ Hines RC, Scheuermann HA, Royster HP (1970). "Invasive Fibrous (Riedel's) Thyroiditis With Bilateral Fibrous Parotitis". JAMA: 869–871. doi:10.1001/jama.1970.03170310147054.
- ↑ "Riedel's Thyroiditis: A Clinical Review | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic".
- ↑ "Riedel's Thyroiditis | American Journal of Clinical Pathology | Oxford Academic".
- ↑ "Redirecting".
- ↑ Papi G, LiVolsi VA (2004). "Current concepts on Riedel thyroiditis". Am. J. Clin. Pathol. 121 Suppl: S50–63. PMID 15298150.