Schwaegerle S M, Bauer T W, Esselstyn C B
Department of Pathology, Cleveland Clinic Foundation, Ohio 44106.
Am J Clin Pathol. 1988 Dec;90(6):715-22. doi: 10.1093/ajcp/90.6.715.
Riedel's thyroiditis is a rare chronic inflammatory disease of the thyroid gland first recognized by Bernhard Riedel in 1893. In order to clarify the clinical and pathologic features of this rare disorder, a recent case of Riedel's thyroiditis is presented, 6 additional cases from the surgical pathology files of the Cleveland Clinic Foundation are reported, and the 178 cases previously reported in the English literature are reviewed. The mean age at presentation has been 47.8 years, and 83% of patients have been female. Sixty-four percent were euthyroid, 32% hypothyroid, and 4% hyperthyroid. Antithyroid antibodies have been detected in 16 of the 25 patients tested. Since 1960, 34% of the published cases of Riedel's thyroiditis have reported the development of multifocal fibrosis. Immunohistologic study of the inflammatory infiltrate reveals a mixed population of B- and T-cells. Comparison with the infiltrate in Hashimoto's thyroiditis shows similar proportions of CD4- and CD8-positive lymphocytes. The relationship and origin of multifocal fibrosing lesions has not been defined, but an immunologic origin seems most likely. The finding of antithyroid antibodies in 67% of patients supports an autoimmune mechanism of injury.
里德尔甲状腺炎是一种罕见的甲状腺慢性炎症性疾病，1893年由伯恩哈德·里德尔首次发现。为了阐明这种罕见疾病的临床和病理特征，本文报告了1例近期的里德尔甲状腺炎病例，还报道了克利夫兰诊所基金会外科病理档案中的另外6例病例，并对英文文献中先前报道的178例病例进行了回顾。患者就诊时的平均年龄为47.8岁，83%为女性。64%的患者甲状腺功能正常，32%甲状腺功能减退，4%甲状腺功能亢进。在接受检测的25例患者中，有16例检测到抗甲状腺抗体。自1960年以来，已发表的里德尔甲状腺炎病例中有34%报告发生了多灶性纤维化。对炎性浸润的免疫组织学研究显示，存在B细胞和T细胞的混合群体。与桥本甲状腺炎中的浸润情况相比，CD4阳性和CD8阳性淋巴细胞的比例相似。多灶性纤维化病变的关系和起源尚未明确，但免疫起源似乎最有可能。67%的患者检测到抗甲状腺抗体这一发现支持了自身免疫性损伤机制。
