Guia Lopes Maria Leonor, Cidade José Pedro, Cunha Clara, Limbert Clotilde, Sequeira Duarte João
Endocrinology Department, Hospital Egas Moniz, CHLO, Lisbon, Portugal.
Intensive Care Unit 4, Intensive Care Department, Hospital São Francisco Xavier, CHLO, Lisbon, Portugal.
Endocrinol Diabetes Metab Case Rep. 2024 Jul 22;2024(3). doi: 10.1530/EDM-24-0053. Print 2024 Jul 1.
Riedel's thyroiditis is the rarest form of thyroiditis, occasionally resulting in rapid thyroid enlargement and potential tracheal obstruction. Here, we detail the case of an 81-year-old woman with a medical history including Hodgkin lymphoma, Hashimoto's thyroiditis, and multinodular goiter. She presented to the emergency room with stridor, cervical swelling, and breathing difficulties for over 2 days. CT scans revealed substantial thyroid enlargement causing significant glottal and tracheal compression, to a minimum tracheal diameter of 7 mm. Due to the severity of the compressive symptoms, orotracheal intubation and mechanical ventilation were deemed necessary. Surprisingly, despite the initial suspicion of malignancy given the rapid growth in the elderly, subsequent cytological and histological evaluations indicated a benign form of invasive fibrous thyroiditis - Riedel's thyroiditis. Although surgical intervention was advised, the patient declined and opted for endobronchial treatment with a prosthetic stent and subsequent treatment with systemic glucocorticoids. Following successful treatment, she was discharged within a week and resumed normal activities without respiratory distress. This case is noteworthy for its rapid benign mass growth, rare emergent presentation, and the patient's advanced age.
The rapid enlargement of the thyroid gland in elderly patients poses a diagnostic challenge, stemming from the higher occurrence of aggressive thyroid carcinomas. Despite the clinical presentation, a comprehensive diagnostic workup, including fine-needle aspiration and core-needle biopsy, is crucial for accurately distinguishing between benign and malignant causes of thyroid nodule enlargement. This case report illustrates diverse treatment options for Riedel's thyroiditis, and the importance of individualized treatment plans based on the degree of airway obstruction, patient preferences, and response to initial interventions. Clinicians should contemplate the inclusion of glucocorticoids in the therapeutic regimen for Riedel's thyroiditis, particularly in cases where surgical intervention is not feasible or declined by the patient.
里德尔甲状腺炎是最罕见的甲状腺炎形式，偶尔会导致甲状腺迅速肿大并可能造成气管阻塞。在此，我们详细介绍一名81岁女性的病例，其病史包括霍奇金淋巴瘤、桥本甲状腺炎和结节性甲状腺肿。她因喘鸣、颈部肿胀和呼吸困难超过2天就诊于急诊室。CT扫描显示甲状腺显著肿大，导致声门和气管严重受压，气管最小直径为7毫米。由于压迫症状严重，经口气管插管和机械通气被认为是必要的。令人惊讶的是，尽管鉴于老年人甲状腺迅速生长最初怀疑为恶性肿瘤，但随后的细胞学和组织学评估表明是一种良性的侵袭性纤维性甲状腺炎——里德尔甲状腺炎。尽管建议进行手术干预，但患者拒绝并选择了支气管内放置人工支架治疗以及随后的全身糖皮质激素治疗。治疗成功后，她在一周内出院，恢复正常活动且无呼吸窘迫。该病例因其甲状腺良性肿块迅速生长、罕见的急诊表现以及患者高龄而值得关注。
老年患者甲状腺迅速肿大带来诊断挑战，原因是侵袭性甲状腺癌发生率较高。尽管有临床表现，但全面的诊断检查，包括细针穿刺和粗针活检，对于准确区分甲状腺结节肿大的良性和恶性原因至关重要。本病例报告说明了里德尔甲状腺炎的多种治疗选择，以及根据气道阻塞程度、患者偏好和对初始干预的反应制定个性化治疗方案的重要性。临床医生应考虑在里德尔甲状腺炎的治疗方案中加入糖皮质激素，特别是在手术干预不可行或患者拒绝的情况下。
