Riedel's thyroiditis diagnostic criteria: Difference between revisions
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==Overview== | ==Overview== | ||
Diagnostic criteria of Riedel's thyroiditis is based on the [[histopathological]] findings and includes infiltration of [[inflammatory cells]] in the thyroid gland, extension beyond the capsule, evidence of occlusive [[phlebitis]] and '''absence''' of [[giant cells]], [[lymphoid follicles]], or [[Granuloma|granulomas]]. | Diagnostic criteria of Riedel's thyroiditis is based on the [[histopathological]] findings and includes infiltration of [[inflammatory cells]] in the [[thyroid gland]], extension beyond the capsule, evidence of occlusive [[phlebitis]] and '''absence''' of [[giant cells]], [[lymphoid follicles]], or [[Granuloma|granulomas]]. | ||
==Diagnostic criteria== | ==Diagnostic criteria== | ||
Definitive diagnosis of Riedel's thyroiditis is made only with [[histopathology]], after an open biopsy or decompressive goiter surgery performed for clinical symptoms. Specific [[histopathological]] criteria required to establish the diagnosis of Riedel’s thyroiditis is:<ref name="pmid21832114">{{cite journal |vauthors=Hennessey JV |title=Clinical review: Riedel's thyroiditis: a clinical review |journal=J. Clin. Endocrinol. Metab. |volume=96 |issue=10 |pages=3031–41 |year=2011 |pmid=21832114 |doi=10.1210/jc.2011-0617 |url=}}</ref><ref name="pmid6195075">{{cite journal |vauthors=Harach HR, Williams ED |title=Fibrous thyroiditis--an immunopathological study |journal=Histopathology |volume=7 |issue=5 |pages=739–51 |year=1983 |pmid=6195075 |doi= |url=}}</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> | Definitive diagnosis of Riedel's thyroiditis is made only with [[histopathology]], after an open [[biopsy]] or decompressive [[goiter surgery]] performed for clinical symptoms. Specific [[histopathological]] criteria required to establish the diagnosis of Riedel’s thyroiditis is:<ref name="pmid21832114">{{cite journal |vauthors=Hennessey JV |title=Clinical review: Riedel's thyroiditis: a clinical review |journal=J. Clin. Endocrinol. Metab. |volume=96 |issue=10 |pages=3031–41 |year=2011 |pmid=21832114 |doi=10.1210/jc.2011-0617 |url=}}</ref><ref name="pmid6195075">{{cite journal |vauthors=Harach HR, Williams ED |title=Fibrous thyroiditis--an immunopathological study |journal=Histopathology |volume=7 |issue=5 |pages=739–51 |year=1983 |pmid=6195075 |doi= |url=}}</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> | ||
#The inflammatory process in the thyroid with extension into surrounding tissue. | #The inflammatory process in the thyroid with extension into surrounding tissue. | ||
#The inflammatory infiltrates should contain '''no''' [[giant cells]], [[lymphoid follicles]], or [[granulomas]]. | #The inflammatory infiltrates should contain '''no''' [[giant cells]], [[lymphoid follicles]], or [[granulomas]]. | ||
#Evidence of occlusive [[phlebitis]]. | #Evidence of occlusive [[phlebitis]]. | ||
#No evidence of thyroid malignancy. | #No evidence of [[Thyroid cancer|thyroid malignancy]]. | ||
===Stepwise clinical diagnosis of Riedel's thyroiditis=== | ===Stepwise clinical diagnosis of Riedel's thyroiditis=== | ||
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{{familytree | | | | | | B01 | | | | | | | | | | | B02 | | |B01=Yes|B02=No}} | {{familytree | | | | | | B01 | | | | | | | | | | | B02 | | |B01=Yes|B02=No}} | ||
{{familytree | | | | | | |!| | | | | | | | | | | | |!| }} | {{familytree | | | | | | |!| | | | | | | | | | | | |!| }} | ||
{{familytree | | | | | | C01 | | | | | | | | | | | C02 |C01=RAIU*|C02=Presenting symptoms and | {{familytree | | | | | | C01 | | | | | | | | | | | C02 |C01=[[RAIU]]*|C02=Presenting symptoms and [[TFTs]]‡}} | ||
{{familytree | | | | |,|-|^|-|-|.| | | | | | | |,|-|^|-|-|-|v|-|-|-|.| }} | {{familytree | | | | |,|-|^|-|-|.| | | | | | | |,|-|^|-|-|-|v|-|-|-|.| }} | ||
{{familytree | | | | D01 | | | D02 | | | | | | D03 | | | | D04 | |D05|D01=Increased|D02=Decreased|D03=Hyperthyroid|D04=Hypothyroid|D05=Euthyroid}} | {{familytree | | | | D01 | | | D02 | | | | | | D03 | | | | D04 | |D05|D01=Increased|D02=Decreased|D03=[[Hyperthyroid]]|D04=[[Hypothyroid]]|D05=[[Euthyroid]]}} | ||
{{familytree | | | | |!| | | | |!| | | | | | | |!| | | | | |!| | | |!|}} | {{familytree | | | | |!| | | | |!| | | | | | | |!| | | | | |!| | | |!|}} | ||
{{familytree | | | | |!| | | | |!| | | | | | | H01 | | | | |!| | | |!|H01=RAIU*}} | {{familytree | | | | |!| | | | |!| | | | | | | H01 | | | | |!| | | |!|H01=[[RAIU]]*}} | ||
{{familytree | | | | |!| | | | |!| | | | | |,|-|^|-|.| | | |!| | | |!|}} | {{familytree | | | | |!| | | | |!| | | | | |,|-|^|-|.| | | |!| | | |!|}} | ||
{{familytree | | | | E01 | | | E04 | | | | E02 | | E03 | | E05 | | |E06 |E01=Suppurative thyroiditis|E02=Increased|E03=Decreased|E04=De Quervain's thyroiditis|E05=Hashimoto's thyroiditis|E06=Riedel's | {{familytree | | | | E01 | | | E04 | | | | E02 | | E03 | | E05 | | |E06 |E01=Suppurative [[thyroiditis]]|E02=Increased|E03=Decreased|E04=[[De Quervain's thyroiditis]]|E05=[[Hashimoto's thyroiditis]]|E06='''Riedel's thyroiditis'''††}} | ||
{{familytree | | | | | | | | | | | | | | | |!| | | |!| }} | {{familytree | | | | | | | | | | | | | | | |!| | | |!| }} | ||
{{familytree | | | | | | | | | | | | | | | F01 | | F02 |F01= | {{familytree | | | | | | | | | | | | | | | F01 | | F02 |F01=[[Grave's disease]]†|F02= | ||
Silent thyroiditis | [[Silent thyroiditis]] | ||
Postpartum thyroiditis}} | [[Postpartum thyroiditis]]}} | ||
{{familytree/end}} | {{familytree/end}} | ||
<small>‡TFT; Thyroid function tests(TSH, T4, and T3), | <small>‡TFT; Thyroid function tests(TSH, T4, and T3), †[[Grave's disease]] is not a thyroiditis, *RAIU; Radioiodine uptake.††One third of Riedel's thyroiditis presents with [[hypothyroidism]].</small> | ||
<small> | |||
<br> | |||
Table modified from <ref name="urlThyroiditis: Differential Diagnosis and Management - American Family Physician">{{cite web |url=http://www.aafp.org/afp/2000/0215/p1047.html#afp20000215p1047-b7 |title=Thyroiditis: Differential Diagnosis and Management - American Family Physician |format= |work= |accessdate=}}</ref></small> | |||
==References== | ==References== | ||
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Latest revision as of 00:01, 30 July 2020
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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
Diagnostic criteria of Riedel's thyroiditis is based on the histopathological findings and includes infiltration of inflammatory cells in the thyroid gland, extension beyond the capsule, evidence of occlusive phlebitis and absence of giant cells, lymphoid follicles, or granulomas.
Diagnostic criteria
Definitive diagnosis of Riedel's thyroiditis is made only with histopathology, after an open biopsy or decompressive goiter surgery performed for clinical symptoms. Specific histopathological criteria required to establish the diagnosis of Riedel’s thyroiditis is:[1][2][3]
- The inflammatory process in the thyroid with extension into surrounding tissue.
- The inflammatory infiltrates should contain no giant cells, lymphoid follicles, or granulomas.
- Evidence of occlusive phlebitis.
- No evidence of thyroid malignancy.
Stepwise clinical diagnosis of Riedel's thyroiditis
The following flowchart describes the clinical approach to the diagnosis of Riedel's thyroiditis.
| Neck pain | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| RAIU* | Presenting symptoms and TFTs‡ | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Increased | Decreased | Hyperthyroid | Hypothyroid | Euthyroid | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| RAIU* | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Suppurative thyroiditis | De Quervain's thyroiditis | Increased | Decreased | Hashimoto's thyroiditis | Riedel's thyroiditis†† | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Grave's disease† | Silent thyroiditis
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
‡TFT; Thyroid function tests(TSH, T4, and T3), †Grave's disease is not a thyroiditis, *RAIU; Radioiodine uptake.††One third of Riedel's thyroiditis presents with hypothyroidism.
Table modified from [4]
References
- ↑ Hennessey JV (2011). "Clinical review: Riedel's thyroiditis: a clinical review". J. Clin. Endocrinol. Metab. 96 (10): 3031–41. doi:10.1210/jc.2011-0617. PMID 21832114.
- ↑ Harach HR, Williams ED (1983). "Fibrous thyroiditis--an immunopathological study". Histopathology. 7 (5): 739–51. PMID 6195075.
- ↑ Papi G, LiVolsi VA (2004). "Current concepts on Riedel thyroiditis". Am. J. Clin. Pathol. 121 Suppl: S50–63. PMID 15298150.
- ↑ "Thyroiditis: Differential Diagnosis and Management - American Family Physician".