A 59-year-old patient presented with dyspnea, dysphagia, sweating and weight loss as well as one rock-hard swelling of the neck. Hypothyroidism was known. The imaging with the help of sonography and computed tomography showed homogeneously distended thyroid gland with tracheal compression, esophageal stenosis and walling of the carotids - finding that is atypical for the differential diagnosis of nodular goiter. An inflammatory myofibroblastic tumor could not be excluded in the punch biopsy. Complete removal was not possible intraoperatively, so ventral thyroid debulking and postoperative corticosteroid therapy were performed to improve breathing difficulties. The intraoperative suspicion of Riedel's thyroiditis was confirmed histologically. This inflammatory disease of unknown etiology is rare differential diagnosis of nodular goiter that leads to the development of severe fibrosis and consequent hypothyroidism. Surgical therapy is usually not indicated - partly because of the high rate of injuries to the recurrent nerve - but is carried out in some patients to confirm the diagnosis. Riedel's thyroiditis cannot be clearly differentiated symptomatically and morphologically from aggressive thyroid processes (anaplastic carcinoma, sarcoma, lymphoma).
Dr. med. Marie-Luise Kromrey, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, marie-luise.kromrey@uni-egoswald.de
Prof. (jr.) Dr. med. Jens Peter Kühn, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald and Institute for X-ray Diagnostics, University Clinic Carl Gustav Carus Dresden
PD Dr. med. Andreas Hoene, Clinic and Polyclinic for General Surgery, Department of Visceral, Thoracic and Vascular Surgery, University Medical Center Greifswald
Conflict of interest: The authors declare that there is no conflict of interest.
Citation: Kromrey ML, Kühn JP, Hoene A: A rare type of thyroid mass with acute dyspnea . Dtsch Arztebl Int 2018; 115: 486. DOI: 10.3238 / arztebl.2018.0486
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