Case report of riedel’s thyroiditis

Background: There is no standard surgical management of Riedl’s thyroditis because it is rare. Indications of surgery in Riedel’s thyroiditis are obstructive symptoms, inability to diagnose the patient using non-invasive tools such as fine needle aspiration (FNA), and suspicions of malignancy. The extensive fibrosis that involves the surrounding structures prevents the surgeon from performinga complete surgery free of complications. Case report: A47-year-old Saudi male presented to our outpatient department as a referral from a secondary care center with a case of goiter with FNA, which showed thyroid lymphoma. The patient was hypothyroid and has a history of subdural hematoma. The review of his FNA in our center showed Hashimoto’s thyroiditis. The patient’s case was followed closely and he was given levothyroxine. After severalthyroid urltrasound, there was a newly appearing lesion which extended to the left internal jugular vein, and disturbed its flow. The repeated Ultrasound Guidance FNA failed to diagnose the extended lesion and the presence of a suspicious lymph node necessitate to operate on the patient. A frozen section of the suspicious lymph node confirmed the benign diagnosis, soa hemithyroidectomy preserving the left internal jugular vein was done. The histopathology result of the hemithyroidectomy showed Riedel's thyroiditis. The patient then was regularly followed up for two years with no relapse. Conclusion: Riedel's thyroiditis is a challenging disease both in diagnosis and in management. In our case report, thehemithyroidectomy was the diagnostic method. We recommend that the management of such disease be done in highly specialized centers with an expert endocrine surgeon and an expert pathologist. Follow up should be continued regardless of thyroid symptoms because of extra thyroid manifestations that can present late in the course of the disease.