Thyroid size decreased in response to tamoxifen
in a patient with Riedel’s thyroiditis
(March 2005)
The background of the study. Riedel’s thyroiditis
(also called invasive fibrous thyroiditis) is characterized by progressive
fibrosis of the thyroid gland and surrounding tissues, which may
lead to hypothyroidism and compression or invasion of the trachea,
recurrent laryngeal nerves, and other neck structures. Treatment
has consisted of thyroidectomy and glucocorticoids, neither of which
is very effective. This article describes a patient with Riedel’s
thyroiditis in whom administration of tamoxifen, an estrogen-like
compound, resulted in marked improvement.
Case report. The patient was a 40-year-old woman
who was found to have a goiter and hypothyroidism in May 2000. She
was treated with thyroxine, in doses up to 175 µg daily, but
the goiter increased in size. One year later, imaging studies revealed
an enlarged heterogeneous thyroid gland. She had high serum antithyroid
peroxidase and antithyroglobulin antibody concentrations and a high
erythrocyte sedimentation rate.
Because of increasing discomfort in her neck, intermittent choking
sensations, and further thyroid enlargement, she was operated on.
Her thyroid gland was very hard and immobile. Anaplastic thyroid
carcinoma was suspected, but biopsy revealed only dense fibrous
tissue and chronic inflammation, and no thyroid tissue, consistent
with Riedel’s thyroiditis.
The patient was treated with tamoxifen, 20 mg twice daily, in addition
to thyroxine. During a 19-month follow-up period, her thyroid gland
progressively decreased in size.
Literature review. This article includes a table
that summarizes the results of tamoxifen therapy in eight other
patients with Riedel’s thyroiditis. All improved, in terms
of both amelioration of respiratory symptoms and a decrease in thyroid
size.
The conclusions of the study. Tamoxifen seemed
to be effective therapy in a patient with Riedel’s thyroiditis.
The original article. Jung YJ, Schaub CR, Rhodes
R, Rich FA, Muehlenbein SJ. A case of Riedel’s thyroiditis
treated with tamoxifen: another successful outcome. Endocr Pract
2004;10:483-6.
|
