Aashi
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A 61-year-old woman presents to her primary care clinic with difficulty breathing and swallowing, as well as throat and neck pain and voice changes over the past two months. She is very sensitive to cold and constantly feels tired. She also has fatty, foul-smelling stools. She denies abdominal pain, vomiting, or weight changes. She has itching, which has increased over the past month, and constantly experiences dryness of the mouth, which is unrelieved by drinking fluids. During the last visit to her gynecologist, she was found to have an immobile, painful, thickened cervix and was diagnosed with sclerosing cervicitis. The diagnosis was supported by cervical biopsy.
On physical examination, her temperature is normal, and the pulse is 62/min. Her face looks slightly puffy, and her skin is dry and pale. There are xanthomatous lesions around the eyelids and on the face. The mucous membranes are dry. The thyroid gland is palpable, enlarged, asymmetrical, hard, and immobile. There is no tenderness on palpation of the thyroid. There is a mild lower extremity edema. Laboratory studies show: sodium 132 mEq/L, potassium 3.4 mEq/L, BUN 24 mg/dL, creatinine 0.9 mg/dL, cholesterol 290 mg/dL, triglycerides 168 mg/dL, TSH 34 mU/L (normal 0.4-5.0 mU/L), and free T4 0.6 ng/dL (normal 0.9-2.4 ng/dL). The thyroid radioiodine uptake is low, and the scan reveals uneven uptake. Antimitochondrial antibodies are present, and thyroid autoantibodies are negative. Thyroid-gland ultrasound reveals diffuse changes, with no nodular structures. An ultrasound-guided, thyroid-gland biopsy reveals an increased amount of fibrotic tissue. What would be the most effective treatment in this thyroid gland disorder?
(A) Surgical decompression
(B) Corticosteroids
(C) Tamoxifen
(D) Levothyroxine
(E) Radiation therapy
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| prathapdoctor
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Riedels thyroiditis, corticosteroids.
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| vrach
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Treatment of choice for Riedel's thyroiditis is Tamoxifen.
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| robin082006
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Yes, Riedel thydoiditis, Tamoxifen
Just known that tamoxifen is used for Riedel's
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| prathapdoctor
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but in harrison its given that for compressive symptoms, surgery is the treatment of choice and tamoxifen is also benificial for riedels thyroiditis so i think here the treatment is DECOMPRESSION SURGERY.
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| vrach
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according to CMDT:
Tamoxifen can induce partial to complete remission whithin 3-6 months. Meanwhile corticosteroids are concomittently given to alliviate compression symptoms. Surgical decompression is usually not successful in permanently alleviating compression symptoms, is difficult to perform, and surgical complications are more likely.
anyhoo, what's the right answer?
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| Aashi
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Ans is TAMOXIFEN
Riedel's thyroiditis is a form of thyroiditis that occurs in middle-aged or elderly women. It is also called invasive fibrous thyroiditis. It causes hypothyroidism but may also cause hypoparathyroidism as well. The gland is asymmetrically enlarged, stony, hard, adherent to the neck structures, and causes signs of compression and invasion, such as dysphagia, dyspnea, pain, and hoarseness. Usually, this is a part of a multifocal, systemic, fibrotic syndrome, which includes biliary tract sclerosis, sclerosing cervicitis, and Sjögren's syndrome. The treatment is oral tamoxifen, which causes remarkable partial-to-complete remissions in most cases within 3 to 6 months. Treatment must be continued for years. Its effect is likely to be related to antiestrogen activity. Corticosteroids may be added for the relief of compression symptoms. Surgical decompression is difficult because of fibrous adhesions. Thyroxine lowers cholesterol levels in hypothyroidism and is cheaper than a statin
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