Management of Riedel Thyroiditis With Completion Thyroidectomy to Relieve Persistent Compressive Symptoms

Riedel thyroiditis is a rare IgG4-related condition characterized by chronic inflammation that results in partial or total fibrosis of the thyroid gland. Medical management aimed at reducing the autoimmune inflammatory response is generally considered to be the first-line treatment; however, not all patients respond to such interventions and require surgical intervention. Herein we report a 40-year-old patient with Riedel thyroiditis and significant compressive symptoms. She underwent several trials of medical therapy, including prednisone, tamoxifen, and mycophenolate mofetil, but saw almost no symptomatic improvement. She then underwent right thyroid lobectomy but again saw incomplete improvement in compressive symptoms. Ultimately, she received completion thyroidectomy, and this led to great improvement in airway obstruction but unfortunately resulted in chronic hypoparathyroidism. Our case adds to the medical literature by highlighting the value of serial imaging and pulmonary function evaluation to assess the severity of tracheal stenosis as well as demonstrating the potential feasibility of complete resection of the thyroid gland for patients with Riedel thyroiditis and concomitant airway obstruction.