UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Infiltrative thyroid disease

Authors
Stephanie L Lee, MD, PhD
Sonia Ananthakrishnan, MD
Section Editor
Douglas S Ross, MD
Deputy Editor
Jean E Mulder, MD

INTRODUCTION

Infiltration of the thyroid may occur as an isolated abnormality or as a manifestation of generalized disease. The infiltration usually presents as progressive thyroid enlargement that is painless, firm, and bilateral, and may be confused with goitrous autoimmune thyroiditis (Hashimoto's thyroiditis), nontoxic multinodular goiter, subacute thyroiditis, infectious thyroiditis or occasionally thyroid cancer or lymphoma. (See "Clinical presentation and evaluation of goiter in adults" and "Overview of thyroiditis" and "Pathogenesis of Hashimoto's thyroiditis (chronic autoimmune thyroiditis)" and "Diagnostic approach to and treatment of thyroid nodules" and "Thyroid lymphoma".)

The clinical course and pathologic findings of the most common forms of infiltrative thyroid disease, excluding those of autoimmune, infectious or malignant origin, are reviewed here. Most of these diseases involve other organs, but the focus here will be on the thyroid manifestations.

GENERAL PRINCIPLES

Infiltrative thyroid diseases are rare. Painless, progressive enlargement of the thyroid is the most common presentation of infiltrative thyroid disease. Changes in thyroid function tests are less commonly seen, although infiltration of the thyroid can be associated with hypothyroidism.

We routinely measure thyroid function tests (thyroid-stimulating hormone [TSH] and free thyroxine [T4]) when thyroid enlargement or nodular thyroid disease is noted on physical examination. Many thyroid experts also check serum thyroid peroxidase (TPO) antibodies in patients with diffuse thyroid enlargement (regardless of the TSH level) to confirm the diagnosis of chronic thyroiditis. (See "Clinical presentation and evaluation of goiter in adults", section on 'Approach to evaluation' and "Diagnostic approach to and treatment of thyroid nodules", section on 'Evaluation'.)

We perform thyroid ultrasonography to assess the morphology of the thyroid gland when infiltration is suspected. Fine-needle aspiration (FNA) of a suspicious nodule or expanding mass in the thyroid may be considered to further evaluate the variable pathology of this entity. The presence of a high titer of TPO antibodies does not negate the need for FNA biopsy of a thyroid nodule or expanding mass in patient with Hashimoto’s.

                                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Mar 31 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Natt N, Heufelder AE, Hay ID, et al. Extracervical fibrosclerosis causing obstruction of a ventriculo-peritoneal shunt in a patient with hydrocephalus and invasive fibrous thyroiditis (Riedel's struma). Clin Endocrinol (Oxf) 1997; 47:107.
  2. Lo JC, Loh KC, Rubin AL, et al. Riedel's thyroiditis presenting with hypothyroidism and hypoparathyroidism: dramatic response to glucocorticoid and thyroxine therapy. Clin Endocrinol (Oxf) 1998; 48:815.
  3. Hay ID. Thyroiditis: a clinical update. Mayo Clin Proc 1985; 60:836.
  4. BEAHRS OH, MCCONAHEY WM, WOOLNER LB. Invasive fibrous thyroiditis (Riedel's struma). J Clin Endocrinol Metab 1957; 17:201.
  5. LiVolsi VA. Fibrosis in the thyroid. In: Surgical pathology of the thyroid, LiVolsi VA (Ed), WB Saunders, Philadelphia 1990. p.98.
  6. Zimmermann-Belsing T, Feldt-Rasmussen U. Riedel's thyroiditis: an autoimmune or primary fibrotic disease? J Intern Med 1994; 235:271.
  7. Volpe R. Subacute and sclerosing thyroiditis. In: Endocrinology, 3rd ed, De Groot LJ (Ed), WB Saunders, Philadelphia 1995. p.745.
  8. Mitchinson MJ. Retroperitoneal fibrosis revisited. Arch Pathol Lab Med 1986; 110:784.
  9. Erdoğan MF, Anil C, Türkçapar N, et al. A case of Riedel's thyroiditis with pleural and pericardial effusions. Endocrine 2009; 35:297.
  10. Hennessey JV. Clinical review: Riedel's thyroiditis: a clinical review. J Clin Endocrinol Metab 2011; 96:3031.
  11. Dahlgren M, Khosroshahi A, Nielsen GP, et al. Riedel's thyroiditis and multifocal fibrosclerosis are part of the IgG4-related systemic disease spectrum. Arthritis Care Res (Hoboken) 2010; 62:1312.
  12. Schwaegerle SM, Bauer TW, Esselstyn CB Jr. Riedel's thyroiditis. Am J Clin Pathol 1988; 90:715.
  13. Chopra D, Wool MS, Crosson A, Sawin CT. Riedel's struma associated with subacute thyroiditis, hypothyroidism, and hypoparathyroidism. J Clin Endocrinol Metab 1978; 46:869.
  14. Yasmeen T, Khan S, Patel SG, et al. Clinical case seminar: Riedel's thyroiditis: report of a case complicated by spontaneous hypoparathyroidism, recurrent laryngeal nerve injury, and Horner's syndrome. J Clin Endocrinol Metab 2002; 87:3543.
  15. de Lange WE, Freling NJ, Molenaar WM, Doorenbos H. Invasive fibrous thyroiditis (Riedel's struma): a manifestation of multifocal fibrosclerosis? A case report with review of the literature. Q J Med 1989; 72:709.
  16. Cho MH, Kim CS, Park JS, et al. Riedel's thyroiditis in a patient with recurrent subacute thyroiditis: a case report and review of the literature. Endocr J 2007; 54:559.
  17. Papi G, Corrado S, Cesinaro AM, et al. Riedel's thyroiditis: clinical, pathological and imaging features. Int J Clin Pract 2002; 56:65.
  18. Slman R, Monpeyssen H, Desarnaud S, et al. Ultrasound, elastography, and fluorodeoxyglucose positron emission tomography/computed tomography imaging in Riedel's thyroiditis: report of two cases. Thyroid 2011; 21:799.
  19. Kotilainen P, Airas L, Kojo T, et al. Positron emission tomography as an aid in the diagnosis and follow-up of Riedel's thyroiditis. Eur J Intern Med 2004; 15:186.
  20. Drieskens O, Blockmans D, Van den Bruel A, Mortelmans L. Riedel's thyroiditis and retroperitoneal fibrosis in multifocal fibrosclerosis: positron emission tomographic findings. Clin Nucl Med 2002; 27:413.
  21. Harigopal M, Sahoo S, Recant WM, DeMay RM. Fine-needle aspiration of Riedel's disease: report of a case and review of the literature. Diagn Cytopathol 2004; 30:193.
  22. Meyer S, Hausman R. Occlusive phlebitis in multifocal fibrosclerosis. Am J Clin Pathol 1976; 65:274.
  23. Wan SK, Chan JK, Tang SK. Paucicellular variant of anaplastic thyroid carcinoma. A mimic of Reidel's thyroiditis. Am J Clin Pathol 1996; 105:388.
  24. Baloch ZW, Saberi M, Livolsi VA. Simultaneous involvement of thyroid by Riedel's [correction of Reidel's] disease and fibrosing Hashimoto's thyroiditis: a case report. Thyroid 1998; 8:337.
  25. Harach HR, Williams ED. Fibrous thyroiditis--an immunopathological study. Histopathology 1983; 7:739.
  26. Vaidya B, Harris PE, Barrett P, Kendall-Taylor P. Corticosteroid therapy in Riedel's thyroiditis. Postgrad Med J 1997; 73:817.
  27. Drury MI, Sweeney EC, Heffernan SJ. Invasive fibrous (Riedel's) thyroiditis. Ir Med J 1974; 67:388.
  28. McIver B, Fatourechi MM, Hay ID, Fatourechi V. Graves' disease after unilateral Riedel's thyroiditis. J Clin Endocrinol Metab 2010; 95:2525.
  29. Eryaman E, Comunoglu C. Could Riedel's thyroiditis be subacute thyroiditis? A case report. Pol J Pathol 2011; 62:176.
  30. Kabalak T, Ozgen AG, Günel O, Yetkin E. Occurrence of Riedel's thyroiditis in the course of sub-acute thyroiditis. J Endocrinol Invest 2000; 23:399.
  31. Few J, Thompson NW, Angelos P, et al. Riedel's thyroiditis: treatment with tamoxifen. Surgery 1996; 120:993.
  32. Jung YJ, Schaub CR, Rhodes R, et al. A case of Riedel's thyroiditis treated with tamoxifen: another successful outcome. Endocr Pract 2004; 10:483.
  33. Levy JM, Hasney CP, Friedlander PL, et al. Combined mycophenolate mofetil and prednisone therapy in tamoxifen- and prednisone-resistant Reidel's thyroiditis. Thyroid 2010; 20:105.
  34. Soh SB, Pham A, O'Hehir RE, et al. Novel use of rituximab in a case of Riedel's thyroiditis refractory to glucocorticoids and tamoxifen. J Clin Endocrinol Metab 2013; 98:3543.
  35. Harreby M, Bilde T, Helin P, et al. Retroperitoneal fibrosis treated with methylprednisolon pulse and disease-modifying antirheumatic drugs. Scand J Urol Nephrol 1994; 28:237.
  36. Falk RH, Comenzo RL, Skinner M. The systemic amyloidoses. N Engl J Med 1997; 337:898.
  37. Hamed G, Heffess CS, Shmookler BM, Wenig BM. Amyloid goiter. A clinicopathologic study of 14 cases and review of the literature. Am J Clin Pathol 1995; 104:306.
  38. Ozdemir D, Dagdelen S, Erbas T. Endocrine involvement in systemic amyloidosis. Endocr Pract 2010; 16:1056.
  39. Sinha RN, Plehn JF, Kinlaw WB. Amyloid goiter due to primary systemic amyloidosis: a diagnostic challenge. Thyroid 1998; 8:1051.
  40. Altiparmak MR, Pamuk ON, Pamuk GE, et al. Amyloid goitre in familial Mediterranean fever: report on three patients and review of the literature. Clin Rheumatol 2002; 21:497.
  41. Ozdemir BH, Akman B, Ozdemir FN. Amyloid goiter in Familial Mediterranean Fever (FMF): a clinicopathologic study of 10 cases. Ren Fail 2001; 23:659.
  42. Law JH, Dean DS, Scheithauer B, et al. Symptomatic amyloid goiters: report of five cases. Thyroid 2013; 23:1490.
  43. Joung KH, Park JY, Kim KS, Koo BS. Primary amyloid goiter mimicking rapid growing thyroid malignancy. Eur Arch Otorhinolaryngol 2014; 271:417.
  44. Rich MW. Hypothyroidism in association with systemic amyloidosis. Head Neck 1995; 17:343.
  45. Kimura H, Yamashita S, Ashizawa K, et al. Thyroid dysfunction in patients with amyloid goitre. Clin Endocrinol (Oxf) 1997; 46:769.
  46. Kennedy JS, Thomson JA, Buchanan WM. Amyloid in the thyroid. Q J Med 1974; 43:127.
  47. Cabrejas Gómez Mdel C, González Cabrera N, Gómez González C, Bergara Elorza S. Amyloid goiter as an initial manifestation of systemic amyloidosis. Reumatol Clin 2015; 11:404.
  48. Ojha SS, Naik LP, Kothari KS, et al. Amyloid goiter: cytomorphological features and differential diagnosis on fine needle aspiration cytology: a case report. Anal Quant Cytopathol Histpathol 2014; 36:241.
  49. Nijhawan VS, Marwaha RK, Sahoo M, Ravishankar L. Fine needle aspiration cytology of amyloid goiter. A report of four cases. Acta Cytol 1997; 41:830.
  50. Michael CW, Naylor B. Amyloid in cytologic specimens. Differential diagnosis and diagnostic pitfalls. Acta Cytol 1999; 43:746.
  51. Himmetoglu C, Yamak S, Tezel GG. Diffuse fatty infiltration in amyloid goiter. Pathol Int 2007; 57:449.
  52. Jacques TA, Stearns MP. Diffuse lipomatosis of the thyroid with amyloid deposition. J Laryngol Otol 2013; 127:426.
  53. Villamil CF, Massimi G, D'Avella J, Cole SR. Amyloid goiter with parathyroid involvement: a case report and review of the literature. Arch Pathol Lab Med 2000; 124:281.
  54. Siddiqui MA, Gertz M, Dean D. Amyloid goiter as a manifestation of primary systemic amyloidosis. Thyroid 2007; 17:77.
  55. Bell NH. Endocrine complications of sarcoidosis. Endocrinol Metab Clin North Am 1991; 20:645.
  56. Winnacker JL, Becker KL, Katz S. Endocrine aspects of sarcoidosis. N Engl J Med 1968; 278:483.
  57. Spencer, J, Warren, S. Boeck's sarcoid: Report of a case with clinical diagnosis confirmed at autopsy. Arch Intern Med 1938; 62:285.
  58. Vailati A, Marena C, Aristia L, et al. Sarcoidosis of the thyroid: report of a case and a review of the literature. Sarcoidosis 1993; 10:66.
  59. Warshawsky ME, Shanies HM, Rozo A. Sarcoidosis involving the thyroid and pleura. Sarcoidosis Vasc Diffuse Lung Dis 1997; 14:165.
  60. Manchanda A, Patel S, Jiang JJ, Babu AR. Thyroid: an unusual hideout for sarcoidosis. Endocr Pract 2013; 19:e40.
  61. Saydam L, Bozkurt MK, Kutluay L, Ozçelik T. Sarcoidosis of the thyroid gland initially diagnosed as malignancy. Otolaryngol Head Neck Surg 2003; 129:154.
  62. Salih AM, Fatih SM, Kakamad FH. Sarcoidosis mimicking metastatic papillary thyroid cancer. Int J Surg Case Rep 2015; 16:71.
  63. Ozkan Z, Oncel M, Kurt N, et al. Sarcoidosis presenting as cold thyroid nodules: report of two cases. Surg Today 2005; 35:770.
  64. Papi G, Briganti F, Artioli F, et al. Sarcoidosis of the thyroid gland associated with hyperthyroidism: review of the literature and report of two peculiar cases. J Endocrinol Invest 2006; 29:834.
  65. Rodriguez MC, Rani D, Faas FH. Unusual clinical course of Graves' thyrotoxicosis and concomitant sarcoidosis: case report and review of literature. Endocr Pract 2007; 13:159.
  66. Mizukami Y, Nonomura A, Michigishi T, et al. Sarcoidosis of the thyroid gland manifested initially as thyroid tumor. Pathol Res Pract 1994; 190:1201.
  67. Weiss IA, Limaye A, Tchertkoff V, Brener JL. Sarcoidosis of the thyroid clinically mimicking malignancy. N Y State J Med 1989; 89:578.
  68. Cabibi D, Di Vita G, La Spada E, et al. Thyroid sarcoidosis as a unique localization. Thyroid 2006; 16:1175.
  69. Yarman S, Kahraman H, Tanakol R, Kapran Y. Concomitant association of thyroid sarcoidosis and Graves' disease. Horm Res 2003; 59:43.
  70. Porter N, Beynon HL, Randeva HS. Endocrine and reproductive manifestations of sarcoidosis. QJM 2003; 96:553.
  71. Antonelli A, Fazzi P, Fallahi P, et al. Prevalence of hypothyroidism and Graves disease in sarcoidosis. Chest 2006; 130:526.
  72. Ilias I, Panoutsopoulos G, Batsakis C, et al. Thyroid function and autoimmunity in sarcoidosis: a case-control study. Croat Med J 1998; 39:404.
  73. Papadopoulos KI, Hörnblad Y, Liljebladh H, Hallengren B. High frequency of endocrine autoimmunity in patients with sarcoidosis. Eur J Endocrinol 1996; 134:331.
  74. Komatsu M, Itoh N, Yazawa M, et al. Sarcoid reaction in thyroid diseases: report of a case of thyroid carcinoma demonstrating sarcoid reaction in regional lymph nodes. Endocr J 1997; 44:697.
  75. Thompson LD, Wenig BM, Adair CF, et al. Langerhans cell histiocytosis of the thyroid: a series of seven cases and a review of the literature. Mod Pathol 1996; 9:145.
  76. Elliott DD, Sellin R, Egger JF, Medeiros LJ. Langerhans cell histiocytosis presenting as a thyroid gland mass. Ann Diagn Pathol 2005; 9:267.
  77. Lollar K, Farrag TY, Cao D, et al. Langerhans cell histiocytosis of the thyroid gland. Am J Otolaryngol 2008; 29:201.
  78. Behrens RJ, Levi AW, Westra WH, et al. Langerhans cell histiocytosis of the thyroid: a report of two cases and review of the literature. Thyroid 2001; 11:697.
  79. Willman CL, Busque L, Griffith BB, et al. Langerhans'-cell histiocytosis (histiocytosis X)--a clonal proliferative disease. N Engl J Med 1994; 331:154.
  80. Foulet-Rogé A, Josselin N, Guyetant S, et al. Incidental langerhans cell histiocytosis of thyroid: case report and review of the literature. Endocr Pathol 2002; 13:227.
  81. Kitahama S, Iitaka M, Shimizu T, et al. Thyroid involvement by malignant histiocytosis of Langerhans' cell type. Clin Endocrinol (Oxf) 1996; 45:357.
  82. Kirchgraber PR, Weaver MG, Arafah BM, Abdul-Karim FW. Fine needle aspiration cytology of Langerhans cell histiocytosis involving the thyroid. A case report. Acta Cytol 1994; 38:101.
  83. Dey P, Luthra UK, Sheikh ZA. Fine needle aspiration cytology of Langerhans cell histiocytosis of the thyroid. A case report. Acta Cytol 1999; 43:429.
  84. Broadbent V, Gadner H. Current therapy for Langerhans cell histiocytosis. Hematol Oncol Clin North Am 1998; 12:327.
  85. Sampathkumar S, Younger C, Cramer H, et al. Langerhans' cell histiocytosis involving the pituitary, thyroid, lung, and liver. Endocr Pract 2002; 8:217.
  86. Xia CX, Li R, Wang ZH, et al. A rare cause of goiter: Langerhans cell histiocytosis of the thyroid. Endocr J 2012; 59:47.
  87. Marupudi KC, Karanth SS, Thomas J. Langerhans cell histiocytosis presenting as hypothyroid goitre: a unique presentation. BMJ Case Rep 2014; 2014.
  88. Antonelli A, Fallahi P, Ferrari SM, et al. Incidence of thyroid disorders in systemic sclerosis: results from a longitudinal follow-up. J Clin Endocrinol Metab 2013; 98:E1198.
  89. Gordon MB, Klein I, Dekker A, et al. Thyroid disease in progressive systemic sclerosis: increased frequency of glandular fibrosis and hypothyroidism. Ann Intern Med 1981; 95:431.
  90. Chan AM, Lynch MJ, Bailey JD, et al. Hypothyroidism in cystinosis. A clinical, endocrinologic and histologic study involving sixteen patients with cystinosis. Am J Med 1970; 48:678.
  91. Czernichow P, Lenoir G, Roy MP, et al. [Thyroid involvement in cystinosis]. Arch Fr Pediatr 1978; 35:930.
  92. Theodoropoulos DS, Krasnewich D, Kaiser-Kupfer MI, Gahl WA. Classic nephropathic cystinosis as an adult disease. JAMA 1993; 270:2200.
  93. Lucky AW, Howley PM, Megyesi K, et al. Endocrine studies in cystinosis: compensated primary hypothyroidism. J Pediatr 1977; 91:204.
  94. Kimonis VE, Troendle J, Rose SR, et al. Effects of early cysteamine therapy on thyroid function and growth in nephropathic cystinosis. J Clin Endocrinol Metab 1995; 80:3257.
  95. Edwards CQ, Kelly TM, Ellwein G, Kushner JP. Thyroid disease in hemochromatosis. Increased incidence in homozygous men. Arch Intern Med 1983; 143:1890.
  96. Livadas DP, Sofroniadou K, Souvatzoglou A, et al. Pituitary and thyroid insufficiency in thalassaemic haemosiderosis. Clin Endocrinol (Oxf) 1984; 20:435.
  97. el-Reshaid K, Seshadri MS, Hourani H, et al. Endocrine abnormalities in hemodialysis patients with iron overload: reversal with iron depletion. Nutrition 1995; 11:521.
  98. Noma S, Konishi J, Morikawa M, Yoshida Y. MR imaging of thyroid hemochromatosis. J Comput Assist Tomogr 1988; 12:623.
  99. Hempenius LM, Van Dam PS, Marx JJ, Koppeschaar HP. Mineralocorticoid status and endocrine dysfunction in severe hemochromatosis. J Endocrinol Invest 1999; 22:369.
  100. Oertel YC, Oertel JE, Dalal K, et al. Black thyroid revisited: cytologic diagnosis in fine-needle aspirates is unlikely. Diagn Cytopathol 2006; 34:106.
  101. Thompson AD, Pasieka JL, Kneafsey P, DiFrancesco LM. Hypopigmentation of a papillary carcinoma arising in a black thyroid. Mod Pathol 1999; 12:1181.
  102. Yusim A, Ghofrani M, Ocal IT, Roman S. Black thyroid syndrome. Thyroid 2006; 16:811.
  103. Tacon L, Tan CT, Alvarado R, et al. Drug-induced thyroiditis and papillary carcinoma in a minocycline-pigmented black thyroid gland. Thyroid 2008; 18:795.
  104. Kang SW, Hong SW, Yeon PJ, et al. A case of black thyroid associated with hyalinizing trabecular tumor. Endocr J 2008; 55:1109.
  105. Bell CD, Kovacs K, Horvath E, Rotondo F. Histologic, immunohistochemical, and ultrastructural findings in a case of minocycline-associated "black thyroid". Endocr Pathol 2001; 12:443.
  106. Di Scioscio V, Loffreda V, Feraco P, et al. Diffuse lipomatosis of thyroid gland. J Clin Endocrinol Metab 2008; 93:8.
  107. Gonulalan G, Esen H, Erikoğlu M, Cakir M. Thyroid lipomatosis. Intern Med 2012; 51:3383.