Rare forms of Thyroiditis

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  • Suppurative thyroiditis
  • Riedel’s struma

Suppurative thyroiditis

It is caused by pyogenic (pus producing) bacterial infection and is rare. It is characterized by:

  • Severe pain and tenderness in the thyroid region
  • Redness in the overlying area

Treatment usually involves an antibiotic therapy and surgical drainage of pus, if necessary.

Riedel’s struma

It is a condition where the normal thyroid tissue is replaced by fibrous tissue which also invades the surrounding structures (hence also called invasive fibrous thyroiditis, or woody thyroiditis). It is the rarest form of thyroiditis and is seen in middle aged or elderly women.

Symptoms and signs

  • Thyroid enlargement which is usually asymmetrical (one sided). The gland is irregular, stony hard and adherent to the neck structures causing pressure symptoms like difficulty in swallowing and breathing, pain and hoarseness.
  • It usually results in hypothyroidism but may cause hypoparathyroidism (decreased functioning of parathyroid gland located just behind the thyroid) as well.
  • There may be associated mediastinal and retro-peritoneal fibrosis, biliary tract sclerosis etc.


  • Treatment of choice is oral Tamoxifen. Treatment has to be continued for years.
  • Short-term glucocorticoid (steroids) treatment may be given for partial relief of pain and pressure symptoms.
  • Surgery may be required to relieve pressure symptoms.