Wednesday, November 10, 2004
The patient today has a rare thyroid disorder. It is called Reidel's Struma. She developed shortness of breath when she turned her head. The left lobe of her thyroid was woody hard, and it crossed the front of her airpipe. The use of steroids failed to improve the obstruction. She had a very difficult surgery to remove the thyroid tissue blocking her windpipe. This worked for a few years, but the symptom returned.I felt a hard mass again over her windpipe. Last weeks biopsy confirmed a recurrence of Reidel's disease. Today, she was told of the recurrence, and we tried to work out a new plan.She agreed to try Tamoxifen. There are published reports of it causing a regression in the fibrosis, and relief of obstruction. She realizes that if this does not work, she may need another surgery. This is an invasive non-cancerous fibrotic disease that invades the tissue outside the thyroid.There is no known cause, and steroids are usually effective. It can recur as in my patient. It is not Hashimoto's Thyroiditis. It can mimic a cancer. In my 30 years of thyroid private practice, this is the first case. However, at USC, I have seen 3-4 cases.