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Riedel's thyroiditis: treatment with tamoxifen

  [ 67 votes ]   [ Discuss This Article ] • December 20, 1996

BACKGROUND: Riedel's thyroiditis is an often disabling disease with
clinical and histologic similarity to several other fibrous
inflammatory disorders. Surgical treatment alone is often
unsatisfactory in permanently alleviating airway compression,
dysphagia, neck immobility, pain, or chronic fatigue syndrome.
Investigation of drugs shown to be of benefit in the
treatment of related fibrous disorders in which hormonal
factors or inflammatory deregulation appear to be important
is indicated. Tamoxifen has not been previously used in the
treatment of Riedel's thyroiditis.
METHODS: Four patients
with clinical and histologic diagnoses of Riedel's
thyroiditis were evaluated before and after treatment with
tamoxifen. Each had progressive symptomatic disease of 3 to
16 years' duration despite one or more surgical procedures
and steroid therapy. Subjective improvement was noted in all
cases, and objective changes were confirmed by periodic
physical and computed tomographic examinations.
Patients have been monitored for 1 to 4 years with subjective
improvement in 100% and objective disease regression ranging
from 50% to 100% in all patients. One patient had complete
regression within 6 months, and another had more than 50%
regression within 3 months. All have returned to predisease
activity levels. There were no significant side effects of
the therapy.
CONCLUSIONS: Tamoxifen has proved to be the most
effective drug therapy available for managing Riedel's
thyroiditis. Our studies suggest that this is unrelated to
antiestrogen activity. Tamoxifen's effectiveness may be caused
by a mechanism by which it stimulates the release of
transforming growth factor-beta, which may inhibit the
fibroblastic proliferation characteristic of Riedel's

Few J, Thompson NW, Angelos P, Simeone D, Giordano T, Reeve T

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