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EMIL GOETSCH, MILDRED KAMNER, CHRONIC THYROIDITIS AND RIEDEL'S STRUMA: ETIOLOGY AND PATHOGENESIS. THE ROLE OF THE HYPERFUNCTIONING PARENCHYMA OF PRIMARY HYPERPLASTIC GOITER, The Journal of Clinical Endocrinology & Metabolism, Volume 15, Issue 8, 1 August 1955, Pages 1010–1034, https://doi.org/10.1210/jcem-15-8-1010
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Abstract
CHRONIC nonspecific thyroiditis is a nonbacterial inflammatory lesion of obscure etiology, characterized by progressive deterioration and dissolution of the thyroid parenchyma and ultimate replacement by fibrous tissue. The purpose of this report is to submit data in support of our belief that the etiology resides in irritative factors inherent in the hyperfunctioning epithelium of hyperplastic (toxic diffuse) goiter. Moreover, we hope to show that the pathologic process originates in an inflammatory tissue response to these factors which, in turn, effects the degeneration and eventual dissolution of the hyperplastic epithelium. Finally we hope to establish that chronic thyroiditis may progress to its terminal stage of Riedel's struma, which should not in any way be confused with struma lymphomatosa (Hashimoto). The latter is a distinct pathologic entity.
In spite of the enormous literature on chronic thyroiditis and Riedel's struma the etiology of both conditions remains completely obscure. Impetus was given to the study of chronic fibrotic lesions of the thyroid by Riedel (1). In 1896 he reported his first 2 cases of the final stage of fibrosis, since designated as Riedel's struma. He pointed out the so-called “iron hard” consistency of the thyroid gland and its tendency to form firm adhesions to neighboring cervical structures. In 1897 he presented his third case, on which he made a “follow up” report (2) in 1910. He described the microscopic findings as accumulations of spindle and round cells between the normal elements of the thyroid, which were more and more displaced by the development of young connective tissue. Though the views of some of the early authors are given little or no credence today, they have a historical interest and may be briefly noted.
