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Chronic fibrous thyroiditis (Ridel's craw)
Chronic fibrous thyroiditis — the disease which is characterized by growth of connecting fabric in a thyroid gland with substitution of its parenchyma and with germination in a capsule and adjacent muscles, vessels and nerves.
Ridel's craw meets quite seldom. According to clinic of Mayo (USA), on 42 000 a thyroid gland operations only 0,05% of cases of a craw are noted. The disease is more often observed at women, than at men, especially at persons 50 years are more senior.
Historical data. The disease is for the first time described by the Swiss surgeon Ridel in 1896.
Etiology and pathogeny. The disease etiology not ustanovlena-Hronichesky inflammatory process in a thyroid gland is followed by primary growth of connecting is woven its germination in a capsule and surrounding fabrics. Usually growth of connecting fabric in a thyroid gland happens fatal, however in some cases can be total from an atrophy of a parenchyma of body and development of a hypothyroidism.
Pathological anatomy. The thyroid gland is usually increased in sizes, soldered to a capsule, the next muscles. In the central part of a thyroid gland find numerous nodes. The disease begins usually gradually, subjective complaints are absent, however in some cases patients are disturbed by feeling of "lump" and pressure in a thyroid gland. In the subsequent, at increase in the sizes of a craw and increment to the next bodies (a throat, a gullet, vessels, nerves), there are a difficulty of breath, pain when swallowing, dry cough, a voice osiplost up to an aphonia, a circulatory disturbance etc. The thyroid gland is usually increased, painless, ligneous density, with a smooth surface. Owing to commissures with surrounding fabrics its mobility is limited or completely lost. Skin over a thyroid gland is not soldered to the last, easily undertakes pleated. Lymph nodes are not increased. Body temperature is not increased.
Datas of laboratory. There are no changes of peripheral blood. Increase in SOE is sometimes observed. Absorption of a radioiodine a thyroid gland, and also indicators of standard metabolism within norm or are a little lowered.
Radiodiagnosis. At X-ray inspection the shift or an esophageal stenosis or tracheas often comes to light.
Diagnosis and differential diagnosis. The diagnosis of a disease is established on the basis of the craw of ligneous density soldered to surrounding fabrics. Differential diagnosis is carried out with an autoimmune thyroiditis and a cancer of a thyroid gland. Existence of an autoimmune thyroiditis is demonstrated by the moderate density of a thyroid gland, its mobility at a palpation, and also increase of a caption of the circulating antitireodny antibodies.
Quite often it is possible to exclude the Cancer of a thyroid gland only after histologic research of the struck share of a thyroid gland.
Forecast. The disease lasts for years and can end potireozy.
In the absence of a compression it is possible it is long (6 — 12 months) to treat the patient with Thyreoidinum. At the phenomena
surgical intervention — a partial or full resection of the struck part of a thyroid gland with excision of unions is shown to a compression. Involution of pathological process after surgical intervention is sometimes observed.