Shahi et al. Journal of Medical Case Reports 2010, 4:15 http://www.jmedicalcasereports.com/content/4/1/15 There have been no controlled trials on the efficacy of therapy for Riedel’s thyroiditis. The condition is extre- mely rare and the therapy is based on empiric data [7]. There are reports of beneficial effects of steroids in some but not all cases. In one report, prednisolone (30 mg/day) was used with relapse in the ESR and development of retroperito- neal fibrosis six months after withdrawal of steroids. Relapse after steroid withdrawal has also been reported in Riedel’s struma [6]. In our case, we used high dose of prednisolone (80 mg/day) for four weeks, followed by gradual withdrawal. This led to rapid regression of symptoms and reduction in the size of the goitre with no symptoms or signs of relapse or development of other fibrosclerotic lesions. Conclusion In conclusion, we describe a rare case of Riedel’s thyroi- ditis which presented with atypical symptoms of a pain- ful goitre that was tender on palpation. Clinical behavior suggested an anaplastic carcinoma, thus providing a major diagnostic challenge. Although complete surgical resection was not possible, wedge biopsy confirmed the diagnosis. The patient was subsequently started on treat- ment with very high dose steroid, with good improve- ment and no recurrence after 12 months. Finally, it is important for clinicians to be aware of this diagnosis when managing patients with thyroid dis- ease, as Riedel’s thyroiditis can mimic malignancy. In addition, our case demonstrates that this condition should be treated with very high dose of steroids to pre- vent relapse. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of the journal. Acknowledgements Mr R W Awad - Consultant General and Vascular Surgeon, Department chair provided support and advise. Dr A Oglivie - Consultant Endocrinologist, Department of Medicine, provided general support. Author details 1Warwick Hospital, Lakin house, Lakin Road, CV34 5BW, UK. 2Department of Surgery, Watford General Hospital, WD18 0HB, UK. 3Department of ENT, University Hospital Coventry and Warwickshire, Second Floor, CV2 2DX, UK. Authors’ contributions NS summarised the patients case notes, did the literature search and was the main contributor in writing the manuscript. MFA contributed to writing the manuscript. MJ edited the manuscript. RA did the final editing of the manuscript. All authors read and approved the final manuscript Competing interests The authors declare that they have no competing interests. Page 3 of 3 Received: 4 November 2009 Accepted: 20 January 2010 Published: 20 January 2010 References 1. Hay ID: Thyroiditis: a clinical update. Mayo Clin Proc 1985, 60:836-846. 2. Malotte MJ, Chonkich GD, Zuppan CW: Riedel’s thyroiditis. Arch Otolaryngol Head Neck Surg 1991, 117(2):214-217. 3. Katsikas D, Shorthouse AJ, Taylor S: Riedel’s thyroiditis. Br J Surg 1976, 63:929-931. 4. Comings DE, Skubi KB, Van Eyes J, Motulsky AG: Familial multifocal fibrosclerosis. Ann Intern Med 1967, 66:884-892. 5. Schwaegerle SM, Bauer TW, Esselstyn CB: Riedel’s thyroiditis. Am J Clin Pathol 1988, 90:715-722. 6. Moulik PK, Al-Jafari MS, Khaleeli AA: Steroid responsiveness in a case of Riedel’s thyroiditis and retroperitoneal fibrosis. Int J Clin Pract 2004, 58(3):312-315. 7. Dabelic N, Jukic T, Labar Z, Novosel SA, Matesa N, Kusic Z: Riedel’s thyroiditis treated with tamoxifen. Croat Med J 2003, 44:239-241. doi:10.1186/1752-1947-4-15 Cite this article as: Shahi et al.: Riedel’s thyroiditis masquerading as anaplastic thyroid carcinoma: a case report. Journal of Medical Case Reports 2010 4:15. Publish with Bio Med Central and every scientist can read your work free of charge "BioMed Central will be the most significant development for disseminating the results of biomedical research in our lifetime." Sir Paul Nurse, Cancer Research UK Your research papers will be: available free of charge to the entire biomedical community peer reviewed and published immediately upon acceptance cited in PubMed and archived on PubMed Central yours — you keep the copyright Submit your manuscript here: http://www.biomedcentral.com/info/publishing_adv.asp BioMedcentral