It is often a multi-organ disease affecting pancreas, liver, kidney, salivary and orbital tissues and retroperitoneal space.

Reduced cardiac output contributes shortness of breath and decreased blood flow explains skin pallor.

[citation needed] It typically present as a painless, hard anterior neck mass, which progresses over weeks to years to produce symptoms of compression, including dysphagia, dyspnea choking and hoarseness.

Patients may present with symptoms of hypothyroidism and hypoparathyroidism as the gland is replaced by Fibrous tissues .

Physical examination reveals a hard "woody" thyroid gland with fixation to surrounding tissue.

[4] The diagnosis needs to be confirmed by open thyroid biopsy because the firm and Fibrous nature of the gland renders FNAB inadequate.