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IgG4-related thyroiditis: a case report and review of literature.

Abo Salook M, Benbassat C, Strenov Y, Tirosh A - Endocrinol Diabetes Metab Case Rep (2014)

Bottom Line: A 55-year-old male, with a positive medical history for hypothyroidism, treated with stable doses for years was admitted with subacute thyroiditis and a feeling of pain and pressure in the neck.We concluded that IgG4-thyroiditis and IgG4-related disease should be considered in all patients with an aggressive form of Hashimoto's thyroiditis.IgG4-related disease is a systemic disease that includes several syndromes; IgG4-related thyroiditis is one among them.IgG4-thyroiditis should be considered in all patients with an aggressive form of Hashimoto's thyroiditis.Patients with suspected IgG4-thyroiditis should have blood tested for IgG4/IgG ratio and appropriate immunohistochemical staining if possible.

View Article: PubMed Central - PubMed

Affiliation: Endocrine Institute, Rabin Medical Center , Beilinson Campus, Petah Tiqva, 49100 , Israel.

ABSTRACT

Unlabelled: A 55-year-old male, with a positive medical history for hypothyroidism, treated with stable doses for years was admitted with subacute thyroiditis and a feeling of pain and pressure in the neck. Laboratory tests showed decrease in TSH levels, elevated erythrocyte sedimentation rate, and very high antithyroid antibodies. Owing to enlarging goiter and exacerbation in the patient's complaints, he was operated with excision of a fibrotic and enlarged thyroid lobe. Elevated IgG4 plasma levels and high IgG4/IgG plasma cell ratio on immunohistochemistry led to the diagnosis of IgG4-mediated thyroiditis. We concluded that IgG4-thyroiditis and IgG4-related disease should be considered in all patients with an aggressive form of Hashimoto's thyroiditis.

Learning points: IgG4-related disease is a systemic disease that includes several syndromes; IgG4-related thyroiditis is one among them.IgG4-thyroiditis should be considered in all patients with an aggressive form of Hashimoto's thyroiditis.Patients with suspected IgG4-thyroiditis should have blood tested for IgG4/IgG ratio and appropriate immunohistochemical staining if possible.

No MeSH data available.


Related in: MedlinePlus

Immunohistochemistry showing that most of the IgG-positive plasmacytic cells are also stained for IgG4.
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fig4: Immunohistochemistry showing that most of the IgG-positive plasmacytic cells are also stained for IgG4.

Mentions: During ambulatory follow-up, TSH levels increased gradually and l-T4 was re-started, with a required daily dose of 300 μg/day. Ultrasound-guided FNA was performed and cytology showed poor material with colloid, few Hurthle cells, grouped follicular cells, and tissue destruction. As neck pain and pressure worsened, a decision was made to perform a thyroidectomy. On operation, the recurrent laryngeal nerve seemed to be damaged due to the mass effect of a stiff thyroid gland (size 5×5.5×8 cm, weight 83 g; Fig. 1), hence only hemithyroidectomy was performed. Pathology of the excised lobe showed extensive fibrotic process, heavy plasmacytic infiltrates, and storiform fibrosis (Fig. 2), which immunostained strongly for IgG and IgG4 (Figs 3 and 4 respectively) with an IgG4/IgG ratio higher than 80%. Serum IgG4 level was 737 mg/dl (normal, 3–201), with normal IgG1 and IgG3 levels and borderline IgG2 levels (805, normal 169–786 mg/dl). Thus, a diagnosis of IgG4-related thyroiditis was established. Eight months after the left hemithyroidectomy, the patient underwent completion right hemithyroidectomy for esthetical reasons. The pathology report was the same as that of the first operation.


IgG4-related thyroiditis: a case report and review of literature.

Abo Salook M, Benbassat C, Strenov Y, Tirosh A - Endocrinol Diabetes Metab Case Rep (2014)

Immunohistochemistry showing that most of the IgG-positive plasmacytic cells are also stained for IgG4.
© Copyright Policy - license
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4120347&req=5

fig4: Immunohistochemistry showing that most of the IgG-positive plasmacytic cells are also stained for IgG4.
Mentions: During ambulatory follow-up, TSH levels increased gradually and l-T4 was re-started, with a required daily dose of 300 μg/day. Ultrasound-guided FNA was performed and cytology showed poor material with colloid, few Hurthle cells, grouped follicular cells, and tissue destruction. As neck pain and pressure worsened, a decision was made to perform a thyroidectomy. On operation, the recurrent laryngeal nerve seemed to be damaged due to the mass effect of a stiff thyroid gland (size 5×5.5×8 cm, weight 83 g; Fig. 1), hence only hemithyroidectomy was performed. Pathology of the excised lobe showed extensive fibrotic process, heavy plasmacytic infiltrates, and storiform fibrosis (Fig. 2), which immunostained strongly for IgG and IgG4 (Figs 3 and 4 respectively) with an IgG4/IgG ratio higher than 80%. Serum IgG4 level was 737 mg/dl (normal, 3–201), with normal IgG1 and IgG3 levels and borderline IgG2 levels (805, normal 169–786 mg/dl). Thus, a diagnosis of IgG4-related thyroiditis was established. Eight months after the left hemithyroidectomy, the patient underwent completion right hemithyroidectomy for esthetical reasons. The pathology report was the same as that of the first operation.

Bottom Line: A 55-year-old male, with a positive medical history for hypothyroidism, treated with stable doses for years was admitted with subacute thyroiditis and a feeling of pain and pressure in the neck.We concluded that IgG4-thyroiditis and IgG4-related disease should be considered in all patients with an aggressive form of Hashimoto's thyroiditis.IgG4-related disease is a systemic disease that includes several syndromes; IgG4-related thyroiditis is one among them.IgG4-thyroiditis should be considered in all patients with an aggressive form of Hashimoto's thyroiditis.Patients with suspected IgG4-thyroiditis should have blood tested for IgG4/IgG ratio and appropriate immunohistochemical staining if possible.

View Article: PubMed Central - PubMed

Affiliation: Endocrine Institute, Rabin Medical Center , Beilinson Campus, Petah Tiqva, 49100 , Israel.

ABSTRACT

Unlabelled: A 55-year-old male, with a positive medical history for hypothyroidism, treated with stable doses for years was admitted with subacute thyroiditis and a feeling of pain and pressure in the neck. Laboratory tests showed decrease in TSH levels, elevated erythrocyte sedimentation rate, and very high antithyroid antibodies. Owing to enlarging goiter and exacerbation in the patient's complaints, he was operated with excision of a fibrotic and enlarged thyroid lobe. Elevated IgG4 plasma levels and high IgG4/IgG plasma cell ratio on immunohistochemistry led to the diagnosis of IgG4-mediated thyroiditis. We concluded that IgG4-thyroiditis and IgG4-related disease should be considered in all patients with an aggressive form of Hashimoto's thyroiditis.

Learning points: IgG4-related disease is a systemic disease that includes several syndromes; IgG4-related thyroiditis is one among them.IgG4-thyroiditis should be considered in all patients with an aggressive form of Hashimoto's thyroiditis.Patients with suspected IgG4-thyroiditis should have blood tested for IgG4/IgG ratio and appropriate immunohistochemical staining if possible.

No MeSH data available.


Related in: MedlinePlus