IgG4-related disease of the thyroid gland

2021 ◽  
Vol 14 (3) ◽  
pp. e238177
Author(s):  
Tânia Matos ◽  
Margarida Mendes de Almeida ◽  
Lucas Batista ◽  
Sónia do Vale
Keyword(s):  
Thyroid Gland ◽  
Hashimoto’S Thyroiditis ◽  
Plasma Cells ◽  
Needle Aspiration ◽  
Hashimoto's Thyroiditis ◽  
Fine Needle ◽  
Related Disease ◽  
Igg4 Related Disease ◽  
Cervical Swelling ◽  
Reduced Mobility

IgG4-thyroid-related disease (TRD) represents an uncommon spectrum of diseases, with four subcategories established so far, IgG4-related Hashimoto’s thyroiditis, fibrosing variant of Hashimoto’s thyroiditis, Riedel’s thyroiditis and Graves disease with elevated IgG4 levels. We report the case of a 59-year-old woman presenting with painless cervical swelling and hypothyroidism. Thyroid gland was enlarged and distinctively very hard, with reduced mobility. Neck ultrasonography showed multiple nodularity and diffuse thyroid enlargement, which on CT scan conditioned slight deviation of the airway. Fine-needle aspiration of the biggest nodule was suggestive of lymphocytic thyroiditis. She developed compressive symptoms and was submitted to total thyroidectomy. Histology of the thyroid revealed extensive areas of fibrosis, oncocytic cells and lymphoplasmacytic infiltrates. Immunohistochemistry confirmed the predominance of IgG4-secreting plasma cells. IgG4-TRD is characterised by a rapidly progressive and destructive thyroiditis process. Typical presentation can often mimic malignancy; hence, an opportune recognition of IgG4-TRD may avoid unnecessary burdens.

scholarly journals IgG4-related Hashimoto’s thyroiditis – A new variant of a well known disease

2014 ◽  
Vol 58 (8) ◽  
pp. 862-868 ◽  
Author(s):  
Henrique Vara Luiz ◽  
Diogo Gonçalves ◽  
Tiago Nunes da Silva ◽  
Isabel Nascimento ◽  
Ana Ribeiro ◽  
...  
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Plasma Cells ◽  
Hashimoto's Thyroiditis ◽  
High Power Field ◽  
Related Disease ◽  
Igg4 Related Disease ◽  
Inflammatory Parameters ◽  
First Case ◽  
New Variant ◽  
Serum Igg4

Hashimoto’s thyroiditis (HT) has been characterized for many years as a well-defined clinicopathologic entity, but is now considered a heterogeneous disease. IgG4-related HT is a new subtype characterized by thyroid inflammation rich in IgG4-positive plasma cells and marked fibrosis. It may be part of the systemic IgG4-related disease. We report a case of a 56-year-old Portuguese man who presented with a one-month history of progressive neck swelling and dysphagia. Laboratory testing revealed increased inflammatory parameters, subclinical hypothyroidism and very high levels of thyroid autoantibodies. Cervical ultrasound (US) demonstrated an enlarged and heterogeneous thyroid gland and two hypoechoic nodules. US-guided fine needle aspiration cytology was consistent with lymphocytic thyroiditis. The patient was submitted to total thyroidectomy and microscopic examination identified typical findings of HT, marked fibrosis limited within the thyroid capsule and lymphoplasmacytic infiltration, with >50 IgG4-positive plasma cells per high-power field and an IgG4/IgG ratio of >40%. After surgery, serum IgG4 concentration was high-normal. Symptoms relief and reduction in laboratory inflammatory parameters were noticed. Thyroid function is controlled with levothyroxine. To our knowledge we report the first case of IgG4-related HT in a non-Asian patient. We also perform a review of the literature regarding IgG4-related disease and IgG4-related HT. Our case highlights this new variant of the well known HT, and helps physicians in recognizing its main clinical features, allowing for proper diagnosis and treatment.

Fine needle aspiration cytology of IgG4-related disease: A potential diagnostic pitfall?

2016 ◽  
Vol 45 (1) ◽  
pp. 14-21 ◽  
Author(s):  
Rajwant Kaur ◽  
Suvradeep Mitra ◽  
Arvind Rajwanshi ◽  
Ashim Das ◽  
Uma Nahar Saikia ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Related Disease ◽  
Diagnostic Pitfall ◽  
Igg4 Related Disease ◽  
Needle Aspiration Cytology

scholarly journals Cytomorphological Aspects of Hashimoto's Thyroiditis: Our Experience at a Tertiary Center

2014 ◽  
Vol 7 ◽  
pp. CPath.S13580 ◽  
Author(s):  
Monika Rathi ◽  
Faiyaz Ahmad ◽  
Satish Kumar Budania ◽  
Seema Awasthi ◽  
Ashutosh Kumar ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Hashimoto’S Thyroiditis ◽  
Fine Needle Aspiration Cytology ◽  
Needle Aspiration ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Function Tests ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Tertiary Center ◽  
Needle Aspiration Cytology

Introduction Hashimoto's thyroiditis is the most common form of acquired hypothyroidism. Fine needle aspiration cytology is one important tool in diagnosing Hashimoto's thyroditis, along with clinical, biochemical, immunological and ultrasonographical modalities. The present study examines cytological aspects of Hashimoto's thyroiditis along with their correlation with clinical, biochemical and immunological findings, whenever available. Materials and Methods This is a retrospective study of 50 cases of Hashimoto's thyroiditis. Cytological findings were reviewed and correlated with clinical, biochemical and immunological findings whenever available. Results The majority of the patients were middle-aged females, with a female to male ratio of 6.14:1. Most patients presented with diffuse thyromegaly (68%) and/or hypothyroidism (56.09%). The antibody profile was available in 22% of patients. Of these, anti-thyroid peroxidase antibodies were raised in 81.81% of patients and anti-thyroglobulin antibodies were raised in 63.63% of patients. In the present study, high lymphoid to epithelial cell ratio was seen in 78% of cases, and 74% of cases showed Hurthle cell change. Follicular atypia was seen in 36% of cases. Lymphoid follicle formation was seen in seen in 54% of cases. Follicular cell infiltration by lymphocytes, eosinophils and neutrophils was seen in 72%, 48% and 26% of cases, respectively. Plasma cells were seen in 18% of cases. Conclusion Thyroid function tests and immunological tests cannot diagnose all cases of Hashimoto's thyroiditis. Fine needle aspiration cytology continues to be a diagnostic tool of significance in diagnosing Hashimoto's thyroiditis. The presence of inflammatory cells, particularly lymphocytes and eosinophils, was detected in a significant proportion of cases.

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

2014 ◽  
Vol 2014 ◽  
Author(s):  
Mahmud Abo Salook ◽  
Carlos Benbassat ◽  
Yulia Strenov ◽  
Amit Tirosh
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Systemic Disease ◽  
Hashimoto's Thyroiditis ◽  
List Type ◽  
Review Of Literature ◽  
Related Disease ◽  
Igg4 Related Disease ◽  
Aggressive Form ◽  
Learning Points ◽  
Very High

Summary 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.

scholarly journals IgG4-Related Disease in a Urachal Tumor

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Travis W. Dum ◽  
Da Zhang ◽  
Eugene K. Lee
Keyword(s):  
Plasma Cells ◽  
Elevated Serum ◽  
Needle Aspiration ◽  
Lung Lesion ◽  
High Rate ◽  
Mediastinal Lymphadenopathy ◽  
Obliterative Phlebitis ◽  
Related Disease ◽  
Igg4 Related Disease ◽  
Serum Igg4

IgG4-related disease is a newly recognized fibroinflammatory disorder that has the ability to affect nearly every organ system. It is characterized by tumefactive lesions and fibrosis and closely mimics neoplasms. Only one case of IgG4-related bladder mass has been reported in the literature, but there are no reports of IgG4-related disease in a urachal mass. Herein, we report a 26-year-old male who initially presented with symptoms of recurrent UTI. Work-up revealed a 6 cm urachal tumor, a 1.4 cm pulmonary lesion, and mediastinal lymphadenopathy; all metabolically active on PET scan and suspicious for urachal adenocarcinoma. Lung lesion fine needle aspiration and TURBT pathology revealed inflammation but no evidence of malignancy. The patient underwent a partial cystectomy and umbilectomy with pathology demonstrating dense plasmacytic cells, a high rate of immunohistochemistry staining positive for IgG4 plasma cells, a storiform pattern of fibrosis, and an obliterative phlebitis. Furthermore, the patient had an elevated serum IgG4 level of 227 mg/dL (range 2.4–121 mg/dL). IgG4-related disease is a newly recognized fibroinflammatory disorder that can mimic neoplastic processes and a high index of suspicion and accurate tissue pathology is necessary for an accurate diagnosis.

scholarly journals Distinct histopathological features of Hashimoto’s thyroiditis with respect to IgG4-related disease

2012 ◽  
Vol 25 (8) ◽  
pp. 1086-1097 ◽  
Author(s):  
Yaqiong Li ◽  
Gengyin Zhou ◽  
Takashi Ozaki ◽  
Eijun Nishihara ◽  
Fumio Matsuzuka ◽  
...  
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Hashimoto's Thyroiditis ◽  
Histopathological Features ◽  
Related Disease ◽  
Igg4 Related Disease
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