Hashimoto’s thyroiditis in a patient with IgG4 related disease

2020 ◽  
Author(s):  
Matali Nur Husnina ◽  
Chong Pui Lin
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Hashimoto's Thyroiditis ◽  
Related Disease ◽  
Igg4 Related Disease

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 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.

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

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.

A small subgroup of Hashimoto’s thyroiditis is associated with IgG4-related disease

2015 ◽  
Vol 468 (3) ◽  
pp. 321-327 ◽  
Author(s):  
Friedrich Jokisch ◽  
Irene Kleinlein ◽  
Bernhard Haller ◽  
Tanja Seehaus ◽  
Heinrich Fuerst ◽  
...  
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Hashimoto's Thyroiditis ◽  
Related Disease ◽  
Igg4 Related Disease ◽  
Small Subgroup

scholarly journals Research Progress on IgG4-Related Hashimoto’s Thyroiditis

2015 ◽  
Vol 4 (2) ◽  
pp. 40-44
Author(s):  
Guang Ji
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Early Stage ◽  
Follicular Epithelium ◽  
Research Progress ◽  
Hashimoto's Thyroiditis ◽  
Systemic Autoimmune Disease ◽  
Thyroid Peroxidase ◽  
Multiple Organs ◽  
Igg4 Related Disease ◽  
Thyroid Peroxidase Antibody

AbstractIgG4-related disease is a systemic autoimmune disease with unknown cause and involves multiple organs and tissues. This disease became one of research hotspots in the last ten years. IgG4-related Hashimoto’s thyroiditis (HT) exhibits unique clinical pathological characteristics: serum-free thyroxine reduction and increases in thyroid peroxidase antibody and IgG4; massive IgG4-positive plasmocyte infiltration in tissues; significant matrix fibrosis; and severe degeneration of thyroid follicular epithelium. IgG4-related HT is a subtype of HT; it presents relatively good therapeutic effect after thyroxine treatment. Cortical hormones can be used for IgG4 HT patients who may suffer from hypothyroidism with significant thyroid injury during early stage to constrain immune injury. This thesis summarizes clinical and pathological histology of IgG4-related HT based on its characteristics.

Vitamin D Treatment in Patients with Hashimoto’s Thyroiditis may Decrease the Development of Hypothyroidism

2016 ◽  
Vol 86 (1-2) ◽  
pp. 9-17 ◽  
Author(s):  
Bekir Ucan ◽  
Mustafa Sahin ◽  
Muyesser Sayki Arslan ◽  
Nujen Colak Bozkurt ◽  
Muhammed Kizilgul ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Hashimoto’S Thyroiditis ◽  
Healthy Control Group ◽  
Hashimoto's Thyroiditis ◽  
Control Group ◽  
Endocrine Society ◽  
Thyroid Autoantibody ◽  
Healthy Control ◽  
The Mean

Abstract.The relationship between Hashimoto’s thyroiditis and vitamin D has been demonstrated in several studies. The aim of the present study was to evaluate vitamin D concentrations in patients with Hashimoto’s thyroiditis, the effect of vitamin D therapy on the course of disease, and to determine changes in thyroid autoantibody status and cardiovascular risk after vitamin D therapy. We included 75 patients with Hashimoto’s thyroiditis and 43 healthy individuals. Vitamin D deficiency is defined as a 25-hydroxy vitamin D (25(OH)D3) concentration less than 20ng/mL. Vitamin D deficient patients were given 50.000 units of 25(OH)D3 weekly for eight weeks in accordance with the Endocrine Society guidelines. All evaluations were repeated after 2 months of treatment. Patients with Hashimoto’s thyroiditis had significantly lower vitamin D concentrations compared with the controls (9.37±0.69 ng/mL vs 11.95±1.01 ng/mL, p < 0.05, respectively). Thyroid autoantibodies were significantly decreased by vitamin D replacement treatment in patients with euthyroid Hashimoto’s thyroiditis. Also, HDL cholesterol concentrations improved in the euthyroid Hashimoto group after treatment. The mean free thyroxine (fT4) concentrations were 0.89±0.02 ng/dL in patients with Hashimoto’s thyroiditis and 1.07±0.03 ng/dL in the healthy control group (p < 0.001). The mean thyroid volumes were 7.71±0.44 mL in patients with Hashimoto’s thyroiditis and 5.46±0.63 mL in the healthy control group (p < 0.01). Vitamin D deficiency is frequent in Hashimoto’s thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.

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