Does the Intensity of IGG4 Immunostaining Have a Correlation with the Clinical Presentation of Riedel’s Thyroiditis?

Simões, Carla; Tavares, Marcos Roberto; Andrade, Natália Martins Magacho de; Uehara, Toru; Dedivitis, Rogério Aparecido; Cernea, Cláudio Roberto

doi:10.1155/2018/4101323

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…There have been fifteen patients from eight reports in the literature on RT with detailed numerical results of IgG4+ plasma cell infiltration 9,13–19 (Table 3). A total of 13/15 patients underwent thyroid surgery, whereas the other two underwent CNB.…”

Section: Resultsmentioning

confidence: 99%

IgG4 immunohistochemistry in Riedel's thyroiditis and the recommended criteria for diagnosis: A case series and literature review

Liu

et al. 2020

Clinical Endocrinology

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Objective Riedel’s thyroiditis (RT) is a very rare chronic fibrosing thyroiditis that is often associated with multifocal fibrosclerosis. Although the relationship of RT and IgG4‐related disease (IgG4‐RD) has been suggested, the expression of IgG and IgG4 in thyroid tissues of patients with RT has seldom been studied. Design A case series and literature review. Patients and Measurements We searched our hospital's pathology database and identified five cases of RT between 2000 and 2019. The expression levels of IgG4 and IgG in thyroid tissues were detected by immunohistochemistry. We also performed a literature search of the electronic databases PubMed/MEDLINE, Web of Science and China National Knowledge Internet (CNKI). Eight papers were included in this study. Results According to immunohistochemistry, the numbers of IgG4+ plasma cells per high‐power field (HPF) of the five RT patients at our hospital were 80, 8, 50, 10 and 22, and the respective IgG4+/IgG+ ratios were 76%, 80%, 43%, 19% and 28%. In the literature, 15 RT patients with confirmed IgG4 and IgG immunohistochemical findings were identified. Only seven of them fulfilled the IgG4‐RD diagnostic criteria in terms of immunohistochemistry (IgG4+ > 10/HPF, IgG4+/IgG+ > 40%). In order to ensure that most RT cases can meet the IgG4 immunohistochemical criteria, an organ‐specific cut‐off value (≥10 IgG4+ plasma cells/HPF and ≥ an IgG4+/IgG ratio of 20%) was finally selected in our study. Conclusion Our findings of IgG4 expression in patients with RT suggest that a cut‐off of 10 IgG4+ plasma cells/HPF and an IgG4+/IgG ratio of 20% are more suitable diagnostic criteria for RT in IgG4‐RD.

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Section: Resultsmentioning

confidence: 99%

IgG4 immunohistochemistry in Riedel's thyroiditis and the recommended criteria for diagnosis: A case series and literature review

Liu

et al. 2020

Clinical Endocrinology

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“…In the event of hyperthyroidism, radioiodine therapy or, in uncontrolled cases, external beam radiotherapy may be used [ 43 ], and levothyroxine is administered when hypothyroidism occurs [ 9 , 10 , 12 , 16 , 18 , 20 , 22 – 25 , 27 , 28 , 31 , 33 , 34 , 36 , 47 , 49 , 99 , 111 ].…”

Section: Managementmentioning

confidence: 99%

IgG4-related sclerosing thyroiditis (Riedel-Struma): a review of clinicopathological features and management

Czarnywojtek

Pietrończyk²,

Thompson

et al. 2023

Virchows Arch

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We present a thorough review of the literature on Riedel thyroiditis (RT) with emphasis on aetiology, diagnosis and management, using the PubMed, Sinomed, and China National Knowledge Infrastructure databases. Although the exact aetiology of RT remains obscure, the histopathological features are consistent with a localized form of IgG4-related systemic disease (IgG4-RSD). Nevertheless, IgG4-RSD as a systemic fibroinflammatory disorder per se rarely affects the thyroid in the context of multiorgan manifestations. The initial diagnosis of RT is based on clinical history and imaging, but confirmation by histopathological examination is mandatory. In contrast to the historical surgical approach, glucocorticosteroid therapy is currently considered first line therapy, in line with the RT currently being viewed as a manifestation of, or analogous to, IgG4-RSD. For disease relapse, immunomodulatory agents (azathioprine, methotrexate, rituximab) can be used.

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“…Riedel’s thyroiditis is considered a generalized immune disorder involving B lymphocytes and immunoglobulin G (IgG) 4-secreting plasma cells. Its systemic nature is clearly manifested by its association with mediastinal and retroperitoneal fibrosis, and sclerosing cholangitis [ 1 , 5 ]. Fibrous thyroiditis should be considered in the differential diagnosis of stony-hard goiters, which includes the fibrous variant of Hashimoto’s disease, anaplastic carcinoma of the thyroid, lymphoma of the thyroid, and thyroid fibrosis resulting from previous radioiodine treatment [ 1 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

IgG4-Related Fibrous Thyroiditis (Riedel’s Thyroiditis): A Case Report

et al. 2020

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Patient: Female, 69-year-old Final Diagnosis: Riedel thyroiditis Symptoms: Dysphagia • goiter Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Rare disease Background: Riedel’s thyroiditis is a rare form of immunoglobulin G (IgG) 4-related invasive fibrosis of the thyroid gland; given its scarce incidence, standardized therapeutic guidelines are unavailable. Although complications are unusual, obstructive symptoms produced by the stony-hard goiter may put patients’ lives at risk. The diagnosis must be biopsy-proven, and treatment consists of thyroid hormone replacement and anti-inflammatory drugs, although sometimes thyroidectomy may be required. Case Report: A 69-year-old woman presented with a 7-month history of progressive hypothyroidism and obstructive dysphagia. On physical examination, she had a large, stony-hard goiter. A Doppler ultrasound study revealed a massive, avascular enlargement of the thyroid gland. A computed tomography scan failed to demonstrate any extrathyroidal extension of the abnormal tissue. A Tru-Cut biopsy of the thyroid was performed. Extensive replacement of thyroid follicles by prominent bands of fibrous tissue was observed, with follicular obliteration and mild focal occlusive phlebitis. A lymphoplasmacytic infiltrate was clearly identified; no oxyphilic nor giant cells were found. On immunohistochemistry, the immunoglobulin G (IgG) 4/IgG ratio in the plasma cell infiltrate was 40%; increased serum IgG4 levels were also found, supporting the diagnosis of Riedel’s thyroiditis. The patient was successfully treated with levothyroxine replacement and tamoxifen with prompt resolution of obstructive symptoms. Conclusions: Fibrous thyroiditis should be considered in the differential diagnosis of primary hypothyroidism in a patient with a stony-hard goiter. Although steroids are often used as a therapeutic strategy for this disease, our patient had an excellent therapeutic response to tamoxifen, avoiding adverse effects associated with steroid therapy, the higher cost of monoclonal antibody therapy, and surgery-associated risks.

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Does the Intensity of IGG4 Immunostaining Have a Correlation with the Clinical Presentation of Riedel’s Thyroiditis?

Cited by 4 publications

References 13 publications

IgG4 immunohistochemistry in Riedel's thyroiditis and the recommended criteria for diagnosis: A case series and literature review

IgG4 immunohistochemistry in Riedel's thyroiditis and the recommended criteria for diagnosis: A case series and literature review

IgG4-related sclerosing thyroiditis (Riedel-Struma): a review of clinicopathological features and management

IgG4-Related Fibrous Thyroiditis (Riedel’s Thyroiditis): A Case Report

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