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

Abstract

SummaryA 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.

IgG4‐positive extranodal marginal zone lymphoma arising in Hashimoto's thyroiditis: clinicopathological and cytogenetic features of a hitherto undescribed condition

“…The cytological findings of IgG4 thyroiditis are poorly documented, with rare reports in the literature describing features of lymphocytic thyroiditis, without additional details. 10,11 The cytological features in our case corroborate the histological findings. The prominent microfollicular distribution with Hurthle cell change may result in a false diagnosis of Hurthle cell neoplasm, as illustrated in our case.…”

“…The cytological findings of IgG4 thyroiditis are poorly documented, with rare reports in the literature describing features of lymphocytic thyroiditis, without additional details . The cytological features in our case corroborate the histological findings.…”

IgG4-Related Hashimoto's Thyroiditis of the Thyroid Gland

“…5 IgG4-RD is now considered a systemic disease that may affect various organs and that is characterized by progressively growing fibroinflammatory lesions causing mass effects. 6 Since its first description, 2 IgG4-related thyroiditis has been considered a subtype of Hashimoto's thyroiditis. 7 Its clinicopathologic features are similar to those of the fibrous variant of HT and Riedel's thyroiditis (RT), suggesting that IgG4-related HT is a type of fibrous variant of HT and RT.…”

Igg4-Related Disorder and Endocrine Diseases: A Review of the Literature

“…Salook et al [14] reported a patient who presented with an acute elevation in T4 and suppressed TSH associated with neck pain. The patient had already been diagnosed with Hashimoto's thyroiditis and was on a stable dose of thyroxine.…”