Immunoglobulin G4-Related Thyroid Diseases

Kottahachchi, Dulani; Topliss, Duncan J.

doi:10.1159/000452623

Cited by 63 publications

(48 citation statements)

References 53 publications

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“…On the thyroid, four conditions of IgG4-RD have been identified, namely, Riedel thyroiditis, fibrosing variant of Hashimoto's disease, IgG4-related thyroiditis (RT), and Grave's disease [3][4][5][6][7][8][9][10]. IgG4-RT was first proposed by Li et al in 2009 [9] and is associated with more rapid clinical course, subclinical hypothyroidism, diffuse low echogenicity on ultrasound, and higher serum thyroid autoantibodies than non-IgG4-RT [11].…”

Section: Immunoglobulin G4 (Igg4)-related Dis-ease (Rd) Is a New Clinmentioning

confidence: 99%

Warthin-like papillary thyroid carcinoma with immunoglobulin G4-positive plasma cells possibly related to Hashimoto’s thyroiditis

et al. 2018

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Abstract. Hashimoto's thyroiditis with heavy lymphoplasmacytic infiltration is a common comorbidity of immunoglobulin G4 (IgG4)-related thyroiditis and Warthin-like papillary thyroid carcinoma (WL-PTC). We hypothesized that WL-PTC may have a strong association with IgG4-related thyroiditis. To validate this hypothesis, we clinically and immunohistochemically studied 17 WL-PTC cases. Fourteen patients (82.4%) had anti-thyroglobulin antibody and were confirmed to have Hashimoto's thyroiditis through microscopic analysis. Among them, five (29.4%) had disease consistent with IgG4-related thyroiditis but did not exhibit a "storiform" pattern or obliterative phlebitis. IgG4-related diseases were not found in other organs. No cases with serum IgG4 level of >135 mg/dL were noted. A total of 94.1% of WL-PTC cases had IgG4-positive plasma cells ( + PCs) in the stroma, and cases with rich IgG4 + PCs were more frequently associated with Hashimoto's thyroiditis than those with poor IgG4 + PCs. In this study, all three cases without Hashimoto's thyroiditis had poor IgG4 + PCs, and one of them did not exhibit IgG4 + PCs in the stroma of WL-PTC and Hashimoto's thyroiditis. Nodal metastatic lesions were seen in eight cases, all of which were not WL-PTC. As such, we should consider that the Hashimoto's disease with rich IgG4 + PCs seen in our cases is representative of non-IgG4-related disease and not IgG4-related disease involving multiple organs. This study is the first to demonstrate the presence of IgG4 + PCs in the stroma of WL-PTC. We concluded that the appearance of IgG4 + PCs in the stroma of WL-PTC may be related to Hashimoto's thyroiditis with rich IgG4 + PC.

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Section: Immunoglobulin G4 (Igg4)-related Dis-ease (Rd) Is a New Clinmentioning

confidence: 99%

Warthin-like papillary thyroid carcinoma with immunoglobulin G4-positive plasma cells possibly related to Hashimoto’s thyroiditis

et al. 2018

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“…However, it is often associated with significant morbidity (1). Patients frequently undergo surgical excision to relieve obstructive symptoms as well as to establish definitive diagnosis (2,6,8). Medical intervention includes anti-inflammatory treatments used in an effort to diminish the inflammatory mass.…”

Section: Discussionmentioning

confidence: 99%

Successful Use of Rituximab in a Case of Riedel Thyroiditis Resistant to Treatment with Prednisone and Tamoxifen

Mammen¹,

Gordon²

2019

AACE Clinical Case Reports

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Objective: Riedel thyroiditis (RT) is a rare disorder with high morbidity and limited treatment options. We describe a case resistant to conventional treatment with corticosteroids and tamoxifen, which subsequently responded to rituximab. Methods: Surgical pathology with hematoxylin and eosin staining was initially performed to confirm diagnosis, followed by IgG4 immunostaining and IgG4 serology in the setting of refractory RT, given its association with IgG4-related disease. Response to treatment was monitored subjectively as well as objectively with serial computed tomography scans. Results: A 51-year-old female with history of Hashimoto thyroiditis presented with compressive neck symptoms. Imaging was suggestive of a multinodular goiter with a large right thyroid nodule. Total thyroidectomy was planned, however intraoperative findings of a densely adherent thyroid with disruption of resection planes led to early termination of surgery. Biopsies obtained during surgery showed benign thyroid tissue with chronic lymphocytic thyroiditis, dense fibrous scar tissue, and benign lymph nodes, confirming the diagnosis of RT. The patient had minimal symptomatic improvement with chronic prednisone as high as 60 mg daily with tamoxifen at 30 mg twice a day. She subsequently received 4 doses of intravenous rituximab at 375 mg/m 2 every 3 weeks, resulting in significant subjective improvement of her compressive symptoms as well as an objective decrease in size of the thyroid mass as seen on a subsequent computed tomography scan. Conclusion: Evidence regarding etiology and management of RT is limited. We present a case of refractory RT treated with rituximab with resultant symptomatic improvement, thus providing further evidence for use of rituximab in resistant cases. (AACE Clinical Case Rep. 2019;5:e218-e221) Abbreviations: IgG4-RD = IgG4-related disease; RT = Riedel thyroiditis

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“…From 30 to 60% of patients present clinical or subclinical hypothyroidism. It is one of the IgG4-related disease varieties, together with Fibrosing hashimoto thyroiditis, Igg4related Hashimoto's disease, and Graves' disease associated with IgG4 [43][44][45].…”

Section: Infiltrative Diseasesmentioning

confidence: 99%

Hypothyroidism

Álvarez¹,

Rosero²

2020

Cellular Metabolism and Related Disorders

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Hypothyroidism is a condition that results from thyroid hormone deficiency that can range from an asymptomatic condition to a life-threatening disease. The prevalence of hypothyroidism varies according to the population, from up to 3 to 4% in some populations and in the case of subclinical hypothyroidism up to 5-10%. Clinical symptoms of hypothyroidism are diverse, broad, and non-specific and can be related to many systems, reflecting the systemic effects of thyroid hormones. The severity of the symptoms is usually related to the severity of the thyroid hormone deficit. The most common form of hypothyroidism, primary hypothyroidism, is diagnosed when there is elevation of TSH and decrease in the level of free T4 and Subclinical hypothyroidism is diagnosed when there is an elevation of TSH with normal levels of free T4. The most frequent cause of primary hypothyroidism in populations without iodine deficiency is Hashimoto's thyroiditis or chronic lymphocytic thyroiditis. Iodine deficiency is the main cause of hypothyroidism in populations with deficiency of iodine intake. The treatment of choice for hypothyroidism is thyroxine (T4), which has shown efficacy in multiple studies to restore the euthyroid state and improve the symptoms of hypothyroidism. In subclinical hypothyroidism, the treatment depends on the age, functionality, and comorbidities of the patients. The total replacement dose of levothyroxine in adults is approximately 1.6 mcg/kg; however in elderly patients with heart disease or coronary heart disease, the starting dose should be from 0.3 to 0.4 mcg/kg/day with progressive increase of 10% of the dose monthly.

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Immunoglobulin G4-Related Thyroid Diseases

Cited by 63 publications

References 53 publications

Warthin-like papillary thyroid carcinoma with immunoglobulin G4-positive plasma cells possibly related to Hashimoto’s thyroiditis

Warthin-like papillary thyroid carcinoma with immunoglobulin G4-positive plasma cells possibly related to Hashimoto’s thyroiditis

Successful Use of Rituximab in a Case of Riedel Thyroiditis Resistant to Treatment with Prednisone and Tamoxifen

Hypothyroidism

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