Painful immunoglobulin G4-related thyroiditis treated by total thyroidectomy

Lee, Ihn Suk; Lee, Jung Uee; Lee, Kwan Ju; Jang, Yi Sun; Lee, Jong Min; Kim, Hye Soo

doi:10.3904/kjim.2014.283

Cited by 6 publications

(5 citation statements)

References 5 publications

(12 reference statements)

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“…At present, there is no standard treatment for IgG4related thyroiditis. GCs are the first choice, with levothyroxine supplementation for hypothyroidism and surgical excision of the thyroid for compression [9,[26][27][28]. In patients who fail to respond to GCs, tamoxifen can be used as monotherapy or as add-on therapy to GCs.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with medical therapy, total thyroidectomy improves health-related quality of life and fatigue in patients with classic HT who still have symptoms despite having normal thyroid function, along with a concomitant elimination of serum anti-TPO antibodies [33]. Similarly, total thyroidectomy can quickly relieve the symptoms of IgG4-related thyroiditis, and the dosage of GCs can be reduced [26]. Additionally, the long-term use of GCs can cause a variety of adverse reactions.…”

Section: Discussionmentioning

confidence: 99%

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Clinical features and treatment efficacy for IgG4-related thyroiditis

Han

Zhang

et al. 2021

Orphanet J Rare Dis

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Purpose This study aimed to clarify the clinical features of and evaluate the treatment efficacy for IgG4-related thyroiditis. Methods Fourteen IgG4-related thyroiditis patients and 42 randomly matched IgG4-related disease (IgG4-RD) patients without thyroiditis in a prospective cohort at the Peking Union Medical College Hospital (PUMCH) were enrolled from 2011 to 2019. Patient demographics, clinical characteristics, laboratory parameters and treatment efficacy were analysed. Results The prevalence of IgG4-related thyroiditis in our cohort was 2.0%. The average patient age was 42.8 ± 14.9 years, and the male: female ratio was 1:1. Goiter (14, 100.0%), hard thyroid (14, 100.0%) and neck compression (5, 35.7%) were the most prevalent onset symptoms observed. IgG4-related thyroiditis was characterized by asymmetric diffuse thyroid enlargement on ultrasound. Thirteen (92.9%) patients had hypothyroidism, and all patients had significantly elevated circulating thyroid antibodies. Compared with patients without thyroiditis, patients with IgG4-related thyroiditis had less submandibular gland involvement and lacrimal gland involvement and lower serum IgG4 and T-IgE levels (P = 0.019, P = 0.022, P = 0.004, and P = 0.006, respectively) and more single-organ involvement (P = 0.011). After treatment, the symptoms were relieved, while the size of the thyroid gland did not change significantly, and levothyroxine as a supplemental therapy was still needed. Conclusions IgG4-related thyroiditis is a distinct subtype of IgG4-RD characterized by positive circulating thyroid antibodies and a high rate of hypothyroidism. Although compression symptoms could be relieved with treatment, the thyroid size did not change significantly, and the damage to thyroid function was often irreversible.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical features and treatment efficacy for IgG4-related thyroiditis

Han

Zhang

et al. 2021

Orphanet J Rare Dis

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“…Может возникнуть необходимость дифференциировать ПТ с IgG4-ассоциированным тиреоидитом, так как изредка при втором заболевании можно обнаружить болезненность в области шеи. К сожалению, клинические диагностические критерии тиреоидита, связанного с IgG4, до конца не сформулированы, условным ориентиром является сохранение болевого синдрома на фоне длительной терапии глюкокортикостероидами, золотым стандартом для диагностики тиреоидита, связанного с IgG4, является иммуноокрашивание IgG4 послеоперационного материала [ 80 ][ 81 ].…”

Section: диагностика заболевания или состояния (группы заболеваний ил...unclassified

Clinical practice guidelines for acute and chronic thyroiditis (excluding autoimmune thyroiditis)

Трошина

Panfilova

Mikhina

et al. 2021

Probl Endokrinol (Mosk)

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Acute and chronic thyroid diseases are the most frequently detected disorders being second only to diabetes mellitus.The World Health Organization points out that thyroid diseases’ incidence tends to grow every year. The present paper consists of clinical practice guidelines that consider etiology, clinical course, diagnostics and treatment of acute and chronic inflammatory thyroid diseases (except those of autoimmune type).The clinical practice guidelines provide an important working tool for clinicians including specialty physicians and medical experts. Containing structured and concise information on the specific nosology, diagnostic methods and treatment tips these guidelines allow medical specialists to quickly resolve difficulties and choose the most efficient and personalized treatment (following strict principles of evidence-based medicine at the same time).The clinical practice guidelines were drawn up by highly-skilled professional team of specialty physicians approved by the Expert Council of Russian Federation’s Health Department. These guidelines contain the most complete and up-to-date information required to diagnose acute and chronic thyroiditis, provide patient care and treatment.The working group publishes the present paper in the professional journal dealing with endocrinology topics to improve healthcare quality and refine treatment of acute and chronic thyroiditis (autoimmune thyroiditis excluded). It is advisable to acquaint as many endocrinology and general (family) medicine specialists as possible with the full text of these clinical guidelines.

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“…Although not fully elucidated, the putative mechanism would be related to the higher expression of the pro-tumorigenic molecule TGFβ1 found in patients with IgG4 thyroiditis as compared to those with non-IgG4 thyroiditis (20). In addition, although the presence of pain is not mandatory for the diagnosis of IgG4-related thyroiditis, it is worth noting that pathologic findings typical of IgG4-RD were observed in a Korean patient undergoing thyroidectomy for the rare painful variant of HT (21). Even if limited to a single case, a link between the painful variant of HT and IgG4 could be suggested (22).…”

Section: Hashimoto's Thyroiditismentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: IgG4-related thyroid autoimmune disease

Rotondi

Carbone

Coperchini

et al. 2019

European Journal of Endocrinology

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IgG4-related disease (IgG4-RD) is fibro-inflammatory, immune-mediated, systemic disease recognized as a defined clinical condition only in 2001. The prevalence of IgG4-RD is 6/100 000, but it is likely to be underestimated due to insufficient awareness of the disease. The diagnostic approach is complex because of the heterogeneity of clinical presentation and because of rather variable diagnostic criteria. Indeed, high concentrations of IgG4 in tissue and serum are not a reliable diagnostic marker. The spectrum of IgG4-RD also includes well-known thyroid diseases including Riedel’s thyroiditis, Hashimoto’s thyroiditis and its fibrotic variant, Graves’ disease and Graves’ orbitopathy. Results from clinical studies indicate that a small subset of patients with the above-mentioned thyroid conditions present some features suggestive for IgG4-RD. However, according to more recent views, the use of the term thyroid disease with an elevation of IgG4 rather than IgG4-related thyroid diseases would appear more appropriate. Nevertheless, the occurrence of high IgG4 levels in patients with thyroid disease is relevant due to peculiarities of their clinical course.

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Painful immunoglobulin G4-related thyroiditis treated by total thyroidectomy

Cited by 6 publications

References 5 publications

Clinical features and treatment efficacy for IgG4-related thyroiditis

Clinical features and treatment efficacy for IgG4-related thyroiditis

Clinical practice guidelines for acute and chronic thyroiditis (excluding autoimmune thyroiditis)

DIAGNOSIS OF ENDOCRINE DISEASE: IgG4-related thyroid autoimmune disease

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