Serum <scp>I</scp>mmunoglobulin <scp>G</scp>4 levels are elevated in patients with <scp>G</scp>raves’ ophthalmopathy

Bozkirli, Emre; Bakıner, Okan; Bozkırlı, Emine Duygu Ersözlü; Haydardedeoğlu, Filiz Ekşi; Torun, Aysenur; Ertorer, Melek Eda

doi:10.1111/cen.12671

Cited by 31 publications

(27 citation statements)

References 35 publications

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“…The association with GO is also a matter of interest. Bozkirly et al first suggested that an elevation of IgG4 would preferably be observed in patients with GO (35). In their series the proportion of patients with an IgG4 serum level >135 mg/mL was significantly higher in patients with GO as opposed with that found in patients without GO (37.5 vs 9.1%, respectively).…”

Section: Graves' Diseasementioning

confidence: 88%

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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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Section: Graves' Diseasementioning

confidence: 88%

“…Indeed, the prevalence of GD with elevated IgG4 in previously reported series ranges from 6.0 to 11.1%. The highest prevalence (23%) was reported by a single study on a GD series characterized by an extremely high (50%) prevalence of Graves' orbitopathy (GO) (35).…”

Section: Graves' Diseasementioning

confidence: 98%

DIAGNOSIS OF ENDOCRINE DISEASE: IgG4-related thyroid autoimmune disease

Rotondi

Carbone

Coperchini

et al. 2019

European Journal of Endocrinology

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“…These patients were older and had more hypoechoic areas on ultrasonography, but any histological differences have not been evaluated [41]. An association of Graves ophthalmopathy with elevated serum IgG4 levels has also been found [42], but more data are required to link this to IgG4-RTD.…”

Section: Graves Disease In the Context Of Igg4-rtdmentioning

confidence: 99%

Immunoglobulin G4-Related Thyroid Diseases

Kottahachchi¹,

Topliss²

2016

Eur Thyroid J

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Immunoglobulin G4-related disease (IgG4-RD) is a new disease category involving many organ systems, including the endocrine system in general and the thyroid in particular. Since an initial association was made between hypothyroidism and autoimmune (IgG4-related) pancreatitis, more forms of IgG4-related thyroid disease (IgG4-RTD) have been recognized. Four subcategories of IgG4-RTD have so far been identified: Riedel thyroiditis (RT), fibrosing variant of Hashimoto thyroiditis (FVHT), IgG4-related Hashimoto thyroiditis, and Graves disease with elevated IgG4 levels. Although a male predominance is seen for IgG4-RD in general, RT and FVHT have a female preponderance. The pathogenesis of IgG4-RD is not completely understood; however, genetic factors, antigen-antibody reactions, and an allergic phenomenon have been described. Diagnosis of IgG4-RD requires a combination of clinical features, serological evidence, and histological features. Histology is the mainstay of diagnosis, with IgG4 immunostaining. Although serum IgG4 levels are usually elevated in IgG4-RD, raised serum IgG4 is neither necessary nor adequate for diagnosis. Imaging supports the diagnosis and is a useful tool in disease monitoring. Management of IgG4-RTD is both medical and surgical. Steroids are the first-line treatment and may produce a swift response. Tamoxifen and rituximab are second-line agents used in steroid-resistant patients. Surgical debulking is carried out in RT solely as a procedure to relieve obstruction. Other endocrine associations described with IgG4-RD are hypophysitis and Hashimoto encephalopathy. IgG4-RTD is an uncommon disease entity, and prompt diagnosis and treatment can improve outcomes.

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“…It is believed to occur equally among males and females [1,2]. Recent reports have also suggested that a small fraction of Graves' disease patients also have elevated IgG4 levels with some features suggestive of IgG4TD [21,22]. Takeshima K et al reported that 6.4% of 109 patients with Graves' disease had elevated IgG4 titres [21].…”

Section: Igg4 Related Thyroid Disease (Igg4rtd)mentioning

confidence: 99%

“…in patients of Graves' disease with Graves' orbitopathy (GO) as compared to those without orbitopathy, and the levels correlated with clinical activity score [22]. Riedel's thyroiditis, first reported in 1896, is an inflammatory sclerosing disorder of the thyroid, having an estimated incidence of 1.06 cases per 100,000 population [23].…”

Section: Prace Poglądowementioning

confidence: 99%

Zaburzenia tarczycy związane z immunoglobuliną G4 — wyzwanie diagnostyczne i wyniki kliniczne

Dutta

Ahuja

Selvan

2016

Endokrynologia Polska

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Ig-G4 related disease (IgG4RD) is a heterogeneous disorder with multi-organ involvement recognised as a separate entity at the start of this century only. It is currently one of the hottest areas of clinical and translational research across specialties. Thyroid involvement in IgG4RD is rare, believed to occur in less than 4% of cases, may be isolated or may be associated with other organ involvement. As of today Riedel's thyroiditis, fibrosing variant of Hashimoto's thyroiditis, and few patients of Graves' orbitopathy represent the types of IgG4-related thyroid disease (IgG4RTD). This disorder is frequently confused with malignancy due to the intense sclerosis of thyroid resulting in hard texture on palpation compounded by often-associated compressive symptoms. Diagnosis involves establishing high circulating levels of IgG4 > 135 mg/dL, increased serum IgG4 to IgG ratio of > 8%, immunohistochemistry showing dense lymphoplasmacellular inflammatory infiltrate consisting of IgG4-positive plasma cells with storiform fibrosis and obliterative phlebitis, and increased IgG4 positive plasma cell > 10 cells per high-power field when at least three fields are evaluated. Glucocorticoids are the primary form of therapy in IgG4RD. However, their role in IgG4RTD needs to be evaluated. As of today levothyroxine supplementation for resulting hypothyroidism, appropriate management of Graves' disease, and surgical excision of thyroid in case of compressive symptoms remain the primary treatment options. StreszczenieChoroba związana z Ig-G4 (IgG4RD) jest heterogennym zaburzeniem z zajęciem wielu narządów. Jako osobna jednostka chorobowa została wyodrębniona dopiero na początku tego stulecia. Choroba ta stanowi aktualnie najgorętszy obszar badań klinicznych i translacyjnych w różnych dziedzinach medycyny. Zajęcie tarczycy w IgG4RD jest rzadkie, szacuje się, że występuje w około 4% przypadków, może być izolowane lub związane zajęciem innych narządów. Na chwilę obecną zapalenie tarczycy związane z IgG4 (IgG4RTD) reprezentują: zapalenie tarczycy Riedela, które jest włókniejącą odmianą zapalenia tarczycy w chorobie Hashimoto oraz niektórzy pacjenci z orbitopatią Gravesa. Zapalenie tarczycy związane z IgG4 jest często mylone z chorobą nowotworową ze względu na nasilone stwardnienie tarczycy, które powoduje powstanie twardej struktury wyczuwalnej w badaniu palpacyjnym z towarzyszącymi często objawami uciskowymi. Rozpoznanie choroby obejmuje: stwierdzenie wysokich stężeń krążącej IgG4 > 135 mg/dl, zwiększony stosunek w surowicy IgG4 do IgG > 8%, w badaniu immunohistochemicznym stwierdzenie gęstych nacieków zapalnych złożonych z limfocytów i IgG4 dodatnich plazmocytów , z włóknieniem i zarostowym zapaleniem żył oraz zwiększeniem liczby IgG4 dodatnich plazmocytów > 10 w polu widzenia, jeżeli oceniono minimum 3 pola. Glikokortykosteroidy stanowią leczenie pierwszego wyboru w IgG4RTD. Niemniej ich rola w IgG4RTD wymaga dalszej oceny. Na chwilę obecną podstawowe opcje terapeutyczne obejmują: suplementację lewotyroksyny we wtórnej nied...

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Serum Immunoglobulin G4 levels are elevated in patients with Graves’ ophthalmopathy

Cited by 31 publications

References 35 publications

DIAGNOSIS OF ENDOCRINE DISEASE: IgG4-related thyroid autoimmune disease

DIAGNOSIS OF ENDOCRINE DISEASE: IgG4-related thyroid autoimmune disease

Immunoglobulin G4-Related Thyroid Diseases

Zaburzenia tarczycy związane z immunoglobuliną G4 — wyzwanie diagnostyczne i wyniki kliniczne

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