The importance of IgG4 in the predictive model of thyroiditis

Abstract

SummaryImmunoglobulin (Ig)G4-related sclerosing disease (IgG4-RSD) is a new disease entity first proposed with regard to autoimmune pancreatitis. A 67-year-old male patient was examined because of weight loss and an abdominal pain. Based on the clinical characteristics, laboratory parameters and ultrasound features, we identified the diagnosis of the IgG4-related systemic disease (IgG4-RSD), that was confirmed by the histopathological analysis after the biopsy of the head of pancreas. After confirmation, we started with the corticosteroid therapy with a good clinical, biochemical and morphological response. During the previous therapy, the disturbance of glucoregulation appeared, so we had to change the modality of treatment. We decided to add Azathioprine to the therapy in a dose of 150 mg/day. We achieved a stable phase of the disease with IgG 4.37 g/l and IgG4 0.179 g/l, and with no side effects from the therapy.Learning points There are potential clinical applications of identifying subsets of patients with IgG4 thyroiditis (FVHT and Riedel thyroiditis).A trial of immunosuppressive therapy should be included if a resection is deemed inadvisable.In particular, cases of FVHT that mimic malignancy, tissue and serum IgG4 may provide supportive diagnostic information.

Hashimoto Encephalopathy—Still More Questions than Answers

“…It has been observed that IgG4 antibodies are present in 70% of patients with hypothyroidism, compared to only 47% of euthyroid patients [ 51 ]. Some researchers suggest that HT should be divided into IgG4 positive and IgG4 negative, due to their different clinical presentations and prognoses [ 52 , 53 ]. A less important determinant of the disease is anti-TG antibodies, which can occur in isolation or coexist with anti-TPO antibodies.…”

IgG4-related disease; a newly recognized entity with expanding spectrum

“…Among such recently discovered rare entities is IgG4-related disease (IgG4RD) (1). A family of multi-systemic autoimmune diseases involves the vast parts of the human body, such as: the pancreas, kidneys, salivary glands, lungs, thyroid gland, biliary tree, mastoid bone, eyes, meninges, otorhinological organs, blood vessels, skin and the retroperitoneum (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). It is distinguished by the presence of IgG4 positive cells in body tissues and elevated serum levels of IgG and IgG4 along with a raised serum IgE and/or peripheral eosinophilia (1).…”