IgG4-related disease of the thyroid gland

Matos, Tânia; Almeida, Margarida; Batista, Lucas; Vale, Sónia do

doi:10.1136/bcr-2020-238177

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…As mentioned, a small number of patients confirmed with Hashimoto’s thyroiditis develop its fibrotic variant, with this entity belonging to IgG4-RTD [ 88 ]. Most authors consider that the list of IgG4-RTD includes four distinct types of conditions, with Hashimoto’s thyroiditis being distinct from its fibrotic variant [ 88 , 89 ]. Some suggested that identifying a high level of serum IgG4 in one patient with Hashimoto’s thyroiditis represents an early predictor for developing its fibrotic variant [ 90 ].…”

Section: Discussionmentioning

confidence: 99%

Reshaping the Concept of Riedel’s Thyroiditis into the Larger Frame of IgG4-Related Disease (Spectrum of IgG4-Related Thyroid Disease)

Cârșote

Nistor

2023

Biomedicines

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Recently, Riedel’s thyroiditis (RT) was assimilated into the larger spectrum of immunoglobulin IgG4-related disease (IgG4-RD) in addition to a particular frame of IgG4-related thyroid disease (IgG4-RTD), underlying IgG4-RT, IgG4-associated Hashimoto’s thyroiditis (and its fibrotic variant), and IgG4-related Graves’s disease. Our objective was to overview recent data on RT, particularly IgG4-RD and IgG4-RTD. The case and study– sample analysis (2019–2023) included 293 articles and selected 18 original studies: nine single case reports (N = 9, female/male = 2/1, aged: 34–79 years, 5/9 patients with serum IgG4 available data, 2/5 with high serum IgG4) and four case series (N = 21; 4/5 series provided data on IgG4 profile, 3/21 had serum IgG4 assays, and 2/3 had abnormally high values). IgG4-RD and thyroid findings were analyzed in three cohorts (N = 25). Another two studies (N = 11) specifically addressed IgG4-RTD components. On presentation, the patients may have hypothyroidism, transitory thyrotoxicosis, goiter, long-term history of positive anti-thyroid antibodies, and hypoechoic ultrasound thyroid pattern. The 5-year analysis (N = 66) showed the rate of serum IgG4 evaluation remained low; normal values do not exclude RT. Mandatory histological and immunohistochemistry reports point out a high content of IgG4-carrying plasma cells and IgG4/IgG ratio. Unless clinically evident, histological confirmation provides a prompt indication of starting corticoid therapy since this is the first-line option. Surgery, if feasible, is selective (non-responders to medical therapy, emergency tracheal intervention, and open/core needle biopsy). Current open issues are identifying the role of serum IgG4 assays in patients with IgG4-RD, finding out if all cases of RT are IgG4-mediated, applying IgG4-RTD criteria of differentiation among four entities, and providing an RT/IgG4-RTD guideline from diagnosis to therapy. It remains that the central aim of approaching RT in daily practice is the early index of suspicion in order to select patients referred for further procedures that provide enough histological/immunohistochemistry material to confirm RT and its high IgG4 burden.

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Section: Discussionmentioning

confidence: 99%

Reshaping the Concept of Riedel’s Thyroiditis into the Larger Frame of IgG4-Related Disease (Spectrum of IgG4-Related Thyroid Disease)

Cârșote

Nistor

2023

Biomedicines

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“…This immune attack targets the thyroid cells, causing damage and interfering with their normal function. Over time, this inflammation can lead to the development of Hashimoto’s thyroiditis ( 45 ). IgG4-related thyroid disease showed correlations with a younger age group, a higher occurrence in males, higher levels of thyroid autoantibodies, diffuse low echogenicity, and a higher prevalence of subclinical hypothyroidism ( 46 ).…”

Section: Discussionmentioning

confidence: 99%

The use of intravenous immunoglobulin in the treatment of Hashimoto’s encephalopathy: case based review

Şorodoc,

Constantin,

Asaftei

et al. 2023

Front. Neurol.

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BackgroundHashimoto’s encephalopathy (HE) is a controversial immunological neuropsychiatric disease, with a poorly understood pathogenesis. It is characterized by symptoms of acute or subacute encephalopathy which usually occur in the presence of elevated levels of antithyroid antibodies. Even though it is also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT), some cases appear to be steroid-resistant. This review examined whether treatment of Hashimoto’s encephalopathy with intravenous immunoglobulin (IVIG) is associated with better clinical outcomes than the standard therapy. Additionally, we presented a case of a 59-year-old man who presented with severe neurological manifestations and was successfully treated with intravenous immunoglobulin.MethodsThe online databases PubMed and EMBASE were searched.ResultsA total of 1,365 articles were identified. After the deletion of 112 duplicates, 1,253 studies were screened by evaluating the title and abstract, focusing on Hashimoto’s encephalopathy cases where IVIG were used. 846 studies were excluded because they were not relevant to the topic or included pediatric population. Therefore, 407 full-text articles were assessed for eligibility. The final analysis included 14 eligible articles after 393 were excluded (irrelevant texts, not written in English, full-text not available). In the majority of the selected case-reports, IVIG was associated with a good outcome, sometimes even with dramatic improvements in patient’s status.ConclusionIn last years, intravenous immunoglobulin therapy proved its utility in Hashimoto’s encephalopathy’s treatment, being a well tolerated therapy associated with remarkable improvement in patient’s status. Further research is still needed in order to define the optimal treatment protocol for Hashimoto’s encephalopathy and to establish if intravenous immunoglobulin can also be used as a first-line therapy, alone or in combination with steroids.

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“…The threshold to confirm increased IgG4-positive plasma cells ranges from more than 20 to more than 30 IgG4-positive plasma cells per high-power field by microscopic examination ( 78 – 81 ). The FNA specimens show lymphoplasmacytic infiltrates and oncocytes and the cytological features are usually classified as benign ( 80 ). Clinical history, radiological characteristics, and cytological features, such as abundant plasma cells, fibroblast, and epithelial atypia, should raise the suspicion of IgG4-related disease ( 82 ).…”

Section: Differentiating Benign From Malignant Thyroid Neoplasmsmentioning

confidence: 99%

Immunohistochemistry in the pathologic diagnosis and management of thyroid neoplasms

Crescenzi

Baloch

2023

Front. Endocrinol.

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The use of immunohistochemistry cannot be underestimated in the everyday practice of thyroid pathology. It has evolved over the years beyond the traditional confirmation of thyroid origin to molecular profiling and the prediction of clinical behavior. In addition, immunohistochemistry has served to implement changes in the current thyroid tumor classification scheme. It is prudent to perform a panel of immunostains, and the immunoprofile should be interpreted in light of the cytologic and architectural features. Immunohistochemistry can also be easily performed in the limited cellularity specimen preparation generated from thyroid fine-needle aspiration and core biopsy; however, it will require laboratory validation of immunostains specific to these preparations to avoid diagnostic pitfalls. This review discusses the application of immunohistochemistry in thyroid pathology with a focus on limited cellularity preparations.

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IgG4-related disease of the thyroid gland

Cited by 4 publications

References 17 publications

Reshaping the Concept of Riedel’s Thyroiditis into the Larger Frame of IgG4-Related Disease (Spectrum of IgG4-Related Thyroid Disease)

Reshaping the Concept of Riedel’s Thyroiditis into the Larger Frame of IgG4-Related Disease (Spectrum of IgG4-Related Thyroid Disease)

The use of intravenous immunoglobulin in the treatment of Hashimoto’s encephalopathy: case based review

Immunohistochemistry in the pathologic diagnosis and management of thyroid neoplasms

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