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

Abstract

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.

Immunoglobulin G4-related thyroiditis associated with Graves’ disease: A case report

“…In general, IgG4-related thyroiditis associated with Reidel's thyroiditis clinically presents with compressive symptoms (dyspnea, hoarseness, and dysphagia) that cause suspicion of malignancy. This is in line with the histopathological findings of dense lymphoplasmacytic infiltration, a high content of IgG4-positive plasma cells, storiform fibrosis with extra-thyroid fibrosis, and obliterate phlebitis [ 8 ]. However, few studies have reported the histology of IgG4-RTD in Graves' disease [ 9 ].…”

The clinical case of IgG4-related thyroid disease in a 6-year-old child

“…В описательном обзоре Carsote M. и соавт., опубликованном в июне 2023 г., проанализировано 66 клинических случаев ТР с 2019 по 2023 гг. [ 22 ]. Было отмечено, что в большинстве клинических случаев наличие ТР предполагалось на этапе постановки диагноза, что свидетельствует о возросшей осведомленности врачей о данном заболевании [ 22 ].…”

“…[ 22 ]. Было отмечено, что в большинстве клинических случаев наличие ТР предполагалось на этапе постановки диагноза, что свидетельствует о возросшей осведомленности врачей о данном заболевании [ 22 ].…”