Serum immunoglobulin G4 levels and Graves’ disease phenotype

Martin, Sorina; Sîrbu, Anca; Betivoiu, Minodora; Florea, Suzana; Barbu, Carmen; Fica, Simona

doi:10.1007/s12020-016-1157-5

Cited by 17 publications

(15 citation statements)

References 28 publications

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“…Based on our data, none of the factors including age, sex, duration of AITD, smoking status, the presence of ophthalmopathy, and thyroid auto-antibodies have any association with the elevated serum IgG4 levels. This was different from previous studies which reported that elevated serum IgG4 were positively correlated with the titers of thyroid auto- antibodies [27] , [28] . It should be also noted from current study that the presence or absence of ophthalmopathy did not affect the levels of serum IgG4 which our findings were contrast with Bozkirli et al [29] which found the positive correlation between serum IgG4 and severity of Graves’ ophthalmopathy.…”

Section: Discussioncontrasting

confidence: 99%

A study of serum IgG4 levels in the clinical metamorphosis of autoimmune thyroid disease

Thewjitcharoen

Krittiyawong

Porramatikul

et al. 2017

Journal of Clinical & Translational Endocrinology

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BackgroundMeasurement of serum IgG4 had been suggested to distinguish the unique subtypes of autoimmune thyroid disease (AITD) which demonstrated patterns of fluctuating between hyperthyroidism and hypothyroidism. However, the clinical utility of serum IgG4 measurement is inconclusive due to few studies having addressed these unusual patients compared with the specificity of serum IgG4 in healthy patients.AimTo investigate whether elevated serum IgG4 levels could be used as a marker to identify fluctuating AITD patients.Materials and Methods20 AITD patients who evolved from hyperthyroid Graves’ disease to spontaneous hypothyroidism or vice versa were compared with 40 healthy subjects, 40 patients with hyperthyroid Graves’ disease (GD) and 40 patients with subclinical or overt hypothyroid Hashimoto’s thyroiditis (HT). Serum levels of total IgG and IgG4 were measured and the proportion of elevated serum IgG4 levels (defined by serum IgG4 levels ≥ 135 mg/dL) was compared with control patients.ResultsA series of 20 Thai patients with clinical evolution of AITD was analyzed with a median follow-up at 92 months (range 3–380 months). Elevated serum IgG4 levels were not found in fluctuating AITD patients but were found in 5% of the control GD patients, 2.5% of the control HT, and 2.5% of healthy subjects which were not statistically significant between each group.ConclusionOur results contrasted with those of previous studies from Japan which reported elevated serum IgG4 as a marker to identify subset of AITD patients. At present, the clinical utility of serum IgG4 measurements in AITD is inconclusive and requires further investigation.

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Section: Discussioncontrasting

confidence: 99%

A study of serum IgG4 levels in the clinical metamorphosis of autoimmune thyroid disease

Thewjitcharoen

Krittiyawong

Porramatikul

et al. 2017

Journal of Clinical & Translational Endocrinology

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“…Higher IgG4 levels as well as a higher IgG4/IgG ratio also characterized patients with moderate-to-severe and/or active GO as opposed with those having mild and/ or inactive GO. In this study, serum IgG4 levels positively correlated with TRAb levels, similarly to the finding by Takeshima (38) and in contrast to those of Martin (39). Similarly to HT, also in GD, a decrease in IgG4 levels following thyroidectomy was described (41).…”

Section: Graves' Diseasesupporting

confidence: 88%

“…Indeed, this 47-year-old woman was diagnosed with Graves' hyperthyroidism and, started on MMI therapy, experienced a successful restoration of euthyroidism. More than 4 years after the initial diagnosis, and 6 months after the withdrawal of MMI, the patient developed overt hypothyroidism and, owing to the presence of a large (38), no such a correlation was found by Martin et al (39). On the other hand, the latter study reported that thyroid autoantibody-positive patients had significantly higher serum IgG4 levels compared to the negative ones.…”

Section: Graves' Diseasementioning

confidence: 79%

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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“…In fact, IgG4 levels do not increase with age, suggesting that some unknown factor may be responsible for the abnormal expression of IgG4. 22 We found that the IgG4-positive subtype was an independent factor associated with the active stage in patients with TED. There were more active patients and patients with a higher CAS in the IgG4-positive group than in the IgG4-negative group in our study, consistent with the conclusion presented in a previous Korean study.…”

Section: Discussionmentioning

confidence: 64%

Elevated Immunoglobulin G4 Levels in Patients with Thyroid Eye Disease and Their Clinical Implications

Xiao

Chen

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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The purpose of this study was to assess the relationship between thyroid eye disease (TED) in patients undergoing orbital decompression and immunoglobulin G4 (IgG4) levels. METHODS. A prospective observational cohort study was conducted among 185 consecutive patients who were diagnosed with TED and underwent orbital decompression. Serum levels of IgG4 were measured, and immunohistochemical staining for IgG and IgG4 was performed in orbital adipose tissue. Data related to clinicopathologic features were analyzed. RESULTS. Among the 185 enrolled patients with TED, 64 (34.6%) were IgG4-positive. The IgG4-positive patients were older, had higher clinical activity scores (CAS), and had worse best-corrected visual acuity (BCVA) than the IgG4-negative patients. Higher thyrotropin receptor antibody (TRAb) levels, histopathological IgG4 counts, IgG4/IgG ratios, and dense lymphocyte infiltration were more frequently observed in IgG4-positive than in IgG4-negative patients. Definitive and probable IgG4 subtypes were independently associated with the active stage in patients with TED. CONCLUSIONS. Our data suggest that the IgG4 subtype in TED is common. IgG4-positive patients with TED may be older, have more severe disease, and have higher clinical activity scores. IgG4 may play an important role in the pathogenesis of TED.

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Serum immunoglobulin G4 levels and Graves’ disease phenotype

Cited by 17 publications

References 28 publications

A study of serum IgG4 levels in the clinical metamorphosis of autoimmune thyroid disease

A study of serum IgG4 levels in the clinical metamorphosis of autoimmune thyroid disease

DIAGNOSIS OF ENDOCRINE DISEASE: IgG4-related thyroid autoimmune disease

Elevated Immunoglobulin G4 Levels in Patients with Thyroid Eye Disease and Their Clinical Implications

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