IgG4-Related Hashimoto's Thyroiditis - A New Variant of a Well Known Disease
Autor(a) principal: | |
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Data de Publicação: | 2014 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.17/1956 |
Resumo: | Hashimoto's thyroiditis (HT) has been characterized for many years as a well-defined clinicopathologic entity, but is now considered a heterogeneous disease. IgG4-related HT is a new subtype characterized by thyroid inflammation rich in IgG4-positive plasma cells and marked fibrosis. It may be part of the systemic IgG4-related disease. We report a case of a 56-year-old Portuguese man who presented with a one-month history of progressive neck swelling and dysphagia. Laboratory testing revealed increased inflammatory parameters, subclinical hypothyroidism and very high levels of thyroid autoantibodies. Cervical ultrasound (US) demonstrated an enlarged and heterogeneous thyroid gland and two hypoechoic nodules. US-guided fine needle aspiration cytology was consistent with lymphocytic thyroiditis. The patient was submitted to total thyroidectomy and microscopic examination identified typical findings of HT, marked fibrosis limited within the thyroid capsule and lymphoplasmacytic infiltration, with >50 IgG4-positive plasma cells per high-power field and an IgG4/IgG ratio of >40%. After surgery, serum IgG4 concentration was high-normal. Symptoms relief and reduction in laboratory inflammatory parameters were noticed. Thyroid function is controlled with levothyroxine. To our knowledge we report the first case of IgG4-related HT in a non-Asian patient. We also perform a review of the literature regarding IgG4-related disease and IgG4-related HT. Our case highlights this new variant of the well known HT, and helps physicians in recognizing its main clinical features, allowing for proper diagnosis and treatment. |
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IgG4-Related Hashimoto's Thyroiditis - A New Variant of a Well Known DiseaseCHLC ANPATBiopsy, Fine-NeedleHashimoto Disease/immunologyHashimoto Disease/pathologyHashimoto Disease/ultrasonographyImmunoglobulin G/analysisNeck/ultrasonographyPlasma Cells/immunologyThyroid Gland/immunologyThyroid Gland/pathologyThyroid Gland/ultrasonographyThyroid Nodule/immunologyThyroid Nodule/pathologyThyrotropin/bloodHashimoto's thyroiditis (HT) has been characterized for many years as a well-defined clinicopathologic entity, but is now considered a heterogeneous disease. IgG4-related HT is a new subtype characterized by thyroid inflammation rich in IgG4-positive plasma cells and marked fibrosis. It may be part of the systemic IgG4-related disease. We report a case of a 56-year-old Portuguese man who presented with a one-month history of progressive neck swelling and dysphagia. Laboratory testing revealed increased inflammatory parameters, subclinical hypothyroidism and very high levels of thyroid autoantibodies. Cervical ultrasound (US) demonstrated an enlarged and heterogeneous thyroid gland and two hypoechoic nodules. US-guided fine needle aspiration cytology was consistent with lymphocytic thyroiditis. The patient was submitted to total thyroidectomy and microscopic examination identified typical findings of HT, marked fibrosis limited within the thyroid capsule and lymphoplasmacytic infiltration, with >50 IgG4-positive plasma cells per high-power field and an IgG4/IgG ratio of >40%. After surgery, serum IgG4 concentration was high-normal. Symptoms relief and reduction in laboratory inflammatory parameters were noticed. Thyroid function is controlled with levothyroxine. To our knowledge we report the first case of IgG4-related HT in a non-Asian patient. We also perform a review of the literature regarding IgG4-related disease and IgG4-related HT. Our case highlights this new variant of the well known HT, and helps physicians in recognizing its main clinical features, allowing for proper diagnosis and treatment.ScieloThyroidectomyRepositório do Centro Hospitalar Universitário de Lisboa Central, EPEVara Luiz, HGonçalves, DNunes da Silva, TNascimento, IRibeiro, AMafra, MManita, IPortugal, J2014-12-05T17:15:24Z20142014-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/1956engArq Bras Endocrinol Metabol. 2014 Nov;58(8):862-8info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:34:03Zoai:repositorio.chlc.min-saude.pt:10400.17/1956Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:19:20.424184Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
IgG4-Related Hashimoto's Thyroiditis - A New Variant of a Well Known Disease |
title |
IgG4-Related Hashimoto's Thyroiditis - A New Variant of a Well Known Disease |
spellingShingle |
IgG4-Related Hashimoto's Thyroiditis - A New Variant of a Well Known Disease Vara Luiz, H CHLC ANPAT Biopsy, Fine-Needle Hashimoto Disease/immunology Hashimoto Disease/pathology Hashimoto Disease/ultrasonography Immunoglobulin G/analysis Neck/ultrasonography Plasma Cells/immunology Thyroid Gland/immunology Thyroid Gland/pathology Thyroid Gland/ultrasonography Thyroid Nodule/immunology Thyroid Nodule/pathology Thyrotropin/blood |
title_short |
IgG4-Related Hashimoto's Thyroiditis - A New Variant of a Well Known Disease |
title_full |
IgG4-Related Hashimoto's Thyroiditis - A New Variant of a Well Known Disease |
title_fullStr |
IgG4-Related Hashimoto's Thyroiditis - A New Variant of a Well Known Disease |
title_full_unstemmed |
IgG4-Related Hashimoto's Thyroiditis - A New Variant of a Well Known Disease |
title_sort |
IgG4-Related Hashimoto's Thyroiditis - A New Variant of a Well Known Disease |
author |
Vara Luiz, H |
author_facet |
Vara Luiz, H Gonçalves, D Nunes da Silva, T Nascimento, I Ribeiro, A Mafra, M Manita, I Portugal, J |
author_role |
author |
author2 |
Gonçalves, D Nunes da Silva, T Nascimento, I Ribeiro, A Mafra, M Manita, I Portugal, J |
author2_role |
author author author author author author author |
dc.contributor.none.fl_str_mv |
Thyroidectomy Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE |
dc.contributor.author.fl_str_mv |
Vara Luiz, H Gonçalves, D Nunes da Silva, T Nascimento, I Ribeiro, A Mafra, M Manita, I Portugal, J |
dc.subject.por.fl_str_mv |
CHLC ANPAT Biopsy, Fine-Needle Hashimoto Disease/immunology Hashimoto Disease/pathology Hashimoto Disease/ultrasonography Immunoglobulin G/analysis Neck/ultrasonography Plasma Cells/immunology Thyroid Gland/immunology Thyroid Gland/pathology Thyroid Gland/ultrasonography Thyroid Nodule/immunology Thyroid Nodule/pathology Thyrotropin/blood |
topic |
CHLC ANPAT Biopsy, Fine-Needle Hashimoto Disease/immunology Hashimoto Disease/pathology Hashimoto Disease/ultrasonography Immunoglobulin G/analysis Neck/ultrasonography Plasma Cells/immunology Thyroid Gland/immunology Thyroid Gland/pathology Thyroid Gland/ultrasonography Thyroid Nodule/immunology Thyroid Nodule/pathology Thyrotropin/blood |
description |
Hashimoto's thyroiditis (HT) has been characterized for many years as a well-defined clinicopathologic entity, but is now considered a heterogeneous disease. IgG4-related HT is a new subtype characterized by thyroid inflammation rich in IgG4-positive plasma cells and marked fibrosis. It may be part of the systemic IgG4-related disease. We report a case of a 56-year-old Portuguese man who presented with a one-month history of progressive neck swelling and dysphagia. Laboratory testing revealed increased inflammatory parameters, subclinical hypothyroidism and very high levels of thyroid autoantibodies. Cervical ultrasound (US) demonstrated an enlarged and heterogeneous thyroid gland and two hypoechoic nodules. US-guided fine needle aspiration cytology was consistent with lymphocytic thyroiditis. The patient was submitted to total thyroidectomy and microscopic examination identified typical findings of HT, marked fibrosis limited within the thyroid capsule and lymphoplasmacytic infiltration, with >50 IgG4-positive plasma cells per high-power field and an IgG4/IgG ratio of >40%. After surgery, serum IgG4 concentration was high-normal. Symptoms relief and reduction in laboratory inflammatory parameters were noticed. Thyroid function is controlled with levothyroxine. To our knowledge we report the first case of IgG4-related HT in a non-Asian patient. We also perform a review of the literature regarding IgG4-related disease and IgG4-related HT. Our case highlights this new variant of the well known HT, and helps physicians in recognizing its main clinical features, allowing for proper diagnosis and treatment. |
publishDate |
2014 |
dc.date.none.fl_str_mv |
2014-12-05T17:15:24Z 2014 2014-01-01T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.17/1956 |
url |
http://hdl.handle.net/10400.17/1956 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Arq Bras Endocrinol Metabol. 2014 Nov;58(8):862-8 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Scielo |
publisher.none.fl_str_mv |
Scielo |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799131291311931392 |