IgG4-related Hashimoto’s thyroiditis – A new variant of a well known disease

Detalhes bibliográficos
Autor(a) principal: Luiz,Henrique Vara
Data de Publicação: 2014
Outros Autores: Gonçalves,Diogo, Silva,Tiago Nunes da, Nascimento,Isabel, Ribeiro,Ana, Mafra,Manuela, Manita,Isabel, Portugal,Jorge
Tipo de documento: Relatório
Idioma: eng
Título da fonte: Arquivos Brasileiros de Endocrinologia & Metabologia (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27302014000800862
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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spelling IgG4-related Hashimoto’s thyroiditis – A new variant of a well known diseaseHashimoto’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.Sociedade Brasileira de Endocrinologia e Metabologia2014-11-01info:eu-repo/semantics/reportinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27302014000800862Arquivos Brasileiros de Endocrinologia & Metabologia v.58 n.8 2014reponame:Arquivos Brasileiros de Endocrinologia & Metabologia (Online)instname:Sociedade Brasileira de Endocrinologia e Metabologia (SBEM)instacron:SBEM10.1590/0004-2730000003283info:eu-repo/semantics/openAccessLuiz,Henrique VaraGonçalves,DiogoSilva,Tiago Nunes daNascimento,IsabelRibeiro,AnaMafra,ManuelaManita,IsabelPortugal,Jorgeeng2014-11-26T00:00:00Zoai:scielo:S0004-27302014000800862Revistahttps://www.aem-sbem.com/ONGhttps://old.scielo.br/oai/scielo-oai.php||abem-editoria@endocrino.org.br1677-94870004-2730opendoar:2014-11-26T00:00Arquivos Brasileiros de Endocrinologia & Metabologia (Online) - Sociedade Brasileira de Endocrinologia e Metabologia (SBEM)false
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
Luiz,Henrique Vara
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 Luiz,Henrique Vara
author_facet Luiz,Henrique Vara
Gonçalves,Diogo
Silva,Tiago Nunes da
Nascimento,Isabel
Ribeiro,Ana
Mafra,Manuela
Manita,Isabel
Portugal,Jorge
author_role author
author2 Gonçalves,Diogo
Silva,Tiago Nunes da
Nascimento,Isabel
Ribeiro,Ana
Mafra,Manuela
Manita,Isabel
Portugal,Jorge
author2_role author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Luiz,Henrique Vara
Gonçalves,Diogo
Silva,Tiago Nunes da
Nascimento,Isabel
Ribeiro,Ana
Mafra,Manuela
Manita,Isabel
Portugal,Jorge
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 2014-11-01
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dc.publisher.none.fl_str_mv Sociedade Brasileira de Endocrinologia e Metabologia
publisher.none.fl_str_mv Sociedade Brasileira de Endocrinologia e Metabologia
dc.source.none.fl_str_mv Arquivos Brasileiros de Endocrinologia & Metabologia v.58 n.8 2014
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