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IgG4-Related Hashimoto's Thyroiditis - A New Variant of a Well Known Disease

2014Journal article Open access
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dc.contributor.advisorThyroidectomy
dc.contributor.authorVara Luiz, H
dc.contributor.authorGonçalves, D
dc.contributor.authorNunes da Silva, T
dc.contributor.authorNascimento, I
dc.contributor.authorRibeiro, A
dc.contributor.authorMafra, M
dc.contributor.authorManita, I
dc.contributor.authorPortugal, J
dc.date.accessioned2014-12-05T17:15:24Z
dc.date.available2014-12-05T17:15:24Z
dc.date.issued2014
dc.description.abstractHashimoto'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.por
dc.identifier.citationArq Bras Endocrinol Metabol. 2014 Nov;58(8):862-8por
dc.identifier.urihttp://hdl.handle.net/10400.17/1956
dc.language.isoengpor
dc.peerreviewedyespor
dc.publisherScielopor
dc.subjectCHLC ANPATpor
dc.subjectBiopsy, Fine-Needlepor
dc.subjectHashimoto Disease/immunologypor
dc.subjectHashimoto Disease/pathology
dc.subjectHashimoto Disease/ultrasonography
dc.subjectImmunoglobulin G/analysis
dc.subjectNeck/ultrasonography
dc.subjectPlasma Cells/immunology
dc.subjectThyroid Gland/immunology
dc.subjectThyroid Gland/pathology
dc.subjectThyroid Gland/ultrasonography
dc.subjectThyroid Nodule/immunology
dc.subjectThyroid Nodule/pathology
dc.subjectThyrotropin/blood
dc.titleIgG4-Related Hashimoto's Thyroiditis - A New Variant of a Well Known Diseasepor
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage868por
oaire.citation.startPage862por
oaire.citation.titleArquivos Brasileiros de Endocrinologia e Metabolismopor
rcaap.rightsopenAccesspor
rcaap.typearticlepor

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