Immunoglobulin G4-Related Thyroid Diseases. Issue 4 (3rd December 2016)

• Record Type: Journal Article
• Authors: Kottahachchi, Dulani; Topliss, Duncan J.
• Is Part Of: European thyroid journal. Volume 5:Issue 4(2016)
• Page Start: 231
• Page End: 239
• Publication Date: 2016-12-03
• Subjects: Riedel thyroiditis -- Graves disease -- Immunoglobulin G4 -- Hashimoto thyroiditis -- Tamoxifen -- Rituximab; Thyroid gland -- Diseases -- Periodicals; Thyroid Diseases -- Periodicals; 612.44
• DOI: 10.1159/000452623
• Languages: English
• ISSNs: 2235-0640

Abstract

Abstract : Immunoglobulin G4-related disease (IgG4-RD) is a new disease category involving many organ systems, including the endocrine system in general and the thyroid in particular. Since an initial association was made between hypothyroidism and autoimmune (IgG4-related) pancreatitis, more forms of IgG4-related thyroid disease (IgG4-RTD) have been recognized. Four subcategories of IgG4-RTD have so far been identified: Riedel thyroiditis (RT), fibrosing variant of Hashimoto thyroiditis (FVHT), IgG4-related Hashimoto thyroiditis, and Graves disease with elevated IgG4 levels. Although a male predominance is seen for IgG4-RD in general, RT and FVHT have a female preponderance. The pathogenesis of IgG4-RD is not completely understood; however, genetic factors, antigen-antibody reactions, and an allergic phenomenon have been described. Diagnosis of IgG4-RD requires a combination of clinical features, serological evidence, and histological features. Histology is the mainstay of diagnosis, with IgG4 immunostaining. Although serum IgG4 levels are usually elevated in IgG4-RD, raised serum IgG4 is neither necessary nor adequate for diagnosis. Imaging supports the diagnosis and is a useful tool in disease monitoring. Management of IgG4-RTD is both medical and surgical. Steroids are the first-line treatment and may produce a swift response. Tamoxifen and rituximab are second-line agents used in steroid-resistant patients. Surgical debulking is carried out in RT solely as a procedure to relieve obstruction. Other endocrine associations described with IgG4-RD are hypophysitis and Hashimoto encephalopathy. IgG4-RTD is an uncommon disease entity, and prompt diagnosis and treatment can improve outcomes.