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Immunoglobulin G4-Related Thyroid Disease: A Single-Center Experience and Literature Review
김미화,Bictdeun Kim,장아름,전민지,최영준,이유미,송동은,김원구 대한내분비학회 2022 Endocrinology and metabolism Vol.37 No.2
Background: Immunoglobulin G4 (IgG4)-related disease is an entity that can involve the thyroid gland. The spectrum of IgG4-related thyroid disease (IgG4-RTD) includes Hashimoto thyroiditis (HT) and its fibrotic variant, Riedel thyroiditis, as well as Graves’disease. The early diagnosis of IgG4-RTD is important because it is a medically treatable disease, and a delay in the diagnosis mightresult in unnecessary surgery. We present a case series of IgG4-RTD with a review of the literature. Methods: We retrospectively reviewed the clinical presentation and the radiological and pathological findings of patients diagnosedwith IgG4-RTD between 2017 and 2021 at a tertiary medical center in Korea. We also conducted a literature review of IgG4-RTD. Results: Five patients were diagnosed with IgG4-RTD during the study period. The patients’ age ranged from 31 to 76 years, and threepatients were men. Most patients visited the clinic for a neck mass, and hypoechogenic nodular lesions were observed on neck ultrasonography. Three patients had IgG4 HT, and two patients had IgG4 Riedel thyroiditis. All patients developed hypothyroidism that necessitated L-thyroxine replacement. The diagnosis of IgG4-RTD was confirmed after a pathological examination of the surgical specimen in the first two cases. However, the early diagnosis was possible after a core needle biopsy in three clinically suspected patients. Conclusion: The diagnosis of IgG4-RTD requires clinical suspicion combined with serology and histological analyses using IgG4immunostaining. The early diagnosis of IgG4-RTD is difficult; thus, biopsy with IgG4 immunostaining and serum IgG4 measurements will help diagnose patients suspected of having IgG4-RTD.
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