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IgG4-related Hashimoto's thyroiditis--a new variant of a well known disease.
Luiz, Henrique Vara; Gonçalves, Diogo; Silva, Tiago Nunes da; Nascimento, Isabel; Ribeiro, Ana; Mafra, Manuela; Manita, Isabel; Portugal, Jorge.
Afiliação
  • Luiz HV; Department of Endocrinology and Diabetology, Hospital Garcia de Orta, Almada, Portugal.
  • Gonçalves D; Department of Anatomic Pathology, Hospital Garcia de Orta, Almada, Portugal.
  • Silva TN; Department of Endocrinology and Diabetology, Hospital Garcia de Orta, Almada, Portugal.
  • Nascimento I; Department of General Surgery, Hospital Garcia de Orta, Almada, Portugal.
  • Ribeiro A; Department of Anatomic Pathology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
  • Mafra M; Department of Anatomic Pathology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
  • Manita I; Department of Endocrinology and Diabetology, Hospital Garcia de Orta, Almada, Portugal.
  • Portugal J; Department of Endocrinology and Diabetology, Hospital Garcia de Orta, Almada, Portugal.
Arq Bras Endocrinol Metabol ; 58(8): 862-8, 2014 Nov.
Article em En | MEDLINE | ID: mdl-25465611
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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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Glândula Tireoide / Imunoglobulina G / Doença de Hashimoto Tipo de estudo: Diagnostic_studies / Prognostic_studies Limite: Humans / Male / Middle aged Idioma: En Revista: Arq Bras Endocrinol Metabol Ano de publicação: 2014 Tipo de documento: Article País de afiliação: Portugal País de publicação: Brasil
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Glândula Tireoide / Imunoglobulina G / Doença de Hashimoto Tipo de estudo: Diagnostic_studies / Prognostic_studies Limite: Humans / Male / Middle aged Idioma: En Revista: Arq Bras Endocrinol Metabol Ano de publicação: 2014 Tipo de documento: Article País de afiliação: Portugal País de publicação: Brasil