Takahashi Hiroyuki, Kajita Sabine, Katoh Hiroshi, Matsumoto Toshihide, Inoue Akemi, Sangai Takafumi, Saegusa Makoto
Department of Pathology, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan.
Department of Pathology, School of Medicine, Kitasato University, Kanagawa, Japan.
Heliyon. 2024 Feb 7;10(4):e25843. doi: 10.1016/j.heliyon.2024.e25843. eCollection 2024 Feb 29.
We report a case of immunoglobulin (ig)-g4-related thyroiditis associated with graves' disease. a 45-year-old man was diagnosed with graves' disease due to asymptomatic enlarged thyroid gland and high serum levels of thyrotropin receptor antibodies and thyroid hormones. surgical resection of the thyroid gland was performed because of further thyroid gland enlargement and severe fluctuations in the thyroid hormonal levels, despite medical therapy with a combination of an antithyroid drug and a thyroid hormone preparation. macroscopic examination of the resected thyroid gland revealed a grayish-white diffuse swelling, and histopathological findings revealed follicular destruction, chronic inflammatory cell infiltration with diffuse igg4-positive plasma cells (IgG4/IgG >40%), storiform fibrosis, and phlebitis obliterans throughout the thyroid tissue. Additionally, there were small foci of high columnar follicular components with scalloping, resembling Graves' disease. We propose that all patients with Graves' disease should be evaluated for coexisting IgG4-related thyroiditis to detect ophthalmopathies as soon as possible.
我们报告一例与格雷夫斯病相关的免疫球蛋白（Ig）-G4相关性甲状腺炎。一名45岁男性因无症状性甲状腺肿大以及血清促甲状腺素受体抗体和甲状腺激素水平升高而被诊断为格雷夫斯病。尽管采用抗甲状腺药物和甲状腺激素制剂联合进行药物治疗，但由于甲状腺进一步肿大以及甲状腺激素水平严重波动，仍对其实施了甲状腺手术切除。对切除的甲状腺进行大体检查发现灰白色弥漫性肿胀，组织病理学结果显示滤泡破坏、伴有弥漫性IgG4阳性浆细胞的慢性炎性细胞浸润（IgG4/IgG>40%）、席纹状纤维化以及整个甲状腺组织的闭塞性静脉炎。此外，还有小灶性高柱状滤泡成分并伴有扇贝样改变，类似格雷夫斯病。我们建议对所有格雷夫斯病患者评估是否并存IgG4相关性甲状腺炎，以便尽早发现眼病。
