IgG4-Related Disease of the Thyroid Gland Requiring Emergent Total Thyroidectomy: A Case Report

IgG4-Related Disease of the Thyroid Gland Requiring Emergent Total Thyroidectomy: A Case Report IgG4-related disease of the thyroid gland is a recently recognized subtype of thyroiditis, often with rapid progression requir- ing surgical treatment. It is considered as a spectrum of disease varying from early IgG4-related Hashimoto’s thyroiditis (HT) pattern to late fibrosing HT or Riedel’s thyroiditis patterns. Here, we report a 47-year-old Malay woman presenting with progressively painless neck swelling over 3 years and subclinical hypothyroidism. Computed tomography (CT) scan revealed diffuse thyroid enlargement (up to 13 cm) with retrosternal extension and without regional lymphadenopathy. Fine needle aspiration of the thyroid showed a limited number of follicular epithelial cell groups with widespread Hurthle cell change and scanty background colloid, but no evidence of lymphocytosis. The cytologic features fell into the category of ‘atypia of undetermined significance’. Subsequently, the patient developed hypercapnic respiratory failure secondary to extrinsic upper airway compression by the thyroid mass and underwent emergent total thyroidectomy. Histology of the thyroid showed diffuse dense lymphoplasmacytic infiltrate and fibrosis. Follicular cells exhibited reactive nuclear features and some Hurthle cell change. IgG4+ plasma cells were over 40/high power field while overall IgG4/IgG ratio was above 50%. The overall features suggest the diagnosis of IgG4-related disease of the thyroid gland in the form of IgG4-related http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Head and Neck Pathology Springer Journals

IgG4-Related Disease of the Thyroid Gland Requiring Emergent Total Thyroidectomy: A Case Report

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Publisher
Springer US
Copyright
Copyright © 2018 by Springer Science+Business Media, LLC, part of Springer Nature
Subject
Medicine & Public Health; Pathology; Otorhinolaryngology; Oral and Maxillofacial Surgery; Dentistry
eISSN
1936-0568
D.O.I.
10.1007/s12105-018-0940-4
Publisher site
See Article on Publisher Site

Abstract

IgG4-related disease of the thyroid gland is a recently recognized subtype of thyroiditis, often with rapid progression requir- ing surgical treatment. It is considered as a spectrum of disease varying from early IgG4-related Hashimoto’s thyroiditis (HT) pattern to late fibrosing HT or Riedel’s thyroiditis patterns. Here, we report a 47-year-old Malay woman presenting with progressively painless neck swelling over 3 years and subclinical hypothyroidism. Computed tomography (CT) scan revealed diffuse thyroid enlargement (up to 13 cm) with retrosternal extension and without regional lymphadenopathy. Fine needle aspiration of the thyroid showed a limited number of follicular epithelial cell groups with widespread Hurthle cell change and scanty background colloid, but no evidence of lymphocytosis. The cytologic features fell into the category of ‘atypia of undetermined significance’. Subsequently, the patient developed hypercapnic respiratory failure secondary to extrinsic upper airway compression by the thyroid mass and underwent emergent total thyroidectomy. Histology of the thyroid showed diffuse dense lymphoplasmacytic infiltrate and fibrosis. Follicular cells exhibited reactive nuclear features and some Hurthle cell change. IgG4+ plasma cells were over 40/high power field while overall IgG4/IgG ratio was above 50%. The overall features suggest the diagnosis of IgG4-related disease of the thyroid gland in the form of IgG4-related

Journal

Head and Neck PathologySpringer Journals

Published: May 31, 2018

References

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