The Clinical Features Of IgG4-related Graves' Disease And Hashimoto's Thyroiditis

Objective:Investigating the clinical features of Graves' disease(GD)and Hashimoto's thyroiditis(HT)with elevated serum IgG4 levels to guide the clinical practice.Method:In this study,serum IgG4 concentration was detected in patients with GD or HT.Patients with Graves' disease or HT were classified into two groups according to the IgG4 level:positive group(IgG4>1.35g/L)and negative group.The clinical characteristics of these two groups were compared,including age,gender,thyroid function,ultrasound,type of syndrome,history of autoimmune diseases,and so on.Results:(1)10 out of 114 patients(8.77%)with GD had elevated serum IgG4 level,20%of them were male.The age,BMI,FT3,FT4,TgAb and TPOAb levels,the incidence of exophthalmos in positive group and negative group were not statistically significant.In positive group,the age of onset was younger(32.21±15.Oly vs.33.87±13.64y,p=0.482),but there was no statistical significance.Comparing to negative group,patients with increased IgG4 concentration had lower TSH level(0.29±0.83uIU/ml vs.3.09±14.90uIU/ml,p=0.013),higher TRAb level(17.37±13.61mIU/ml vs.9.13±12.04mIU/ml,p=0.017)and higher dosage of ATD(17.13 ±8.62mg vs.9.08±7.93mg,p=0.005).Correlation analysis showed that IgG4 level was positively correlated with TRAb,r=0.339,p=0.016.The results of syndrome analysis showed that XinGanHuoWang syndrome was the main syndrome in both IgG4 positive group and negative group.(2)9 out of 102 patients with HT were positive(8.82%),all of them were women.There was no significant difference in age,FT3,FT4,TSH,TgAb level,nodule incidence,AID family history between the two groups.The level of TPOAb in positive group was significantly higher than that in negative group(1300 ± OU/ml vs.912.21±520.61U/ml,p=0.029),however the correlation analysis showed no correlation between IgG4 and TPOAb.In the positive group,the degree of hypothyroidism was more severe,and the dosage of LT4 substitution was significantly higher than that of the negative group(58.93±48.80ug vs.26.36±37.62ug,p=0.049).The results of syndrome analysis showed that the TanYuHuJie syndrome was the main type in both IgG4 positive group and whole HT patients.However,no one with high IgG4 level performance as the PiShenYangXu syndrome which accounting for a large proportion in the whole HT patients.Conclusions:Patients with IgG4 positive GD were more severe than those in negative group,and the dosage was higher,and more likely to relapse.In clinical,patients with severe hyperthyroidism or frequent recurrence should be considered to detect serum IgG4 concentration.If necessary,glucocorticoid administration should be considered.For patients with high TRAb level,evaluation of serum IgG4 is necessary.Those with high IgG4 level and stable TSH level should be treated with glucocorticoid.For HT,the degree of hypothyroidism in positive group is more severe.For patients with high IgG4 level but no serious fibrosis or obvious swelling or compression symptoms,glucocorticoid administration shouldn't be considered.However for patients with the above performance,transient high dose of glucocorticoid therapy is necessary,and then turn to maintenance therapy.