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首页> 外文期刊>American Journal of Case Reports >IgG4-Related Fibrous Thyroiditis (Riedel’s Thyroiditis): A Case Report
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IgG4-Related Fibrous Thyroiditis (Riedel’s Thyroiditis): A Case Report

机译：IgG4相关的纤维状炎（Riedel的甲状腺炎）：案例报告

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Patient: Female, 69-year-old Final Diagnosis: Riedel thyroiditis Symptoms: Dysphagia ? goiter Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Rare disease Background: Riedel’s thyroiditis is a rare form of immunoglobulin G (IgG) 4-related invasive fibrosis of the thyroid gland; given its scarce incidence, standardized therapeutic guidelines are unavailable. Although complications are unusual, obstructive symptoms produced by the stony-hard goiter may put patients’ lives at risk. The diagnosis must be biopsy-proven, and treatment consists of thyroid hormone replacement and anti-inflammatory drugs, although sometimes thyroidectomy may be required. Case Report: A 69-year-old woman presented with a 7-month history of progressive hypothyroidism and obstructive dysphagia. On physical examination, she had a large, stony-hard goiter. A Doppler ultrasound study revealed a massive, avascular enlargement of the thyroid gland. A computed tomography scan failed to demonstrate any extrathyroidal extension of the abnormal tissue. A Tru-Cut biopsy of the thyroid was performed. Extensive replacement of thyroid follicles by prominent bands of fibrous tissue was observed, with follicular obliteration and mild focal occlusive phlebitis. A lymphoplasmacytic infiltrate was clearly identified; no oxyphilic nor giant cells were found. On immunohistochemistry, the immunoglobulin G (IgG) 4/IgG ratio in the plasma cell infiltrate was 40%; increased serum IgG4 levels were also found, supporting the diagnosis of Riedel’s thyroiditis. The patient was successfully treated with levothyroxine replacement and tamoxifen with prompt resolution of obstructive symptoms. Conclusions: Fibrous thyroiditis should be considered in the differential diagnosis of primary hypothyroidism in a patient with a stony-hard goiter. Although steroids are often used as a therapeutic strategy for this disease, our patient had an excellent therapeutic response to tamoxifen, avoiding adverse effects associated with steroid therapy, the higher cost of monoclonal antibody therapy, and surgery-associated risks.
机译：病人：女性，69岁的最终诊断：Riedel甲状腺炎症状：吞咽困难？甲状腺药物： - 临床手术： - 专业：内分泌和代谢目标：稀有疾病背景：Riedel的甲状腺炎是一种罕见的免疫球蛋白G（IgG）4相关的甲状腺侵袭性纤维化;鉴于其稀缺发病率，标准化的治疗指南不可用。虽然并发症是不寻常的，但石硬甲状腺果产生的阻塞性症状可能让患者的生活有风险。诊断必须是活组织检查证明的，并且治疗包括甲状腺激素置换和抗炎药，但有时可能需要甲状腺切除术。案例报告：一名69岁女性展示了7个月的渐进式甲状腺功能亢进历史和阻塞性吞咽困难。在体检时，她有一个大的石头硬甲状腺肿。多普勒超声研究揭示了甲状腺腺体的巨大，荒谬的扩大。计算的断层摄影扫描未能证明异常组织的任何脱细胞脱滴延伸。进行甲状腺的Tru-Cut活检。观察到通过突出的纤维组织突出的纤维组织的甲状腺卵泡的广泛替代，卵泡湮灭和轻度局灶性闭塞性静脉炎。清楚地识别出淋巴基术渗透;没有发现辛杂环或巨细胞。在免疫组织化学中，血浆细胞浸润中的免疫球蛋白G（IgG）4 / IgG比为40％;还发现了增加血清IgG4水平，支持Riedel的甲状腺炎的诊断。患者已成功用左旋甲胺替代品和他莫昔芬治疗，并迅速分辨阻塞性症状。结论：纤维状炎应在用石硬甲状腺肿的患者鉴别诊断鉴别诊断。虽然类固醇通常被用作这种疾病的治疗策略，但我们的患者对他莫昔芬的治疗反应具有出色的治疗反应，避免了与类固醇治疗相关的不利影响，单克隆抗体治疗的成本更高，以及手术相关的风险。

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