Clinical relationship between IgG4-positive Hashimoto's thyroiditis and papillary thyroid carcinoma.

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Clinical relationship between IgG4-positive Hashimoto's thyroiditis and papillary thyroid carcinoma.

J Clin Endocrinol Metab. 2016 Feb 11;:jc20153783

Authors: Yu Y, Zhang J, Lu G, Li T, Zhang Y, Yu N, Gao Y, Gao Y, Guo X

Abstract
CONTEXT: Hashimoto's thyroiditis (HT) can be divided into IgG4-positive and IgG4-negative HT. The potential association between IgG4-positive HT and papillary thyroid carcinoma (PTC) remains poorly understood.
OBJECTIVE: The aim was to investigate the relationship between IgG4-positive HT and PTC, and to compare the prognostic parameters of PTC patients with and without IgG4-positive HT.
DESIGN: A retrospective study.
PATIENTS AND SETTING: 66 HT patients (18 HT alone, 48 HT with PTC) with serum samples stored before operation were collected. Another 18 PTC alone patients were collected as controls.
MAIN OUTCOME MEASURES: Expression of IgG4, IgG and TGF-β1 in thyroid tissues, serum levels of IgG4, TgAb IgG, TgAb IgG4, TPOAb IgG, and TPOAb IgG4.
RESULTS: 17 (35.4%) HT with PTC patients were IgG4-positive HT, while only one patient (5.6%) was found to be IgG4-positive in HT alone group. In contrast, there were only few IgG4-positive plasma cells in PTC alone group. The association of IgG4-positive HT and PTC was statistically significant (P < 0.05). Moreover, serum levels of TgAb IgG4 and the ratios of TgAb IgG4/TgAb IgG were significantly higher in HT with PTC and PTC alone groups than in the HT alone group (P < 0.05). Furthermore, in the HT with PTC group, the average tumor diameter of 17 IgG4-positive HT with PTC patients was 1.7 ± 0.8 cm while of 31 IgG4-negative HT with PTC patients the diameter was 1.2 ± 0.6 cm (P = 0.01). A considerably higher percentage of lymph node metastasis (41.2% vs. 12.9%; P = 0.026) was found in PTC patients with IgG4-positive HT as compared to those with IgG4-negative HT.
CONCLUSION: PTC may be facilitated by pre-existing autoimmune inflammation of IgG4-positive HT. IgG4-positive HT with PTC cases may have worse clinical outcomes. The high levels of TgAb IgG4 might present a risk factor for PTC.

PMID: 26866571 [PubMed - as supplied by publisher]

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