title: Graves' Disease Patients with Persistent Hyperthyroidism and Diffuse Lymphoplasmacytic Infiltration in the Thyroid Show No Histopathological Compatibility with IgG4-Related Disease.
abstract: BACKGROUND
  IgG4-related disease is a novel disease entity characterized by diffuse lymphoplasmacytic infiltration rich in IgG4-positive plasma cells and fibrosis into multiple organs. There is still controversy over whether some thyroid diseases are actually IgG4-related disease. The objective of this study was to elucidate the clinicopathological features of Graves' disease with diffuse lymphoplasmacytic infiltration in the thyroid.
  
  
  METHODS
  Among 1,484 Graves' disease patients who underwent thyroidectomy, we examined their histopathological findings including the degree of lymphoplasmacytic and fibrotic infiltration and levels of IgG4-positive plasma cells in the thyroid. Their clinical pictures were defined by laboratory and ultrasonographic evaluation.
  
  
  RESULTS
  A total of 11 patients (0.74%) showed diffuse lymphoplasmacytic infiltration in the stroma of the thyroid gland. Meanwhile, other patients showed variable lymphoid infiltration ranging from absent to focally dense but no aggregation of plasma cells in the thyroid gland. Based on the diagnostic criteria of IgG4-related disease, 5 of the 11 subjects had specifically increased levels of IgG4-positive plasma cells in the thyroid. Fibrotic infiltration was present in only 1 patient developing hypothyroidism after anti-thyroid drug treatment for 4 years, but not in the other 10 patients with persistent hyperthyroidism. Obliterative phlebitis was not identified in any of the 11 subjects. Thyroid ultrasound examination showed 1 patient developing hypothyroidism who had diffuse hypoechogenicity, but the other hyperthyroid patients had a coarse echo texture.
  
  
  CONCLUSIONS
  In our study, Graves' disease patients with persistent hyperthyroidism who had diffuse lymphoplasmacytic infiltration rich in IgG4-positive plasma cells in the thyroid showed no concomitant fibrosis or obliterative phlebitis.
authors.affiliation: Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan.
authors.forename: Eijun
authors.initials: E
authors.lastname: Nishihara
authors.affiliation: Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan.
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Hirokawa
authors.affiliation: Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ito
authors.affiliation: Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Fukata
authors.affiliation: Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Amino
authors.affiliation: Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Miyauchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000276:immunology / Q000473:pathology*; D002648:Child; D005260:Female; D005355:Fibrosis / Q000175:diagnosis / Q000209:etiology; D005500:Follow-Up Studies; D006111:Graves Disease / Q000150:complications / Q000276:immunology / Q000473:pathology*; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications / Q000276:immunology / Q000473:pathology*; D007124:Immunoenzyme Techniques; D007074:Immunoglobulin G / Q000276:immunology*; D008214:Lymphocytes / Q000276:immunology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010689:Phlebitis / Q000175:diagnosis / Q000209:etiology; D010950:Plasma Cells / Q000276:immunology / Q000473:pathology*; D011379:Prognosis; D055815:Young Adult
chemical_list: D007074:Immunoglobulin G