Proposal of diagnostic criteria for IgG4-related thyroid disease
Proposal of diagnostic criteria for IgG4-related thyroid disease
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DOI：
10.1507/endocrj.ej20-0557
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发表时间：
2021-01-01
影响因子：
2
通讯作者：
Akamizu, Takashi
中科院分区：
文献类型：
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作者：
Takeshima, Ken;Li, Yaqiong;Akamizu, Takashi
在日本，IgG 4相关疾病（IgG 4-RD）患者通过综合或器官特异性诊断标准进行诊断。迄今为止，已为几个器官建立了器官特异性标准，但尚未为甲状腺建立。我们试图根据日本厚生劳动省难治性疾病研究计划的IgG 4-RD研究建立IgG 4相关甲状腺疾病（IgG 4-RTD）的诊断标准。这些标准已公开报告给日本内分泌学会和日本甲状腺协会的成员。与IgG 4相关的甲状腺疾病包括桥本甲状腺炎、格雷夫斯病和里德尔甲状腺炎。作为包括系统性和器官特异性形式的综合定义，我们使用广义术语“IgG 4相关甲状腺疾病”。IgG 4-RTD的诊断标准包括以下五项：I）甲状腺肿大，II）超声检查甲状腺低回声病变，III）血清IgG 4水平升高，IV）甲状腺病变的组织病理学发现（IgG 4（+）浆细胞>20/HPF和IgG 4（+）/IgG（+）浆细胞比值>30%）和V）累及其他器官。当I、II、III和IV全部满足时，作出IgG 4-RTD的“确诊”诊断，而当I、II和IV或V满足时，作出IgG 4-RTD的“可能”诊断。符合I、II和III标准的患者被视为“可能的”IgG 4-RTD。我们认为，建议的诊断标准有助于更准确的诊断IgG 4-RTD以及排除拟态。此外，他们可能会导致更好地了解IgG 4-RTD的临床意义和潜在的发病机制。
Patients with IgG4-related disease (IgG4-RD) are diagnosed in Japan by comprehensive or organ-specific diagnostic criteria. To date, organ-specific criteria have been established for several organs, but not for the thyroid. We attempted to establish diagnostic criteria for IgG4-related thyroid disease (IgG4-RTD) based on IgG4-RD research by The Research Program on Intractable Diseases from the Ministry of Health, Labour and Welfare of Japan. These criteria have been publicly reported to members of both the Japan Endocrine Society and the Japan Thyroid Association. Thyroid diseases associated with IgG4 include Hashimoto's thyroiditis, Graves' disease and Riedel's thyroiditis. As a comprehensive definition that includes both systematic and organ-specific forms, we use the broad term 'IgG4-related thyroid disease'. Diagnostic criteria for IgG4-RTD comprise the following five items: I) enlargement of the thyroid, II) hypoechoic lesions in the thyroid by ultrasonography, III) elevated serum IgG4 levels, IV) histopathological findings in the thyroid lesion (IgG4(+) plasma cells >20/HPF and IgG4(+)/IgG(+) plasma cell ratio >30%) and V) involvement of other organs. "Definitive" diagnosis of IgG4-RTD is made when I, II, III and IV are all fulfilled, while "probable" diagnosis of IgG4-RTD is when I, II, and IV or V are fulfilled. Patients who fulfill I, II and III criteria are considered as "possible" IgG4-RTD. We believe that the proposed diagnostic criteria contribute to more accurate diagnosis of IgG4-RTD as well as exclusion of mimicry. Furthermore, they may lead to better understanding of the clinical implications and underlying pathogenesis of IgG4-RTD.