IgG4相关性甲状腺疾病新进展

Update of IgG4-related thyroid diseases

IgG4相关性甲状腺疾病(IgG4-RTD)包括Riedel甲状腺炎(RT)、桥本甲状腺炎纤维样变型、IgG4相关性桥本甲状腺炎(IgG4-RHT)及伴高IgG4血症的Graves病。此外,IgG4可能与甲状腺癌发病有关。IgG4-RTD的发病机制尚不清楚,其诊断主要依据血IgG4水平和组织病理学检查。糖皮质激素是RT一线治疗方案,对于糖皮质激素不能诱导缓解及存在治疗禁忌证者,可单独或联合免疫抑制剂及生物抑制剂治疗。IgG4-RHT和伴高IgG4血症Graves病的治疗,仍以甲状腺激素替代和抗甲状腺药物治疗为主。

IgG4-related thyroid disease(IgG4-RTD)includes Riedel′s thyroiditis(RT),fibrosing variant of Hashimoto′s thyroiditis,IgG4 related Hashimoto′s thyroiditis(IgG4-RHT),and Graves′disease with elevated serum IgG4.In addition,IgG4 may involve in the onset of thyroid cancer.The pathogenesis of IgG4-RTD is unclear,and its diagnosis is mainly based on the levels of serum IgG4 and histopathology.Glucocorticoid is the first-line treatment for RT,and for patients who cannot receive remission or have contraindications to glucocorticoids,immunosuppressants and biological inhibitors can be administrated alone or in combination with glucocorticoids.However,the therapy of IgG4-RHT and Graves′disease with elevated serum IgG4 still depend on thyroid hormone replacement and antithyroid therapy.