Clinical features of Graves' disease with elevated IgG4 level

JIANG Fan; CHEN Guo-fang; XU Shu-hang; LIU Chao

doi:10.19538/j.nk2018010114

Abstract：Objective To investigate the clinical features of Graves' disease (GD) with elevated so as serum IgG4 levels to guide the clinical practice.Methods Patients were classified into two groups according to the IgG4 level which was detected by nephelometric immunoassay:positive group (IgG4 ＞ 1.35g/L) and negative group.The clinical characteristics of these two groups were compared,including age,gender,thyroid function,ultrasound,history of autoimmune diseases,and so on.Results Ten out of 114 patients with GD had elevated serum IgG4 level,20％ of whom were male.The age,BMI,FT3,FT4,TgAb and TPOAb levels,the incidence of exophthalmos in positive group and negative group were not statistically different.In positive group,the age of onset was younger (32.21±15.01y vs.33.87±13.64y,P=0.482),but there was no statistical significance.Compared to negative group,patients with increased IgG4 concentration had lower TSH level (0.29±0.83 mU/L vs.3.09±14.90 mU/L,P=0.013),higher TRAb level (17.37±13.61 U/L vs.9.13±12.04 U/L,P=0.017) and higher dosage of ATD (17.13±8.62mg vs.9.08±7.93mg,P=0.005).These differences were statistical.Correlation analysis showed that IgG4 level was positively correlated with TRAb,r=0.339,P=0.016.Conclution GD patients with positive IgG4 are more severe than those with negative IgG4,and the dosage is higher,and they are more likely to relapse.Clinically,patients with severe hyperthyroidism or frequent recurrence should be considered to receive detection of serum IgG4 concentration.If necessary,glucocorticoid administration should be considered.For patients with high TRAb level,evaluation of serum IgG4 is necessary.Those with high IgG4 level and stable TSH level should be treated with glucocorticoid.