- 期刊
IgG4相關性亞急性甲狀腺炎模擬甲狀腺惡性腫瘤－病例報告
IgG4-Related Subacute Thyroiditis Masquerading as Thyroid Malignancy-Case Report
摘要
在臨床上，快速增大的甲狀腺情況並不少見，其中涵蓋了從甲狀腺炎到甲狀腺腫瘤的範圍。IgG4相關性甲狀腺炎是一種罕見的免疫介導性疾病，特徵為高IgG4水平和淋巴細胞浸潤，可能影響多個器官，包括甲狀腺。一位70歲女性病患於2023年7月中旬至本院門診，主訴為頸部疼痛3週，無心悸、手抖、聲音沙啞等症狀，經由理學檢查發現甲狀腺腫大，並有按壓疼痛，超音波顯示右側1.5cm結節，左側4.3cm結節，均無鈣化現象，free T4 1.04（正常值0.7-1.48），TSH 0.251（正常值0.35-4.94），TA>1000，超音波導引細針穿刺結果顯示左、右側結節均為甲狀腺惡性腫瘤可能性高，因此安排接受手術。術中左側全甲狀腺切除冰凍病理報告為亞急性甲狀腺炎，後續右側全甲狀腺切除冰凍病理報告亦為亞急性甲狀腺炎，術後無併發症。最終病理報告顯示為IgG4相關性亞急性甲狀腺炎，術後血清IgG4為374（正常值3-201）。本病例報告旨在揭示IgG4相關性甲狀腺炎如何模仿甲狀腺惡性腫瘤的臨床特徵，為臨床醫生提供評估和診斷此類病例的重要參考。強調即便細針穿刺顯示惡性腫瘤可能性，亦應考慮IgG4相關性甲狀腺炎的可能，並通過進一步的核心針活檢或影像學檢查來避免不必要的治療，特別當疾病可用藥物治療時。
並列摘要
In clinical practice, rapidly enlarging thyroid conditions are not uncommon, encompassing a range from thyroiditis to thyroid tumors. IgG4-related thyroiditis is a rare immune-mediated disease characterized by high levels of IgG4 and lymphocytic infiltration, which can affect multiple organs including the thyroid. A 70-year-old female patient visited our clinic in mid-July 2023, complaining of neck pain for three weeks without symptoms of palpitations, tremors, or hoarseness. Physical examination revealed an enlarged thyroid with tenderness upon palpation. Ultrasound showed a 1.5 cm nodule on the right side and a 4.3 cm nodule on the left, neither showing calcification. Blood tests showed free T4 at 1.04 (normal range 0.7-1.48), TSH at 0.251 (normal range 0.35-4.94), and TA > 1000. Ultrasound-guided fine needle aspiration suggested a high likelihood of malignant thyroid tumors for both nodules, leading to the decision for surgery. Intraoperative frozen section analysis of the left thyroidectomy showed subacute thyroiditis, and subsequent right thyroidectomy also confirmed subacute thyroiditis with no postoperative complications. The final pathology report identified the condition as IgG4-related subacute thyroiditis, with postoperative serum IgG4 levels at 374 (normal range 3-201). This case report elucidates the clinical presentation of IgG4-related thyroiditis and its resemblance to thyroid malignancies serving as a crucial guide for clinicians in the evaluation and diagnostic process of such conditions. It highlights that the potential for IgG4-related thyroiditis should remain a consideration even when fine needle aspiration results suggest a high likelihood of malignancy. It also advocates for additional investigations, such as core needle biopsies or advanced imaging techniques, to circumvent unnecessary interventions, particularly in scenarios where pharmacological management is feasible.