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IgG4 serum levels in Graves' orbitopathy.

S Comi1, G Lanzolla1,2, G Cosentino1

  • 1Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.

Journal of Endocrinological Investigation
|December 21, 2023
PubMed
Summary

This study found no association between immunoglobulin G4 (IgG4) and Graves' orbitopathy (GO) in patients with Graves' disease (GD). Elevated IgG4 levels did not differ between patients with or without GO, suggesting IgG4 is not a key factor in GO development.

Keywords:
Graves’ diseaseGraves’ orbitopathyIgG4Thyroid eye disease

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Area of Science:

  • Endocrinology
  • Immunology

Background:

  • Immunoglobulin G4-related disease (IgG4-RD) can affect multiple organs, and a potential link between IgG4, Graves' disease (GD), and Graves' orbitopathy (GO) has been debated.
  • Conflicting results exist regarding the association between IgG4 and GO, necessitating further investigation.

Purpose of the Study:

  • To investigate the association between serum immunoglobulin G4 (IgG4) levels and Graves' orbitopathy (GO) in patients with Graves' disease (GD).
  • To evaluate serum IgG4 concentrations, IgG4/IgG ratio, and their prevalence in relation to GO.
  • To explore the correlation between IgG4 and specific eye features or anti-TSH receptor antibodies (TRAbs).

Main Methods:

  • A retrospective study involving 297 patients with GD and 152 patients with GO.
  • Assessment of serum IgG4 concentrations and IgG4/IgG ratio, with a focus on IgG4 levels ≥135 mg/dL (a threshold for IgG4-RD).
  • Analysis of subgroups based on FT3 concentrations to account for potential confounding factors.

Main Results:

  • In a relevant subgroup analysis (second and third FT3 quartiles), no significant differences in baseline parameters were observed between patients with and without GO.
  • The prevalence of elevated IgG4 levels (≥135 mg/dL) was similar in patients with and without GO (17.9% vs 17.3%).
  • No differences were found in IgG4 concentrations, IgG4/IgG ratio prevalence (≥8.0%), or correlations between IgG4 and eye features or TRAb levels.

Conclusions:

  • The study suggests that serum IgG4 levels are not associated with Graves' orbitopathy (GO) in patients with Graves' disease (GD).
  • These findings indicate that IgG4 may not play a significant role in the pathogenesis of GO within the context of GD.