Ocular Manifestations and Clinical Implications of Serum Immunoglobulin G4 Levels in Graves’ Ophthalmopathy Patients

ABSTRACT

Purpose

To investigate the association between serum immunoglobulin G4 (IgG4) levels and laboratorial parameters. Moreover, the ocular manifestations were compared in Graves’ ophthalmopathy (GO) patients.

Methods

Fifty-seven GO patients and fifty sex- and age-matched euthyroid subjects were enrolled. Serum IgG4 and immunoglobulin G (IgG) levels, thyroid hormones and thyroid autoantibodies were measured in all participants. Ophthalmologic examinations were performed to GO patients.

Results

Serum IgG4 levels were increased in GO patients compared with euthyroid subjects (p<0.001). Multivariate analysis showed that TRAb levels were correlated with IgG4 levels in GO patients (β=1.45, p = 0.024). There were eight GO patients with IgG4 levels ≥ 135 mg/dL. They all had both eyelids swelling and the differences of HER were less than 2mm. Seven patients (7/8) showed bilateral symmetrical thickening of the extraocular muscles.

Conclusions

Bilateral symmetry of ocular manifestation was observed in GO patients with IgG4 levels ≥135 mg/dL. IgG4 levels may be helpful in monitoring GO and diagnosing a new subtype of GO.

KEYWORDS:

• Graves’ ophthalmopathy
• IgG4
• TRAb
• thyroid autoantibody

Acknowledgments

Liwen Chen, Nan Xiang designed and coordinated the study. Ban Luo, Xu Yuan, Rong Liu, Weikun Hu and Jing Zhang collected data. Liwen Chen, Ban Luo performed and analyzed the data. Ban Luo, Wei Wang, Xin Qi and Jing Zhang prepared the tables the figure. Ban Luo wrote the manuscript. All authors reviewed the results, revised the manuscript and approved it for submission. The authors declare that they have no conflicts of interest with the contents of this article.This study was supported by the Natural Science Foundation of Hubei Province (Grant numbers 2019CFB494).

Declaration of Interest

The authors declare no conflict of interest.

Additional information

Funding

This work was supported by the Natural Science Foundation of Hubei Province [2019CFB494].