Tuberc Respir Dis.  2007 May;62(5):417-420.

A Case of Graves' Disease Coexistent with Pulmonary Sarcoidosis

• Jo KW
• Koh JH
• Lee MY
• Jung FM
• Shin YG
• Yong SJ
• Chung CH

Abstract

Sarcoidosis is a multisystemic granulomatous disease with an of unknown etiology, involving bilateral hilar lymphadenopathy, pulmonary, skin and eye lesions. However, involvement of the endocrine system in sarcoidosis is quite rare, and the coexistence of both diseases is extremely unusual. We describe a 60-year-old woman presenting with sarcoidosis and Graves' disease. She was admitted for evaluation of dry cough, dyspnea, palpitation and general weakness. Both thyroid glands were enlarged diffusely. The thyroid function tests showed suppressed serum thyrotropin and an increased thyroid hormone level. The levels of the TSH receptor antibody, anti-thyroglobulin antibody and anti-microsomal antibody were higher than normal. The radionuclide scan(131I) showed increased iodine uptake. The chest X-ray revealed pulmonary hilar enlargement and high resolution CT showed both hilar lymph nodes enlargement and tiny parenchymal nodules. The transbronchial lung biopsy showed a noncaseating granuloma without necrosis. We report this case of pulmonary sarcoidosis plus Graves' disease with a review of the relevant literatures.

Keyword

Graves' disease; Sarcoidosis; Hyperthyroidism

MeSH Terms

Biopsy
Cough
Dyspnea
Endocrine System
Female
Granuloma
Graves Disease*
Humans
Hyperthyroidism
Iodine
Lung
Lymph Nodes
Lymphatic Diseases
Middle Aged
Necrosis
Receptors, Thyrotropin
Sarcoidosis
Sarcoidosis, Pulmonary*
Skin
Thorax
Thyroid Function Tests
Thyroid Gland
Thyrotropin
Iodine
Receptors, Thyrotropin
Thyrotropin

Figure

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  Figure 1 Chest computed tomography showed bilateral hilar lymphadenopathy (red arrows) and parenchymal tiny nodules.

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  Figure 2 Lung biopsy showed noncaseating granulomas with lymphangitic distribution (A: ×100, B: ×400, H&E stain).

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  Figure 3 After injection of Tc-99m pertechnetate 5mCi, the increased uptake of radioactivity and diffusely enlarged both lobe of thyroid gland can be seen without any focal photon abnormality (A). The uptake ratios of I-131 at 2hours, 24 hours and the uptake ratio of Tc-99m pertechnetate at 20 minutes are measured 71.37%, 92.91% and 6.22%, respectively (B).

Reference

1. Ronald GC. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Chapter 309. Sarcoidosis. Harrison's principles of internal medicine. 2005. 16th ed. New York: McGraw-Hill,Inc.;2017–2023.

2. Zimmermann-Belsing T, Christensen L, Hansen HS, Kirkegaard J, Blichert-Toft M, Feldt-Rasmussen U. A case of sarcoidosis and sarcoid granuloma, papillary carcinoma, and Graves' disease in the thyroid gland. Thyroid. 2000. 10:275–278.

3. James DG, Sharma OP. From Hutchinson to now: a historical glimpse. Curr Opin Pulm Med. 2002. 8:416–423.

4. Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med. 1997. 336:1224–1234.

5. Mayock RL, Bertrand P, Morrison CE, Scott JH. Manifestations of sarcoidosis: analysis of 145 patients with a review of nine series selected from literature. Am J Med. 1963. 35:67–89.

6. Yamauchi M, Inoue D, Fukunaga Y, Kakudo K, Koshiyama H. A case of sarcoid reaction associated with papillary thyroid carcinoma. Thyroid. 1997. 7:901–903.

7. Papadopoulos KI, Hornblad Y, Liljebladh H, Hallengren B. High frequency of endocrine autoimmunity in patients with sarcoidosis. Eur J Endocrinol. 1996. 134:331–336.

8. Nakamura H, Genma R, Mikami T, Kitahara A, Natsume H, Andoh S, et al. High incidence of positive autoantibodies against thyroid peroxidase and thyroglobulin in patients with sarcoidosis. Clin Endocrinol. 1997. 46:467–472.

9. Romagnani S. The TH1/Th2 paradigm. Immunol Today. 1997. 18:263–266.

10. Mundlein E, Greten T, Ritz E. Graves' disease and sarcoidosis in a patient with minimal change glomerulonephritis. Nephrol Dial Transplant. 1996. 11:860–862.

11. Gurrieri C, Bortoli M, Brunetta E, Piazza F, Agostini C. Cytokines, chemokines and other biomolecular markers in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2005. 22:S9–S14.

12. Volpe R. Immunological aspects of autoimmune thyroid disease. Prog Clin Biol Res. 1981. 74:1–27.

13. Hancock BW, Millard LG. Sarcoidosis and thyrotoxicosis: a study of five patients. Br J Dis Chest. 1976. 70:129–133.

14. Yarman S, Kahraman H, Tanakol R, Kapran Y. Concomitant association of thyroid sarcoidosis and Graves' disease. Horm Res. 2003. 59:43–46.

15. Antonelli A, Fazzi P, Fallahi P, Ferrari SM, Ferrannini E. Prevalence of hypothyroidism and Graves' disease in sarcoidosis. Chest. 2006. 130:526–532.