A Case of Sarcoidosis and Sarcoid Granuloma, Papillary Carcinoma, and Graves' Disease in the Thyroid Gland
| Autor: | Mogens Blichert-Toft, Ulla Feldt-Rasmussen, Jørgen Kirkegaard, Lise Christensen, Tina Zimmermann-Belsing, Hanne Sand Hansen |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Adult
Male endocrine system Pathology medicine.medical_specialty Wolff–Chaikoff effect Sarcoidosis endocrine system diseases Pertechnetate Endocrinology Diabetes and Metabolism Graves' disease Thyrotropin Scintigraphy chemistry.chemical_compound Endocrinology Chronic granulomatous disease Antithyroid Agents medicine Humans Thyroid Neoplasms Granuloma Methimazole Triiodothyronine medicine.diagnostic_test business.industry Thyroid medicine.disease Thyroid Diseases Carcinoma Papillary Graves Disease Thyroxine medicine.anatomical_structure chemistry Lymphatic Metastasis business |
| Zdroj: | Thyroid. 10:275-278 |
| ISSN: | 1557-9077 1050-7256 |
| Popis: | Sarcoidosis is a systemic chronic granulomatous disease of unknown etiology most commonly affecting young females. The disease was first described in the thyroid gland in 1938. Our patient, a 27-year-old male with known sarcoidosis, was referred to the National University Hospital for acute symptoms of thyrotoxicosis (weight loss of 6 kg, tremor, thyroid enlargement, and tachycardia). Laboratory findings showed suppressed serum thyrotropin (TSH,0.03 mU/L [0.5-4.20]), increased total thyroxine (T4) (223 nmol/L, [60-140]), and triiodothyronine (T3) (8.5 nmol/L, [1.5-2.7]). Furthermore, Tc-99m pertechnetate scintigraphy disclosed diffuse accumulation of the isotope confirming the diagnosis of Graves' disease. During the next 18 months of antithyroid treatment (thiamazole, Thycapzol) hyperthyroidism was difficult to control, the thyroid gland gradually enlarged, and surgery was recommended. Initially, the patient declined surgery but after an additional 18 months, he accepted surgery. During the 36-month period of antithyroid drug treatment TSH was suppressed (0.01 mU/L) and T3 often elevated despite high doses of thiamazole. Total thyroidectomy was performed, and histologic examination of the removed thyroid tissue confirmed the diagnosis of Graves' disease and also the presence of sarcoid granuloma and metastatic papillary adenocarcinoma with spread to neck lymph nodes. Four months later, a modified radical neck dissection was performed with removal of neck lymph nodes followed by external radiation therapy (2 Gy x 32 fractions to the neck). The concomitant presence of sarcoidosis, papillary carcinoma, and Graves' disease in a thyroid gland, to our knowledge, has not previously been described in the literature. |
| Databáze: | OpenAIRE |
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