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Review
. 2017 Aug 15;56(16):2181-2186.
doi: 10.2169/internalmedicine.8324-16. Epub 2017 Aug 1.

Systemic Sarcoidosis with Thyroid Involvement

Hideyuki Okuma  1   2 , Koshi Hashimoto  2   3 , Xin Wang  1 , Noriaki Ohkiba  1 , Nozomi Murooka  1 , Norikazu Akizuki  4 , Takeshi Inazawa  1 , Yoshihiro Ogawa  2
Affiliations
Review

Systemic Sarcoidosis with Thyroid Involvement

Hideyuki Okuma et al. Intern Med. .

Abstract

A 66-year-old woman, who was diagnosed with iritis, visited our hospital due to general malaise. A blood analysis revealed hypercalcemia. Computed tomography revealed mediastinal and hilar lymph node hyperplasia. Moreover, 67Gallium scintigraphy demonstrated strong accumulation in the lesions, suggesting sarcoidosis. A core needle biopsy (CNB) of the hypoechoic areas of the thyroid was performed because the patient refused to undergo a bronchoscopic examination. The scattering of slightly acidophilic epithelioid cell granulomas was observed in the pathological examination of the biopsy specimen. Based on this finding, the patient was diagnosed with sarcoidosis. Although sarcoidosis rarely involves the thyroid gland, in the present case, thyroid CNB was an alternative diagnostic method that allowed a pathological diagnosis to be obtained.

Keywords: thyroid needle biopsy; thyroid sarcoidosis.

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Figures

Figure 1.
Figure 1.
A chest X-ray film on admission. Arrowheads indicate hilar lymphadenopathy.
Figure 2.
Figure 2.
Contrast-enhanced CT on admission A: The arrow indicates the low absorption area in the right thyroid lobe. B: Arrows indicate the enlarged hilar lymph nodes.
Figure 3.
Figure 3.
The clinical course until 57 weeks after admission to our department. The serum calcium concentration (Ca) was corrected for the serum albumin concentration with the following equation when the serum albumin concentration was<4.0 g/dL: serum Ca (mg/dL)=measured calcium concentration (mg/dL)+4- serum albumin concentration (g/dL).
Figure 4.
Figure 4.
67Ga scintigraphy on admission (whole body image). Arrowheads indicate the accumulation in each bilateral hilar region and the mediastinal lymph nodes. Arrows indicate the accumulation in the bilateral parotid gland, submandibular gland and lachrymal gland.
Figure 5.
Figure 5.
Thyroid ultrasonography on admission (A), and 57 weeks after the admission (B). The largest low-echoic area (φ 13.6×10.3×12.6 mm), in which CNB was performed (A).
Figure 6.
Figure 6.
Histopathological examinations of the thyroid (Hematoxylin and Eosin (H&E) staining 40×). Arrows indicate non-caseating granulomas surrounded by lymphocyte infiltration.
See this image and copyright information in PMC

References

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