Letter to the Editor
Comorbidity of sarcoidosis and Graves’ disease
Comorbilidad de la sarcoidosis y la enfermedad de Graves–Basedow
a Sifa University, Faculty of Medicine, Department of İnternal Medicine, Turkey
b Sifa University, Faculty of Medicine, Department of Rheumatology, Turkey
c Sifa University, Faculty of Medicine, Department of Chest Diseases, Turkey
d Sifa University, Faculty of Medicine, Department of Endocrinology, Turkey
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"paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "235" "paginaFinal" => "236" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Hüseyin Semiz, Senol Kobak, Fidan Sever, Muamer Karadeniz" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Hüseyin" "apellidos" => "Semiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Senol" "apellidos" => "Kobak" "email" => array:1 [ 0 => "senolkobak@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Fidan" "apellidos" => "Sever" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Muamer" "apellidos" => "Karadeniz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Sifa University, Faculty of Medicine, Department of İnternal Medicine, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sifa University, Faculty of Medicine, Department of Rheumatology, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sifa University, Faculty of Medicine, Department of Chest Diseases, Turkey" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Sifa University, Faculty of Medicine, Department of Endocrinology, Turkey" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comorbilidad de la sarcoidosis y la enfermedad de Graves–Basedow" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 897 "Ancho" => 995 "Tamanyo" => 107358 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Torax CT showed bilateral hilar and mediastinal lymphadenopathy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Sarcoidosis is a chronic inflammatory disease with unknown etiology, characterized by non-caseating granuloma formation. Extrapulmonary involvement is usually seen in locomotor system, skin, lymph nodes, eyes and liver, but could be in any organ.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> Sarcoid involvement of the endocrine glands has rarely been observed.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> The incidence of thyroid autoimmune disease has been reported in patients with sarcoidosis in various studies, but comorbidity of Graves’ disease (GD) is not common. Comorbidity of sarcoidosis and GD has been described in this paper.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case presentation</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 35-year-old female patient was admitted to our Rheumatology clinic with complaints of pain and swelling in the ankle joint, morning stiffness, fatigue, dry cough, and palpitations. Physical examination revealed findings related with right ankle arthritis, growth and tenderness of the thyroid gland in palpation and tachycardia in cardiac auscultation. As for thyroid function tests; we determined FT3: 14.27<span class="elsevierStyleHsp" style=""></span>pg/ml (normal 2.0–4.4<span class="elsevierStyleHsp" style=""></span>pg/ml), FT4: 5.25<span class="elsevierStyleHsp" style=""></span>ng/dl (normal 0.93–1.7<span class="elsevierStyleHsp" style=""></span>ng/dl), TSH: 0.01<span class="elsevierStyleHsp" style=""></span>ng/dl (normal 0.27–4.2<span class="elsevierStyleHsp" style=""></span>ng/dl), anti-thyroglobulin: 164.7<span class="elsevierStyleHsp" style=""></span>IU/ml (normal 0–115<span class="elsevierStyleHsp" style=""></span>IU/ml), anti-TPO: 7.10<span class="elsevierStyleHsp" style=""></span>IU/ml (normal 0–34<span class="elsevierStyleHsp" style=""></span>IU/ml), TSH receptor antibody: 12.77<span class="elsevierStyleHsp" style=""></span>IU/L (normal<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>1.22<span class="elsevierStyleHsp" style=""></span>IU/L). Serum ACE level was found as 89 (normal <35). In the serological tests; ANA, ANCA, anti-CCP, RF were found to be negative. Thoracic CT revealed mediastinal and bilateral hilar lymphadenopathy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The chest disease specialist was contacted, endobronchial ultrasound (EBUS) guided biopsy was performed. Histopathological evaluation showed non-caseating granulomas, thus sarcoidosis was considered in the patient. Thyroid ultrasonography showed the increased size of the thyroid gland, with heterogeneous and coarse parenchyma, which appeared to be related with Graves’ disease. Diffusely increased uptake of radioactive iodine was found in thyroid scintigraphy. The patient was diagnosed with sarcoidosis and Graves’ disease based on clinical, laboratory, radiological and histological data. Moderate dose of a corticosteroid (40<span class="elsevierStyleHsp" style=""></span>mg/day) and propylthiouracil 3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1/day were initiated to the patient. At the 6th month of clinical follow-up, thyroid function tests were observed to be normalized, palpitations and complaints of locomotor system were found to be decreased. Control thorax CT showed significant regression in terms of mediastinal and hilar lymphadenopathy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Sarcoidosis is a multisystemic, chronic granulomatous disease with unknown etiology, characterized by non-caseating granuloma formation. Sarcoid involvement of the thyroid gland has been detectedupon autopsy or fine needle aspiration biopsy and thyroidectomy.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> Graves’ disease is an autoimmune disease in which activated T and B cells can cause intrathyroidal lymphocytic infiltrations.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> Graves’ disease was shown in a case of sarcoidosis, although hyperthyroidism is considered rare.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> On the other hand, Graves’ disease in patients with sarcoidosis may be simply coincidental. Goiter, subacute thyroiditis and thyroid cancer have been reported among other thyroid disorders accompanying sarcoidosis.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> In a Swedish study, significantly elevated levels of antithyroglobulin autoantibodies have been reported in patients with sarcoidosis.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> Nakamura et al. have reported that the prevalence of sarcoidosis related with Hashimoto's thyroiditis was 3–11%, much more common than other thyroid diseases.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> In another study, antithyroglobulin autoantibodies were significantly higher in patients with sarcoidosis, but the basic thyroid function tests were in the normal range.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> However, comorbidity of sarcoidosis of the thyroid gland and Graves’ disease has rarely been reported.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">10,11</span></a> Karlish and McGregor have reported that hyperthyroidism developed in 6 patients with sarcoidosis but long-acting thyroid stimulating antibodies could not be detected.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">As a result, based on clinical, radiological and histopathological examinations, we hereby report the comorbidity of Graves’ disease and sarcoidosis in our patient. Since both are chronic and inflammatory diseases, this suggests that they may have a common etiopathogenesis and/or it may be just a coincidence. Further studies on this topic are required.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case presentation" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 897 "Ancho" => 995 "Tamanyo" => 107358 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Torax CT showed bilateral hilar and mediastinal lymphadenopathy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical characteristics of patients in a case control study of sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.P. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 12 | 20 |
| 2024 October | 68 | 30 | 98 |
| 2024 September | 87 | 19 | 106 |
| 2024 August | 104 | 28 | 132 |
| 2024 July | 88 | 33 | 121 |
| 2024 June | 79 | 27 | 106 |
| 2024 May | 84 | 26 | 110 |
| 2024 April | 92 | 22 | 114 |
| 2024 March | 115 | 26 | 141 |
| 2024 February | 61 | 20 | 81 |
| 2024 January | 78 | 17 | 95 |
| 2023 December | 54 | 34 | 88 |
| 2023 November | 84 | 24 | 108 |
| 2023 October | 93 | 25 | 118 |
| 2023 September | 101 | 39 | 140 |
| 2023 August | 53 | 12 | 65 |
| 2023 July | 89 | 18 | 107 |
| 2023 June | 88 | 25 | 113 |
| 2023 May | 83 | 22 | 105 |
| 2023 April | 58 | 19 | 77 |
| 2023 March | 75 | 25 | 100 |
| 2023 February | 68 | 28 | 96 |
| 2023 January | 60 | 11 | 71 |
| 2022 December | 84 | 31 | 115 |
| 2022 November | 73 | 24 | 97 |
| 2022 October | 76 | 32 | 108 |
| 2022 September | 50 | 27 | 77 |
| 2022 August | 68 | 37 | 105 |
| 2022 July | 52 | 32 | 84 |
| 2022 June | 53 | 26 | 79 |
| 2022 May | 52 | 37 | 89 |
| 2022 April | 66 | 43 | 109 |
| 2022 March | 81 | 47 | 128 |
| 2022 February | 72 | 28 | 100 |
| 2022 January | 60 | 29 | 89 |
| 2021 December | 72 | 28 | 100 |
| 2021 November | 54 | 41 | 95 |
| 2021 October | 70 | 45 | 115 |
| 2021 September | 63 | 33 | 96 |
| 2021 August | 43 | 34 | 77 |
| 2021 July | 86 | 29 | 115 |
| 2021 June | 65 | 30 | 95 |
| 2021 May | 98 | 48 | 146 |
| 2021 April | 285 | 81 | 366 |
| 2021 March | 67 | 17 | 84 |
| 2021 February | 72 | 21 | 93 |
| 2021 January | 80 | 12 | 92 |
| 2020 December | 75 | 17 | 92 |
| 2020 November | 65 | 22 | 87 |
| 2020 October | 36 | 15 | 51 |
| 2020 September | 86 | 24 | 110 |
| 2020 August | 68 | 21 | 89 |
| 2020 July | 49 | 16 | 65 |
| 2020 June | 42 | 17 | 59 |
| 2020 May | 31 | 12 | 43 |
| 2020 April | 19 | 10 | 29 |
| 2020 March | 9 | 7 | 16 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 42 | 3 | 45 |
| 2018 March | 61 | 4 | 65 |
| 2018 February | 33 | 3 | 36 |
| 2018 January | 17 | 2 | 19 |
| 2017 December | 25 | 5 | 30 |
| 2017 November | 28 | 1 | 29 |
| 2017 October | 24 | 6 | 30 |
| 2017 September | 16 | 10 | 26 |
| 2017 August | 18 | 10 | 28 |
| 2017 July | 32 | 14 | 46 |
| 2017 June | 43 | 20 | 63 |
| 2017 May | 37 | 8 | 45 |
| 2017 April | 32 | 7 | 39 |
| 2017 March | 38 | 4 | 42 |
| 2017 February | 23 | 8 | 31 |
| 2017 January | 30 | 4 | 34 |
| 2016 December | 47 | 10 | 57 |
| 2016 November | 38 | 13 | 51 |
| 2016 October | 33 | 10 | 43 |
| 2016 September | 56 | 5 | 61 |
| 2016 August | 66 | 11 | 77 |
| 2016 July | 32 | 12 | 44 |
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