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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"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" => 104333 ] ] "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" => 104333 ] ] "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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 5 | 15 | 20 |
| 2024 Octubre | 57 | 35 | 92 |
| 2024 Septiembre | 47 | 13 | 60 |
| 2024 Agosto | 63 | 28 | 91 |
| 2024 Julio | 53 | 27 | 80 |
| 2024 Junio | 47 | 19 | 66 |
| 2024 Mayo | 53 | 29 | 82 |
| 2024 Abril | 58 | 20 | 78 |
| 2024 Marzo | 57 | 33 | 90 |
| 2024 Febrero | 45 | 21 | 66 |
| 2024 Enero | 58 | 22 | 80 |
| 2023 Diciembre | 33 | 28 | 61 |
| 2023 Noviembre | 47 | 25 | 72 |
| 2023 Octubre | 48 | 23 | 71 |
| 2023 Septiembre | 64 | 33 | 97 |
| 2023 Agosto | 39 | 13 | 52 |
| 2023 Julio | 41 | 23 | 64 |
| 2023 Junio | 41 | 19 | 60 |
| 2023 Mayo | 46 | 18 | 64 |
| 2023 Abril | 34 | 12 | 46 |
| 2023 Marzo | 65 | 27 | 92 |
| 2023 Febrero | 52 | 28 | 80 |
| 2023 Enero | 53 | 22 | 75 |
| 2022 Diciembre | 75 | 36 | 111 |
| 2022 Noviembre | 76 | 22 | 98 |
| 2022 Octubre | 73 | 30 | 103 |
| 2022 Septiembre | 55 | 45 | 100 |
| 2022 Agosto | 65 | 42 | 107 |
| 2022 Julio | 57 | 32 | 89 |
| 2022 Junio | 65 | 34 | 99 |
| 2022 Mayo | 67 | 33 | 100 |
| 2022 Abril | 131 | 47 | 178 |
| 2022 Marzo | 86 | 52 | 138 |
| 2022 Febrero | 65 | 32 | 97 |
| 2022 Enero | 71 | 49 | 120 |
| 2021 Diciembre | 68 | 46 | 114 |
| 2021 Noviembre | 65 | 47 | 112 |
| 2021 Octubre | 59 | 51 | 110 |
| 2021 Septiembre | 56 | 40 | 96 |
| 2021 Agosto | 71 | 47 | 118 |
| 2021 Julio | 49 | 33 | 82 |
| 2021 Junio | 68 | 36 | 104 |
| 2021 Mayo | 93 | 41 | 134 |
| 2021 Abril | 178 | 103 | 281 |
| 2021 Marzo | 107 | 25 | 132 |
| 2021 Febrero | 87 | 21 | 108 |
| 2021 Enero | 69 | 18 | 87 |
| 2020 Diciembre | 58 | 24 | 82 |
| 2020 Noviembre | 133 | 24 | 157 |
| 2020 Octubre | 121 | 19 | 140 |
| 2020 Septiembre | 67 | 32 | 99 |
| 2020 Agosto | 54 | 27 | 81 |
| 2020 Julio | 54 | 15 | 69 |
| 2020 Junio | 59 | 28 | 87 |
| 2020 Mayo | 139 | 13 | 152 |
| 2020 Abril | 57 | 20 | 77 |
| 2020 Marzo | 68 | 33 | 101 |
| 2020 Febrero | 73 | 26 | 99 |
| 2020 Enero | 82 | 17 | 99 |
| 2019 Diciembre | 94 | 28 | 122 |
| 2019 Noviembre | 45 | 20 | 65 |
| 2019 Octubre | 54 | 21 | 75 |
| 2019 Septiembre | 86 | 49 | 135 |
| 2019 Agosto | 49 | 18 | 67 |
| 2019 Julio | 72 | 17 | 89 |
| 2019 Junio | 48 | 18 | 66 |
| 2019 Mayo | 75 | 40 | 115 |
| 2019 Abril | 70 | 20 | 90 |
| 2019 Marzo | 44 | 23 | 67 |
| 2019 Febrero | 33 | 18 | 51 |
| 2019 Enero | 28 | 28 | 56 |
| 2018 Diciembre | 101 | 32 | 133 |
| 2018 Noviembre | 144 | 11 | 155 |
| 2018 Octubre | 147 | 13 | 160 |
| 2018 Septiembre | 46 | 8 | 54 |
| 2018 Agosto | 36 | 9 | 45 |
| 2018 Julio | 12 | 3 | 15 |
| 2018 Mayo | 6 | 0 | 6 |
| 2018 Abril | 41 | 8 | 49 |
| 2018 Marzo | 81 | 6 | 87 |
| 2018 Febrero | 33 | 3 | 36 |
| 2018 Enero | 27 | 8 | 35 |
| 2017 Diciembre | 31 | 12 | 43 |
| 2017 Noviembre | 33 | 9 | 42 |
| 2017 Octubre | 36 | 5 | 41 |
| 2017 Septiembre | 26 | 7 | 33 |
| 2017 Agosto | 26 | 7 | 33 |
| 2017 Julio | 15 | 12 | 27 |
| 2017 Junio | 49 | 10 | 59 |
| 2017 Mayo | 35 | 13 | 48 |
| 2017 Abril | 34 | 25 | 59 |
| 2017 Marzo | 35 | 7 | 42 |
| 2017 Febrero | 8 | 6 | 14 |
| 2017 Enero | 24 | 11 | 35 |
| 2016 Diciembre | 55 | 24 | 79 |
| 2016 Noviembre | 41 | 32 | 73 |
| 2016 Octubre | 66 | 30 | 96 |
| 2016 Septiembre | 39 | 12 | 51 |
| 2016 Agosto | 122 | 17 | 139 |
| 2016 Julio | 97 | 28 | 125 |
| 2016 Junio | 1 | 0 | 1 |
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