Thyroid Sarcoidosis as a Rare Explanation of Resistance to Radioactive Iodine in Graves’ Disease
David M Scott-Coombes, Michael J Stechman, Richard J Egan, Rakan Kabariti, Daniel L Hopkins
Case report, Graves’ disease, Sarcoidosis, Thyroidectomy.
Citation Information :
Scott-Coombes DM, Stechman MJ, Egan RJ, Kabariti R, Hopkins DL. Thyroid Sarcoidosis as a Rare Explanation of Resistance to Radioactive Iodine in Graves’ Disease. World J Endoc Surg 2018; 10 (2):142-144.
Background: Sarcoidosis is a multiorgan idiopathic inflammatory disease that involves the thyroid gland in 1 to 4.6% of the cases.
Case report: We report a case of a 36-year-old man who was diagnosed with Graves’ disease and initially treated with block and replace regimen followed by radioactive iodine (RAI), both of which were unsuccessful. The patient subsequently underwent an uncomplicated total thyroidectomy. Subsequent histological evaluation of the thyroid tissue demonstrated granulomatous inflammation consistent with a diagnosis of sarcoidosis. This was the index presentation of this diagnosis with no previous symptoms or clinical manifestations related to sarcoidosis.
Conclusion: Using this case as an example, we therefore conclude that relative resistance of Graves’ thyrotoxicosis to treatment may be due to a novel underlying presentation of sarcoidosis.
Clinical significance: Sarcoidosis of the thyroid gland should be considered as part of the clinical differential diagnosis in cases of treatment-resistant thyrotoxicosis.
Yarman S, Kahraman H, Tanakol R, Kapran Y. Concomitant association of thyroid sarcoidosis and Grave's disease. Horm Res 2003;59(1):43-46.
Fallahi P, Ferrari SM, Ruffilli I, Elia G, Biricotti M, Vita R, Benvenga S, Antonelli A. The association of other autoimmune diseases in patients with autoimmune thyroiditis: review of the literature and report of a large series of patients. Autoimmun Rev 2016 Dec;15(12):1125-1128.
Ozkan Z, Oncel M, Kurt N, Kargi AB, Ozdemir N, Kaptanoglu L, Eser M, Uzun H. Sarcoidosis presenting as cold thyroid nodules: report of two cases. Surg Today 2005;35(9):770-773.
Vatin L, Rivière d, Podeur P, Cathelinaud O, Legodec J, Okremchouk I, Morvan JB. Sarcoidosis of the thyroid: a case report. Rev Laryngol Otol Rhinol (Bord) 2015;136(2): 73-75.
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 Mar;10(3): 275-278.
Yanamandra U, Kotwal N, Menon A, Nair V. Resistant thyrotoxicosis: a case of sarcoidosis of thyroid. Indian J Endocrinol Metab 2013 Mar-Apr;17(2):332-335.
Rodriguez MC, Rani D, Faas FH. Unusual clinical course of Graves’ thyrotoxicosis and concomitant sarcoidosis: case report and review of literature. Endocr Pract 2007 Mar-Apr;13(2): 159-163.
Myint ZW, Chow RD. Sarcoidosis mimicking metastatic thyroid cancer following radioactive iodine therapy. J Community Hosp Intern Med Perspect 2015 Feb;5(1):26360.