Sarcoidosis is a systemic disease with many localizations. Thyroid involvement has been often described but rarely confirmed histologically. A common immune mechanism appears to be the cause. Thyroid sarcoidosis should be envisaged in patients with a thyroid nodule and mediastino-pulmonary involvement. We report the case of a 63-year-old woman with no past history who was hospitalized for dyspnea. Explorations evidenced a cold thyroid nodule associated with diffuse interstitial lung disease and mediastinal node enlargement. Pathology examination disclosed the sarcoid nature of the thyroid nodule and the lung lesions.
[Show abstract][Hide abstract] ABSTRACT: Sarcoidosis may be associated with granulomatous inflammation in any part of the body, usually in more than one area . Rare manifestations of sarcoidosis include unusual patterns of organ involvement, or are the result of granulomatous inflammation developing in unusual locations for sarcoidosis. In other rare cases, sarcoidosis is associated with a second disorder. Although the frequency of individual rare manifestations is by definition low, together they represent a major cause of morbidity and mortality related to sarcoidosis [1, 2]. Given the protean manifestations of sarcoidosis and potential involvement of any tissue, a comprehensive compilation of all reported rare manifestations of sarcoidosis is not possible in this monograph. Nonetheless, an approach to patients who may have rare manifestation of sarcoidosis can be constructed. These rare manifestations reflect the known pathophysiology and clinical behaviour of more common and easily recognisable systemic sarcoidosis. Alternative diagnoses must be excluded, particularly when there are deviations from well-established manifestations or an expected clinical course for sarcoidosis. Given their rarity, none of the clinical approaches or treatment recommendations for the conditions discussed below have been subjected to clinical trials, rigorous or otherwise. The author has seen patients with the conditions listed below, and offers an approach based on this experience and selected published literature. Emphasis will be placed on a systematic approach to these rare manifestations, focusing on organ systems that are not covered by other sections of this Monograph. General considerations An initial framework for approaching the challenge of diagnosing and treating rare manifestations of sarcoidosis can be formulated based on current knowledge of the disease and the expected clinical behaviour of sarcoidosis. In all cases, granulomatous inflammation from sarcoidosis interferes with local tissue homeostasis and function; thus, organ impairment is dependent on its location. When the clinician is confronted with identifying whether a rare manifestation of sarcoidosis is present in a patient with known sarcoidosis, an internet search of the medical literature is part of a recommended initial approach to establish a possible association. Invariably, the clinician must be prepared to consider competing diagnoses, particularly when a diagnosis of sarcoidosis has not been established. To confirm an association with sarcoidosis or an alternative diagnosis, directed diagnostic evaluations including biopsy, may be needed. In other situations, a trial of corticosteroid (CS) therapy may be indicated to assess whether there is a clinical response consistent with sarcoidosis. With rare manifestations of sarcoidosis, a leading concern is whether the specific clinical problem is the result of an alternative, nonsarcoidosis pathological process. The following generalisations on the clinical behaviour of sarcoidosis provide a useful Eur Respir Mon, 2005, 32, 233–250. Printed in UK -all rights reserved. Copyright ERS Journals Ltd 2005; European Respiratory Monograph; ISSN 1025-448x. ISBN 1-904097-22-7.
European Respiratory Monograph 01/2005; 32. DOI:10.1183/1025448x.00032015
[Show abstract][Hide abstract] ABSTRACT: Sarcoidosis is a systemic disease characterized by noncaseating granulomas. Thyroid involvement is rare in sarcoidosis. In this paper, two sarcoidosis patients who demonstrated cold thyroid nodules are presented. A 42-year-old woman presented with multinodular goiter and was diagnosed as having sarcoidosis when noncaseating granulomas were observed during the pathological examination of the thyroidectomy specimen. Enlarged mediastinal lymph nodes were observed in the routine preoperative chest X-ray in another 53-year-old woman, while she was being prepared to undergo a thyroidectomy. The pathological examination of the thyroid specimens showed noncaseating granulomas in both patients, and the diagnosis was confirmed by either hepatic biopsy or chest X-ray findings. In conclusion, thyroid involvement should be suspected in sarcoidosis patients who present with cold nodules in the thyroid. Furthermore, if noncaseating granulomas are observed in thyroid specimens after a thyroidectomy in an otherwise healthy person, the patient should be evaluated further for sarcoidosis.
Surgery Today 02/2005; 35(9):770-3. DOI:10.1007/s00595-005-3004-9 · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sarcoidosis can affect any organ in the body. Frequently extrapulmonary manifestations of the disease are the major cause of morbidity. Treatment of extrapulmonary sarcoidosis often requires consideration of alternative immunosuppressive agents, topical therapy, or therapy that is not specifically directed against the granulomatous inflammation of the disease. This article reviews the clinical presentation and therapy of extrapulmonary sarcoidosis.
Seminars in Respiratory and Critical Care Medicine 03/2007; 28(1):83-101. DOI:10.1055/s-2007-970335 · 2.71 Impact Factor
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