Endocrine Involvement

THYROID

In sarcoidosis, the thyroid is infrequently affected.

Spencer and Warren provided the first description of sarcoid involvement of the thyroid gland.

The associa- tion, however, remained obscure for more than 25 years until Mayock and coworkers studied 145 patients and mentioned in passing that two (1.4%) had clinical evi- dence of thyroiditis.

Karlish and MacGregor described four (1.3%) patients with clinical evidence of thyroiditis among their 300 sarcoid patients.

Clinically recognizable involvement of the thyroid occurs in fewer than 1% of sarcoid patients. Autopsy reports, however, indicate that the thyroid may be affected in 5% of the patients.

In 1993, Valiati and coworkers reviewed found only 40 patients with sarcoidosis of the thyroid gland in the liter- ature. Middle-aged women were more frequently affected than any other group. In most cases peripheral or intrathoracic lymph node enragement was common.

A 48-year-old women with sarcoidosis had a thyroid scintiscan with Technetium

Tc. It showed multiple nodules. A chest X-ray film showed bilateral hilar adenopathy. Sarcoidosis started with Lofgren syndrome and thyroid gland enlargement. In laboratory tests, T4 and TSH were above the normal values. She was treated with 60 mg/daily of prednisolone, which then tapered.

Three months after the treatment began, the T4 and TSH values were normal.

Thyroid involvement is usually a part of the multi- system disease, but the diagnosis is rarely made clinically.

The clinical diagnosis uses the following criteria:

hypothyroidism, hyperthyroidism because of an autoim- mune disturbance resulting from the loss of T-cell control,

and thyroid nodule.

Diagnosis

The presence of noncaseating granulomas in the gland and the evidence of generalized sarcoidosis are diagnos- tic factors for thyroid involvement in sarcoidosis.

Gallium-67 imaging supports the diagnosis.

It is impor- tant is to distinguish sarcoidosis from other possible causes of granulomatous thyroiditis (e.g., tuberculosis and fungal infections).

PITUITARY

The pituitary and hypothalamus are two most commonly affected endocrine glands in sarcoidosis. Hypothalamic involvement is more common than the pituitary dysfunction.

103

CHAPTER 17

Endocrine Involvement

FIGURE 17.1 Technetium (

Tc) scintiscan of the thyroid gland.

104 Atlas of Sarcoidosis

DIABETES INSIPIDUS

Diabetes insipidus is commonly associated with other features of the disease (e.g., parotid enlargement, uveitis, facial palsy, pulmonary involvement) in some patients, but rarely with the involvement of other parts of the base of brain, resulting in optic atrophy, bitemporal hemi- anopia, deafness, vertigo, and anosmia.

REFERENCES

1. Spencer J, Waren S. Boeck’s sarcoid: report of a cases with clinical diagnosis confirmed at autopsy. Arch Intern Med 1938;62:285–288.

2. Mayock R, Bertrand P, Morrison C, et al. Manifestations of sarcoidosis: analysis of 145 patients with a review of nine series from literature. Am J Med 1963;35:67–89.

3. Karlish A, MacGregor G. Sarcoidosis, thyroiditis, and Addison’s disease. Lancet 1970;2:330–333.

4. Vogt H. Morbus Besnier-Boeck Schaumann: klinishe pathologishe anatomische studie Helio Med Acta (Suppl) 1949;25:1–105.

5. Vailati A, Marena C, Aristia L, et al. Sarcoidosis of the thyroid: report of a case and review of the literature. Sar- coidosis 1993;10:66–68.

6. Hancock B, Millard L. Sarcoidosis and thyrotoxicosis: a study of five patients. Br J Dis Chest 1976;70:129.

7. Coplu L, Caglar M, Kisacik F, et al. Sarcoidosis with thyroid involvement. Sarcoidosis Vasculitis and Diffuse Lung Diseases 1997;14:86–87.

8. Sharma O, Milhailovic-Vucinic V. Sarcoidosis of the thyroid and kidneys and calcium metabolism. Semin Respir Med Crit Care 2002;(6)23:579–589.

9. Seinfeld E, Sharma O. The TASS syndrome: an unusual

association of thyroiditis, Addison’s disease, Sjögren’s syn-

drome, and sarcoidosis. Proc R Soc Med 1983;76:883.