A Case of Sarcoidosis, Differentiated Thyroid Carcinoma, and Graves’ Disease in the Thyroid Gland

  • Filiz Özülker
  • Tamer Özülker


Sarcoidosis is an idiopathic chronic, systemic, and noncaseating granulomatous disease involving multiple systems. There have been reports indicating that there might be an association between autoimmune thyroid diseases and sarcoidosis. Pulmonary sarcoidosis has also been known to coexist with malignancies including differentiated thyroid cancer. It is not clear whether patients with sarcoidosis tend to develop malignancies or malignancies induce sarcoidosis. Overlapping of clinical and radiological findings between malignancies and sarcoidosis causes a difficulty in the management. We present a case of a 49-year-old female patient who had sarcoidosis, autoimmune thyroid disease, and differentiated thyroid cancer.



We would like to thank Professor Dr. Kerim Sönmezoğlu for kindly providing Fig. 9.1 from the archive of Cerrahpasa School of Medicine, Department of Nuclear Medicine, İstanbul, Turkey.


  1. 1.
    Amin MB, Edge SB, Greene FL, Compton CC, Gershenwald JE, Brookland RK, et al., editors. AJCC cancer staging manual. 8th ed. New York: Springer; 2017.Google Scholar
  2. 2.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133. Scholar
  3. 3.
    Harder H, Büchler MW, Fröhlich B, Ströbel P, Bergmann F, Neff W, et al. Extrapulmonary sarcoidosis of liver and pancreas: a case report and review of literature. World J Gastroenterol. 2007;13:2504–9. Scholar
  4. 4.
    Baughman RP, Lower EE. Sarcoidosis. In: Longo DL, editor. Harrison’s principles of internal medicine. 18th ed. New York: McGraw-Hill; 2012. p. 2805–13.Google Scholar
  5. 5.
    Baughman RP, Culver DA, Judson MA. A concise review of pulmonary sarcoidosis. Am J Respir Crit Care Med. 2011;183:573–81. Scholar
  6. 6.
    Fazzi P, Fallahi P, Ferrari SM. Sarcoidosis and thyroid autoimmunity. Front Endocrinol (Lausanne). 2017;8:177. eCollection 2017. Review.CrossRefGoogle Scholar
  7. 7.
    Baughman RP, Drent M, Kavuru M, Judson MA, Costabel U, Du BR, et al. Infliximab therapy in patients with chronic sarcoidosis and pulmonary involvement. Am J Respir Crit Care Med. 2006;174:795–802.CrossRefGoogle Scholar
  8. 8.
    Valeyre D, Bernaudin JF, Uzunhan Y, Kambouchner M, Brillet PY, Soussan M, et al. Clinical presentation of sarcoidosis and diagnostic work-up. Semin Respir Crit Care Med. 2014;35:336–51. Epub 2014 Jul 9. Review.CrossRefPubMedGoogle Scholar
  9. 9.
    Larici AR, Glaudemans AW, Del Ciello A, Slart RH, Calandriello L, Gheysens O. Radiological and nuclear medicine imaging of sarcoidosis. Q J Nucl Med Mol Imaging. 2018;62:14–33. Epub 2017 Nov 30.CrossRefPubMedGoogle Scholar
  10. 10.
    Yoshimizu T, Suga K, Orihashi N, Soejima K, Kaneko T, Kawamura M, et al. The appearance of “lambda” and “panda” sign on Ga-67 scintigraphy in sarcoidosis. Kaku Igaku. 1991;28:1151–7.PubMedGoogle Scholar
  11. 11.
    Skali H, Schulman AR, Dorbala S. 18F-FDG PET/CT for the assessment of myocardial sarcoidosis. Curr Cardiol Rep. 2013;15:352. Review.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Lapa C, Kircher M, Hänscheid H, Schirbel A, Grigoleit GU, Klinker E, et al. Peptide receptor radionuclide therapy as a new tool in treatment-refractory sarcoidosis - initial experience in two patients. Theranostics. 2018;8:644–9. eCollection 2018.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Cooke R. Sarcoidosis of thyroid. Proc R Soc Med. 1959;52:174–5.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Karlish AJ, MacGregor GA. Sarcoidosis, thyroiditis, and Addison’s disease. Lancet. 1970;2:330–3. Scholar
  15. 15.
    Papadopoulos KI, Hörnblad Y, Liljebladh H, Hallengren B. High frequency of endocrine autoimmunity in patients with sarcoidosis. Eur J Endocrinol. 1996;134:331–6. Scholar
  16. 16.
    Antonelli A, Fazzi P, Fallahi P, Ferrari SM, Ferrannini E. Prevalence of hypothyroidism and Graves disease in sarcoidosis. Chest. 2006;130:526–32. Scholar
  17. 17.
    Fallahi P, Ferrari SM, Ruffilli I, Elia G, Biricotti M, Vita R, et al. 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;15:1125–8. Scholar
  18. 18.
    Kmieć P, Lewandowska M, Dubaniewicz A, Mizan-Gross K, Antolak A, Wołyniak B. Two cases of thyroid sarcoidosis presentation as painful, recurrent goiter in patients with Graves’ disease. Arq Bras Endocrinol Metabol. 2012;56:209–14.CrossRefGoogle Scholar
  19. 19.
    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. 1997;7:901–3.CrossRefGoogle Scholar
  20. 20.
    Brincker H. Sarcoid reactions in malignant tumors. Cancer Treat Rev. 1986;13:147–56.CrossRefGoogle Scholar
  21. 21.
    Llombart A Jr, Escudero JM. The incidence and significance of epithelioid and sarcoid-like cellular reaction in the stromata of malignant tumours: a morphological and experimental study. Eur J Cancer. 1970;6:545–51.CrossRefGoogle Scholar
  22. 22.
    Krawczyk BP, Gryglicka B, Kieszko R, Korobowicz E, Sojczuk S. Malignant neoplasms and pulmonary sarcoidosis—a case report. New Med. 2004;7:94–6.Google Scholar
  23. 23.
    Ergin AB, Nasr CE. Thyroid cancer & sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2014;31:239–43.PubMedGoogle Scholar
  24. 24.
    Myint ZW, Chow RD. Sarcoidosis mimicking metastatic thyroid cancer following radioactive iodine therapy. J Community Hosp Intern Med Perspect. 2015;5:26360. eCollection 2015.CrossRefPubMedGoogle Scholar
  25. 25.
    Bruins NA, Oswald JE, Morreau H, Kievit J, Pavel S, Smelt AH. Papillary thyroid carcinoma in a patient with sarcoidosis treated with minocycline. Neth J Med. 2007;65:185–7.PubMedGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Filiz Özülker
    • 1
  • Tamer Özülker
    • 1
  1. 1.Department of Nuclear MedicineUniversity of Health Sciences (SBÜ), Okmeydanı Training and Research HospitalIstanbulTurkey

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