Isern Virginia, Lora-Tamayo Jaime, Capdevila Olga, Villabona Carlos, Mañá Juan
Internal Medicine Service, Institut d'Investigació Biomèdica de Bellvitge, Bellvitge University Hospital, University of Barcelona, Spain.
Sarcoidosis Vasc Diffuse Lung Dis. 2007 Sep;24(2):148-52.
Sarcoidosis coexisting with autoimmune disorders, especially with autoimmune thyroid disease (ATD), has been previously described and a common immunopathogenesis has been proposed. We report a series of ten new cases of this association from a large series of patients with sarcoidosis.
The clinical records of patients diagnosed with sarcoidosis between 1984 and 2006 in the Bellvitge University Hospital were reviewed, and those who were also diagnosed as having ATD were selected. A review of the literature was performed as well.
Ten out of 348 (2.9%) patients with sarcoidosis were identified as having ATD. Sarcoidosis presented as Löfgren's syndrome in 8 patients. Three patients developed Graves' disease, 6 Hashimoto's thyroiditis with hypothyroidism and one had postpartum thyroiditis. In one case, ATD had developed 15 years before sarcoidosis. In the remaining nine cases, sarcoidosis preceded between 4 months to 17 years the development of ATD. In 3 of these cases, sarcoidosis was active when ATD was diagnosed. In one patient, Graves' disease developed immediately after the administration of potassium iodide to treat erythema nodosum.
Sarcoidosis may be associated with ATD at some time of its evolution, either as hyperthyroidism or hypothyroidism. Usually, ATD does not develop during the period of activity of sarcoidosis. We suggest considering personal and family past history of thyroid disease before administering potassium iodide for erythema nodosum in patients with sarcoidosis, as it could trigger hyperthyroidism, especially in patients with iodine deficiency.
结节病与自身免疫性疾病共存，尤其是与自身免疫性甲状腺疾病（ATD）共存的情况此前已有描述，并提出了共同的免疫发病机制。我们从一大系列结节病患者中报告了10例这种关联的新病例。
回顾了1984年至2006年在贝尔维奇大学医院诊断为结节病的患者的临床记录，并挑选出同时也被诊断为患有ATD的患者。同时也进行了文献回顾。
348例结节病患者中有10例（2.9%）被确定患有ATD。8例患者的结节病表现为 Löfgren 综合征。3例患者发生了格雷夫斯病，6例为伴有甲状腺功能减退的桥本甲状腺炎，1例为产后甲状腺炎。1例患者在结节病发生前15年就已出现ATD。在其余9例中，结节病在ATD发生前4个月至17年出现。其中3例在诊断ATD时结节病处于活动期。1例患者在服用碘化钾治疗结节性红斑后立即发生了格雷夫斯病。
结节病在其病程的某个阶段可能与ATD相关，表现为甲状腺功能亢进或减退。通常，ATD不会在结节病活动期发生。我们建议在结节病患者因结节性红斑服用碘化钾之前，考虑其个人和家族甲状腺疾病史，因为这可能引发甲状腺功能亢进，尤其是在碘缺乏的患者中。
