Department of Endocrinology, National Naval Medical Center, Bethesda, Maryland 20889-5600, USA.
Respir Care. 2011 Jul;56(7):1029-32. doi: 10.4187/respcare.01000. Epub 2011 Feb 21.
Sarcoidosis is a chronic systemic disease characterized by noncaseating granulomas. Thyroid involvement is rare, with a prevalence of 1-4% in large series of autopsied patients with systemic sarcoid. We report a case of a 65-year-old woman with a nontoxic multinodular goiter, dyspnea in the supine position, and rightward tracheal deviation as the initial presentation of systemic sarcoidosis. Fine-needle biopsy of the thyroid mass was consistent with benign adenomatoid goiter. A total thyroidectomy was performed because of compression symptoms. Histopathology revealed numerous diffuse noncaseating granulomata typical of thyroid sarcoidosis. Subsequent chest computed tomography showed extensive bulky mediastinal and hilar adenopathy and multiple small pulmonary nodules consistent with sarcoidosis. Transbronchial fine-needle biopsy also revealed noncaseating granulomas. The patient's supine dyspnea resolved quickly after total thyroidectomy. This case report illustrates that in patients with known sarcoidosis, careful thyroid examination is essential and supine dyspnea may be directly related to tracheal compression by a multinodular goiter rather than pulmonary sarcoidosis.
结节病是一种以非干酪样肉芽肿为特征的慢性全身性疾病。甲状腺受累罕见，在大系列尸检患者中，系统性结节病的患病率为 1%-4%。我们报告了一例 65 岁女性病例，其首发表现为系统性结节病，包括无毒性多结节性甲状腺肿、平卧位呼吸困难和右侧气管移位。甲状腺肿块的细针活检符合良性腺瘤样甲状腺肿。由于有压迫症状，行甲状腺全切除术。组织病理学显示大量弥漫性非干酪样肉芽肿，典型的甲状腺结节病。随后的胸部计算机断层扫描显示广泛的大纵隔和肺门淋巴结肿大以及多个与结节病一致的小结节。经支气管细针活检也显示非干酪样肉芽肿。甲状腺全切除术后，患者的平卧位呼吸困难迅速缓解。本病例报告表明，对于已知患有结节病的患者，仔细检查甲状腺至关重要，平卧位呼吸困难可能与多结节性甲状腺肿引起的气管压迫直接相关，而不是与肺部结节病有关。
