폐 사르코이드증에서 동반된 그레이브스병 1예

A Case of Graves' Disease Coexistent with Pulmonary Sarcoidosis

  • 조기원 (연세대학교 원주의과대학 내과학교실) ;
  • 고장현 (연세대학교 원주의과대학 내과학교실) ;
  • 이미영 (연세대학교 원주의과대학 내과학교실) ;
  • 정필문 (연세대학교 원주의과대학 내과학교실) ;
  • 신영구 (연세대학교 원주의과대학 내과학교실) ;
  • 용석중 (연세대학교 원주의과대학 내과학교실) ;
  • 정춘희 (연세대학교 원주의과대학 내과학교실)
  • Jo, Ki Won (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Koh, Jang Hyun (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Lee, Mi Young (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Jung, Feel Moon (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Shin, Young Goo (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Yong, Suk Joong (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Chung, Choon Hee (Department of Internal Medicine, Yonsei University Wonju College of Medicine)
  • 투고 : 2007.02.21
  • 심사 : 2007.04.20
  • 발행 : 2007.05.30

초록

저자들은 사르코이드증 환자에서 그레이브스병이 동반된 1예를 경험하였으며 이는 아직 국내에서 보고된 바 없기에 문헌고찰과 함께 보고하는 바이다.

Sarcoidosis is a multisystemic granulomatous disease with an of unknown etiology, involving bilateral hilar lymphadenopathy, pulmonary, skin and eye lesions. However, involvement of the endocrine system in sarcoidosis is quite rare, and the coexistence of both diseases is extremely unusual. We describe a 60-year-old woman presenting with sarcoidosis and Graves' disease. She was admitted for evaluation of dry cough, dyspnea, palpitation and general weakness. Both thyroid glands were enlarged diffusely. The thyroid function tests showed suppressed serum thyrotropin and an increased thyroid hormone level. The levels of the TSH receptor antibody, anti-thyroglobulin antibody and anti-microsomal antibody were higher than normal. The radionuclide scan($^{131}I$) showed increased iodine uptake. The chest X-ray revealed pulmonary hilar enlargement and high resolution CT showed both hilar lymph nodes enlargement and tiny parenchymal nodules. The transbronchial lung biopsy showed a noncaseating granuloma without necrosis. We report this case of pulmonary sarcoidosis plus Graves' disease with a review of the relevant literatures.

키워드

참고문헌

  1. Ronald GC. Chapter 309. Sarcoidosis. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison's principles of internal medicine. 16th ed. New York: McGraw-Hill,Inc.; 2005. p.2017-23
  2. 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 2000;10:275-8 https://doi.org/10.1089/thy.2000.10.275
  3. James DG, Sharma OP. From Hutchinson to now: a historical glimpse. Curr Opin Pulm Med 2002;8: 416-23 https://doi.org/10.1097/00063198-200209000-00013
  4. Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med 1997;336:1224-34 https://doi.org/10.1056/NEJM199704243361706
  5. Mayock RL, Bertrand P, Morrison CE, Scott JH. Manifestations of sarcoidosis: analysis of 145 patients with a review of nine series selected from literature. Am J Med 1963;35:67-89 https://doi.org/10.1016/0002-9343(63)90165-7
  6. Yamauchi M, Inoue D, Fukunaga Y, Kakudo K, Koshiyama H. A case of sarcoid reaction associated with papillary thyroid carcinoma. Thyroid 1997;7: 901-3 https://doi.org/10.1089/thy.1997.7.901
  7. Papadopoulos KI, Hornblad Y, Liljebladh H, Hallengren B. High frequency of endocrine autoimmunity in patients with sarcoidosis. Eur J Endocrinol 1996;134:331-6 https://doi.org/10.1530/eje.0.1340331
  8. Nakamura H, Genma R, Mikami T, Kitahara A, Natsume H, Andoh S, et al. High incidence of positive autoantibodies against thyroid peroxidase and thyroglobulin in patients with sarcoidosis. Clin Endocrinol 1997;46:467-72 https://doi.org/10.1046/j.1365-2265.1997.1630976.x
  9. Romagnani S. The TH1/Th2 paradigm. Immunol Today 1997;18:263-6
  10. Mundlein E, Greten T, Ritz E. Graves' disease and sarcoidosis in a patient with minimal change glomerulonephritis. Nephrol Dial Transplant 1996;11:860-2 https://doi.org/10.1093/oxfordjournals.ndt.a027415
  11. Gurrieri C, Bortoli M, Brunetta E, Piazza F, Agostini C. Cytokines, chemokines and other biomolecular markers in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2005;22:S9-14
  12. Volpe R. Immunological aspects of autoimmune thyroid disease. Prog Clin Biol Res 1981;74:1-27
  13. Hancock BW, Millard LG. Sarcoidosis and thyrotoxicosis: a study of five patients. Br J Dis Chest 1976;70:129-33 https://doi.org/10.1016/0007-0971(76)90020-6
  14. Yarman S, Kahraman H, Tanakol R, Kapran Y. Concomitant association of thyroid sarcoidosis and Graves' disease. Horm Res 2003;59:43-6 https://doi.org/10.1159/000067937
  15. Antonelli A, Fazzi P, Fallahi P, Ferrari SM, Ferrannini E. Prevalence of hypothyroidism and Graves' disease in sarcoidosis. Chest 2006;130:526-32 https://doi.org/10.1378/chest.130.2.526