Endocrine Abstracts

Background: Papillary thyroid cancer (PTC) incidence has increased substantially over the last decades. Although 4% of thyroid cancers may induce a sarcoid reaction in the thyroid gland, sarcoidosis (SA) as a disease may exist with PTC, although causality remais uncertain and their coexistence is rarely reported in the literature. They occurs in both genres, between 30–40 years, but females are more predisposed.

Case presentation: A 65-year-old man, known with pulmonary SA came to our clinic 4 years ago with the suspicion of PTC lymphnode metastasis (he underwent a mediastinoscopy for SA). Thyroid ultrasound pointed to multinodular goitter with a suspect right lobe nodule. He underwent surgery. The histopathological exam confirmed PTC-T3N1b. He received two radioactive iodine cures (total amount-300mCi). Immediately after administration, he developed transient hypercalcemia with low parathormone, 25 HO-vitamin D and high normal 1,25-HO vitamin D levels, probably sarcoidosis induced. His persistent respiratory symptoms imposed glucocorticoid therapy over the past year. At this admission, he accused moderate dyspneea. Biochemical and hormonal tests revelead diabetes secondary to corticosteroid therapy (HbA1C=6.9%), secondary hyperparathyroidism (parathormone=104.6 pg/ml, 25 HO-vitamin D=11.1 pg/ml), normal crosslaps and low-osteocalcin (3.30 ng/ml), possibly corticoid induced. Cardiology exam diagnosed pulmonary hypertension due to sarcoidosis, ischemic heart disease, atrial fibrillation.

Conclusions: The association of SA and PTC may be a challenge for clinicians in the differential diagnosis of cervical lymphadenopathies. It requires a multidisciplinary approach and the association has a worsen prognosis. Complications occure and are determined by glucocorticoids, late age onset, gender, persistence of symptoms and organ damage.