Unusual clinical course of Graves' thyrotoxicosis and concomitant sarcoidosis: case report and review of literature.

Objective: To report a case of Graves' disease with concomitant sarcoidosis involving the thyroid gland.

Methods: We present the clinical, laboratory, imaging, and pathologic findings and describe the clinical course of a patient with Graves' disease and sarcoidosis, who was unresponsive to propylthiouracil and radioiodine treatment.

Results: A 23-year-old woman presented with thyrotoxicosis and a large goiter. Laboratory studies and findings on thyroid uptake and scan were consistent with Graves' disease. She was also found to have hilar lymphadenopathy and hepatosplenomegaly. Despite treatment with antithyroid drugs and radioiodine therapy, her hyperthyroidism persisted. Surgical resection of the thyroid gland and 2 lymph nodes disclosed noncaseating granulomas, consistent with sarcoid.

Conclusion: Autoimmune endocrinopathies and, less commonly, thyroid autoimmune disease have been reported in patients with sarcoidosis. Similarities exist in the pathogenesis of these two conditions. Concomitant sarcoidosis in the thyroid gland in patients with Graves' disease may contribute to the resistance to antithyroid drugs and radioiodine therapy.