Chest
Volume 130, Issue 2, August 2006, Pages 526-532
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Original Research: SARCOIDOSIS
Prevalence of Hypothyroidism and Graves Disease in Sarcoidosis

https://doi.org/10.1378/chest.130.2.526Get rights and content

Background

The association of sarcoidosis (S) and thyroid autoimmunity has been reported by several studies in a wide range of variability. The aim of our study was to evaluate the prevalence of clinical and subclinical thyroid disorders in patients with S vs gender-matched and age-matched control subjects.

Methods

Thyroid hormones and antithyroid antibodies, thyroid ultrasonography and fine-needle aspiration were performed in 111 patients with S who had been consecutively referred to the Respiratory Pathophysiology Section of the University of Pisa, and the results were compared to 333 gender-matched and age-matched control subjects from the same geographic area.

Results

The odds ratio for subclinical hypothyroidism for female patients with S vs control subjects was 2.7 (95% confidence interval [CI], 1.3 to 5.9); for anti-thyroid peroxidase antibody titer (AbTPO) positivity, 2.2 (95% CI, 1.2 to 3.9); and for thyroid autoimmunity, 1.9 (95% CI, 1.1 to 3.2). The mean values of thyroid-stimulating hormone and AbTPO were higher in female S patients than in control subjects (p < 0.01). A significantly higher prevalence of clinical hypothyroidism (four patients) and Graves disease (three patients) was observed in female S patients than in control subjects (none; p = 0.005 and 0.0026, respectively). Two cases of papillary thyroid cancer were detected in S patients. No significant difference between S patients and control subjects was detected for free triiodothyronine and thyroxine, antithyroglobulin autoantibodies, thyroid volume and nodularity, and subclinical hyperthyroidism.

Conclusions

Thyroid function, AbTPO antibodies, and ultrasonography should be tested as part of the clinical profile in female S patients. Subjects who are at high risk (female subjects, those with positive AbTPOs, and those with hypoechoic and small thyroid) should have thyroid function follow-up and appropriate treatment in due course.

Section snippets

S Patients

A total of 111 S patients who had been consecutively referred to the Respiratory Pathophysiology Section of the University of Pisa were recruited into the study. S was diagnosed according to the accepted criteria123; only patients with biopsy-proven cases of S have been included. Thyroid evaluation was performed before the start of corticosteroid treatment in S patients.

Control Group-General Population

Each of the S patients who was eligible for the study was matched, by sex and age, one to three with a control group of

Results in Female S Patients and Female Control Subjects

TSH serum and AbTPO levels were significantly higher in S patients than in the group of female control subjects (Table 2). Subclinical hypothyroidism (defined as a TSH level of > 3.6 μU/mL with FT4 and FT3 levels within the normal range) was significantly more common in S than in control subjects, as was clinical hypothyroidism (defined as a TSH level of > 3.6 μU/mL with FT4 levels below the normal range). The mean TSH level was 4.5 ± 2.8 μU/mL (range, 3.7 to 11.7 μU/mL) in S patients with

DISCUSSION

Discrepant results have been reported about the prevalence of different antithyroid autoantibodies and hypothyroidism.5678910 The results of our study, using more tests and more sensitive methodology, in a larger group of 111 S patients who were matched by gender18 and age with 333 control subjects, who had a similar risk for iodine deficiency, demonstrated a significantly higher prevalence (5% and 17%, respectively) for clinical and subclinical hypothyroidism in female S patients than in

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