Uncommon diagnosis of multinodular goiter – isolated extrapulmonary manifestation of sarcoidosis in thyroid gland (scientific case reports)

Aim By means of the scientific description of two uncommon cases who underwent. surgical resection of multinodous goiter and following histopathological investigation revealing isolated extrapulmonary manifestation of sarcoidosis, this uncommon diagnosis including symptomatology, clinical findings, diagnostic and therapeutic management is to be illustrated. Case descriptions 1)Clinical findings: 61-years old patient with a multinodous goiter for 10 years characterized by an increasing sizeDiagnostics: Scintigraphy of the thyroid gland with a left-thyroid cold node; ultrasoundguided puncture (cytological investigation, non-suspicious)Therapy: Elective thyroidectomy with no macroscopic anomalies und no abnormal aspects with regard to surgical tactic and technique Histopathological investigation: Complete resection specimen of the thyroid gland with granulomatous inflammation consistent with sarcoidosisClinical course: Uneventful with no further manifestations of sarcoidosis in the following diagnostics2)Clinical finding: 30-years old female patient with soft swelling of increasing size at the right neck Diagnostics Ultrasound, inhomogeneous node (37x30x35 mm) of the right thyroideal gland with echo-poor parts and peripheral vascularization; scintigraphy showing marginally compensated unifocal autonomy of the thyroid gland (laboratory parameters, increased serum level of thyroglobulin [632ng/mL]) Therapy Planned right hemithyroidectomy with confirmed nodous structure of thyroid parenchyma, without suspicious lymph nodes Histopathological investigation 33-mm follicular, nodular, encapsulated structure of thyroid parenchyma (diagnosed as follicular adenoma); 2nd opinion: low-grade differentiated carcinoma of thyroid gland with angioinfiltrating growth and granulomatous inflammation of sarcoidosis type Procedural intent After tumor-board consultation, completing thyroidectomy was performed within a 5-weeks interval (pT2 pN0[0/1] V1 L0 G3 R0) with subsequent ablating radio’active iodine therapy; 18F-FDG-PET-CT (several atypical infiltrates within the right upper lobe of the lung) and bronchoscopy with no detection of further manifestation of sarcoidosis Conclusion Sarcoidosis is considered a rare granulomatous multi-locular, systemic disease of not completely known etiopathogenesis with substantial heterogeneity. In most cases, it is associated with the lung, but which can become manifest in various organs. Frequently, extrapulmonary manifestations are usually detected as histological findings by coincidence, which require further investigation to find out additional manifestations as well as to exclude florid infection or other granulomatous processes (clarifying competently differential diagnosis). Therapy is only indicated in symptomatic organ manifestations, taking into account the high rate of spontaneous healing and possible side effects.