PMC10036575_01
High-resolution computed tomography (HRCT) of the chest suggested pulmonary sarcoidosis: (A) micronodular lesions in pulmonary parenchyma; (B) hilar lymphadenopathy (blue arrows); (C) mediastinal lymphadenopathy (blue arrows). CT scans of the neck (D) indicated nodular mass inside the right thyroid lobe (blue arrow). HRCT, high-resolution computed tomography; CT, computed tomography.
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High-resolution computed tomography (HRCT) of the chest revealed numerous bilateral micronodular lesions in the pulmonary parenchyma and mediastinal and hilar lymphadenopathy (Figures 1A-C). An inhomogeneous, predominantly hypodense abnormality in the enlarged right thyroid lobe, 30x28 mm in diameter, was also observed (Figure 1D).
Histopathological examination: (A,B) non-necrotizing granulomas in bronchial mucosa and acid-fast stain showing absence of AFB; (C,D) thyroid tissue with non-necrotizing granulomas and acid-fast stain showing the absence of AFB. AFB, acid-fast bacilli.
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Histopathological examination confirmed non-necrotizing granulomatous inflammation of pulmonary parenchyma and lymph glands (Figures 2A,B). Histopathological examination of the thyroid tissue revealed non-necrotizing granulomas consistent with sarcoidosis (Figures 2C,D).
Case reports timeline. Presented according to CARE guidelines.
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Substitution therapy with 75 mcg/day oral levothyroxine was prescribed, along with the slow dose tapering of oral steroids over the next 9 months, when oral steroids were stopped (Figure 3).
PMC10036575_02
Histopathological examination: (A,B) non-necrotizing granulomas in bronchial mucosa and acid-fast stain showing absence of AFB; (C,D) thyroid tissue with non-necrotizing granulomas and acid-fast stain showing the absence of AFB. AFB, acid-fast bacilli.
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A total thyroidectomy was performed and definitive pathohistological findings revealed a polynodous goiter with numerous diffuse noncaseating granulomas whose morphology, number, and localization were typical of thyroid sarcoidosis (Figures 4C,D). Histopathological examination of transbronchial and bronchial biopsies revealed non-necrotizing granulomas consistent with sarcoidosis (Figures 4A,B).