Four Cases of Bronchiolitis obliterans Organizing Pneumonia Associated with Thyroid Disease

Abstract

We present 4 cases of bronchiolitis obliterans organizing pneumonia (BOOP) associated with thyroid diseases. Case 1 had previously undergone surgery for thyroid cancer, and had a secondary hypothyroidism at the onset of BOOP. Case 2 developed Basedow’s disease 3 months after the onset of BOOP and BOOP relapsed 21 months after the onset of Basedow’s disease. Case 3 developed subacute thyroiditis 33 months after the onset of BOOP, and has had no relapse of BOOP for 7 years. Case 4 had hypothyroidism at the time of diagnosis of BOOP, and her BOOP relapsed 3 months after the initial onset of BOOP. Two of these 4 cases of BOOP with thyroid diseases relapsed, and thyroid dysfunction could modify the pathophysiology of BOOP.

Cryptogenic organizing pneumonia

“…The predictors of multiple relapses occurrence in our study were delayed treatment and mild cholestasis (elevated gamma-glutamyltransferase and alkaline phosphatase) [55]. The severity of hypoxemia at first presentation has been reported to be a determinant of subsequent relapse [50], but this was not confirmed in our study. Relapses were not associated with increased mortality or increased long-term functional morbidity.…”

Cryptogenic organising pneumonia

“…Other disorders with associated organising pneumonia include: common variable hypogammaglobulinaemia and other immunoglobulin deficiencies [386][387][388]; polyarteritis nodosa [389]; Sweet syndrome [390][391][392]; polymyalgia rheumatica [393,394]; Behçet disease [395]; thyroid disease (including cancer, Basedow disease, thyroiditis, hypothyroidism) [396]; and sarcoidosis (with organising pneumonia at the periphery of granulomatous lesions) [397]. It was also reported after coronary artery bypass graft surgery [398] or in association with localised giant inflammatory polyposis of the caecum and distal ulcerative colitis [399].…”

Interstitial lung disease guideline

“…Secondary OP is most frequent in connective tissue and other autoimmune diseases (especially rheumatoid arthritis and PM/DM),400 – 405 following lung radiotherapy,406 and in drug induced lung disease407 but also occurs in malignant haematological disorders408 409 and immunodeficiency syndromes 410. The distinction between COP and secondary OP is important because the prognosis regarding treatment responsiveness and survival is, on average, much worse in secondary OP 378 385 387 411…”