Thyroid & parathyroid
Other thyroid nonneoplastic
Sarcoidosis
Author: Andrey Bychkov, M.D., Ph.D.
Last author update: 1 February 2015
Last staff update: 11 July 2023
Copyright: 2015-2025, PathologyOutlines.com, Inc.
PubMed Search: sarcoidosis thyroid
Table of Contents
Definition / general | Epidemiology | Clinical features | Diagnosis | Laboratory | Case reports | Treatment | Microscopic (histologic) description | Cytology description | Negative stains | Differential diagnosis | Additional referencesCite this page: Bychkov A. Sarcoidosis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/thyroidsarcoid.html. Accessed January 15th, 2025.
Definition / general
- Idiopathic multisystemic disease with noncaseating granulomas and predominantly pulmonary involvement (see Lung nontumor chapter)
Epidemiology
- Clinically recognizable thyroid involvement occurs in < 1% of sarcoidosis patients
- Autopsy series reports thyroid involvement in 4% of sarcoidosis patients (Am J Med 1963;35:67)
Clinical features
- Hypo- and euthyroidism are more common than hyperthyroidism (Thyroid 2006;16:1175)
- May be manifested as or mimic thyroiditis, nodular and diffuse goiter, and thyroid cancer (Arq Bras Endocrinol Metabol 2012;56:209)
Diagnosis
Diagnosis / Radiology
- Presence of noncaseating granulomas in the gland and the evidence of generalized sarcoidosis
- Isolated sarcoidosis of thyroid is a diagnosis of exclusion - further radiographic evaluation for systemic disease is suggested
- Granulomas often occur as cold nodules
Laboratory
- Serum angiotensin converting enzyme (ACE) level is elevated and represents total body granuloma load
Case reports
- 23 year old woman with Graves' thyrotoxicosis and concomitant sarcoidosis (Endocr Pract 2007;13:159)
- 51 year old man - first report of thyroid sarcoidosis (Arch Intern Med (Chic) 1938;62:285)
- 59 year old man with granulomatous thyroiditis (Acta Biomed 2004;75:69)
- 65 year old woman with multinodular goiter as the initial presentation of systemic sarcoidosis (Respir Care 2011;56:1029)
- Hürthle cell hyperplasia and sarcoidosis of the thyroid (Arch Pathol Lab Med 1991;115:1044)
- Two cases with Graves' disease (Arq Bras Endocrinol Metabol 2012;56:209)
Isolated sarcoidosis of the thyroid:
- 42 year old woman with sarcoidosis presenting as cold thyroid nodules (Surg Today 2005;35:770)
- 54 year old man with asymptomatic nontoxic thyromegaly (Endocr Pract 2013;19:e40)
- Sarcoidosis of the thyroid gland initially diagnosed as malignancy (Otolaryngol Head Neck Surg 2003;129:154)
- Thyroid sarcoidosis as a unique localization (Thyroid 2006;16:1175)
- Two cases of thyroid sarcoidosis associated with hyperthyroidism (J Endocrinol Invest 2006;29:834)
Thyroid sarcoidosis with thyroid cancer:
Treatment
- In patients with compression symptoms, hyperthyroidism, resistance to antithyroid drugs and RAI treatment thyroidectomy is performed
Microscopic (histologic) description
- Multiple scattered noncaseating, epithelioid granulomas with Langhans giant cells and lymphocytes, nonspecific
- Interstitial (rather than intrafollicular) location, usually not surrounding colloid
- Associated sarcoid granulomas in the extrathyroidal tissue such as the lymph nodes, parathyroids and adjacent muscle (Thyroid 2006;16:1175)
Cytology description
- Granulomas with multinucleated cells, nonspecific (Respir Care 2011;56:1029)
- Epithelioid cells and lymphocytes
Negative stains
Differential diagnosis
- Granulomatous diseases:
- Tuberculosis: AFB+, caseating necrosis
- Fungi: positive for GMS, PAS
- Other rare lesions: atypical mycobacteria, granulomatous vasculitis
- Subacute and palpation thyroiditis with involvement of follicles and engulfment of colloid
- Post FNA effects and foreign body granulomas
- Sarcoid reaction in thyroid carcinoma: a noncaseating granuloma found in the primary tumor, its vicinity or within the lymph nodes draining the neoplasm when evidence of systemic sarcoidosis does not exist (Endocr J 1997;44:697); may have similar findings in autoimmune thyroiditis (Endocr Pract 2013;19:e40)
Additional references
