Thyroid & parathyroid

Other thyroid nonneoplastic


Topic Completed: 1 February 2015

Minor changes: 11 August 2021

Copyright: 2015-2021,, Inc.

PubMed Search: sarcoidosis thyroid

Andrey Bychkov, M.D., Ph.D.
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Cite this page: Bychkov A. Sarcoidosis. website. Accessed December 3rd, 2021.
Definition / general
  • Idiopathic multisystemic disease with noncaseating granulomas and predominantly pulmonary involvement (see Lung nontumor chapter)
  • 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
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
  • Serum angiotensin converting enzyme (ACE) level is elevated and represents total body granuloma load
Case reports

Isolated sarcoidosis of the thyroid:
Thyroid sarcoidosis with thyroid cancer:
  • 35 year old woman with papillary thyroid carcinoma with sarcoidosis (Neth J Med 2007;65:185)
  • Thyroid cancer and sarcoidosis (Sarcoidosis Vasc Diffuse Lung Dis 2014;31:239)
  • 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
    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)
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