Thyroid gland
Miscellaneous non-neoplastic disorders
Sarcoidosis

Author: Andrey Bychkov, M.D., Ph.D. (see Authors page)

Revised: 26 January 2017, last major update February 2015

Copyright: (c) 2015-2017, PathologyOutlines.com, Inc.

PubMed Search: sarcoidosis thyroid
Cite this page: Sarcoidosis. PathologyOutlines.com website. http://pathologyoutlines.com/topic/thyroidsarcoid.html. Accessed March 27th, 2017.
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
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

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
    Micro 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)
    Micro Images

    Images hosted on other servers:

    Diffuse noncaseating granulomata

    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)