Diagnosis and management of a painful thyroid nodule in a patient with systemic sarcoidosis.

Painful thyroid nodules caused by sarcoid are exceedingly rare. Painless involvement of the thyroid by sarcoid in patients with systemic sarcoidosis is not. Several autoimmune thyroid illnesses are closely linked to sarcoid. These illnesses may form thyroid nodules which may or may not be painful. We present only the second reported case of a painful thyroid nodule caused by direct sarcoid involvement. Fine needle aspiration may not provide a definitive diagnosis in patients whose appropriate therapy would vary greatly depending on this diagnosis. When an open surgical procedure is indicated, total unilateral thyroid lobectomy should be considered. Multi-centric involvement of a lobe with postoperative recurrence in remaining ipsi-lateral thyroid tissue would be very likely if the entire lobe is not removed.