Objective?To study the influencing factors of thyroid papillary carcinoma in patients with thyroid sarcoidosis, and to provide evidence for the prevention of thyroid papillary carcinoma. Methods?A total of 90 patients with thyroid sarcoidosis admitted to Guangzhou Panyu District Central Hospital from January 2019 to December 2020 were selected as the study subjects for retrospective analysis, all patients underwent surgical treatment, and were divided into papillary carcinoma group (44 cases) and benign nodules group (46 cases) according to pathological results. General information of all patients was collected, including age, sex, body mass index (BMI) and complications. Thyroid ultrasonography was performed to observe the number, size, echo, texture, edge, calcification and aspect ratio of thyroid nodules. The influencing factors of thyroid papillary carcinoma in patients with thyroid sarcoidosis were analyzed by stepstep Logistic regression. The value of ROC analysis of thyroid stimulating hormone (TSH) in diagnosing thyroid papillary carcinoma in patients with thyroid sarcoidosis. Results?Compared with the benign nodules group, the proportion of patients with BMI ≥ 24 kg/m2 , hypoechoic, irregular edge, microcalcification, aspect ratio ＞ 1 was higher in papillary carcinoma group, TSH level were higher in papillary carcinoma group (P ＜0.05). Logistic regression analysis showed that BMI ≥ 24 kg/m2 , low echo, irregular edge, microcalcification, aspect ratio＞1, TSH level≥ 3.36 μIU/mL were risk factors for thyroid papillary carcinoma in patients with thyroid nodules (P ＜0.05). According to ROC analysis, TSH ≥ 3.36 μIU/mL were the best cut-off values for thyroid papillary carcinoma in patients with thyroid sarcoidosis (P ＜0.05). Conclusion?BMI, TSH level, thyroid ultrasound characteristics (echo, margin, microcalcification, aspect ratio) and other factors may increase the risk of thyroid papillary carcinoma in patients with thyroid sarcoidosis, and clinical attention should be paid to them.