Dual ectopic thyroid

Case of Colloid Nodular Goitre in a Rare Submandibular Location

Ectopic thyroid gland occurs due to aberrant descent of primitive thyroid gland to the final pre-tracheal position and failure of fusion of thyroid anlages. Submandibular ectopic thyroid is a rare thyroid anomaly that can present with or without an orthotopic thyroid gland. We present a case of a young female with hypothyroidism and left submandibular swelling demonstrated to be an ectopic thyroid with the colloid nodular goitre on imaging and cytology.

Ectopic thyroid as multiple nodules in bilateral lung lobes: a case report

Ectopic thyroid rarely occurs in the thoracic or abdominal cavity, especially in the lung. Here, we describe an intrapulmonary thyroid tissue case in bilateral lung lobes without thyroid malignant history, which was found during a routine physical examination. A 37-year-old Chinese female showed multiple pulmonary nodules appearing in bilateral lung lobes on a computed tomography (CT) scan during a routine medical examination. To rule out the possibility of lung metastasis from occult cancer, a percutaneous lung biopsy was performed on a larger nodule. Histopathological examination confirmed that the nodule was completely consistent with normal thyroid tissue, which prevented the patient from requiring any unnecessary treatment. During the patient's follow-up, there was no abnormal thyroid function, and there was no change in the size of the nodule in the lung during serial CT scan. Currently, there is no guidance or consensus on the diagnosis of ectopic thyroid with bilateral multiple pulmonary nodules due to its rarity in clinical practice. When such pulmonary nodules are encountered, very careful diagnosis and follow-up should be performed.

Thyroid Embryonic Anomalies Involving the Medial and Lateral Anlagen: Two Surgical Case Reports

Introduction

An ectopic anomalous accessory thyroid is extremely rare. We present two related case reports.

Case

A 43-year-old morbidly obese female presented with a palpable left thyroid mass. Initial impression after preoperative workup was a diffuse bilateral multinodular goiter with a left nodule suspicious for malignancy. She underwent a total thyroidectomy. On further palpation after initial excision, two masses on the left neck area were noted, dissected, and excised. In the second case, a 65-year-old female presented with a substernal exophytic mass displacing the trachea to the right after a left thyroid lobectomy 4 years ago. Cytology revealed a retained substernal thyroid. She is scheduled for a substernal thyroidectomy through a median sternotomy.

Discussion

In all partial or complete thyroidectomy cases, care should be taken to palpate or to use intraoperative ultrasound (IOUS) for any extra thyroid mass. An intuitive surgical approach is needed to evaluate for possible embryologic anomalies of the thyroid. There are two thyroid anlagen that can explain ectopic aberrant anomalies: the median anlage-thyroid rest and the lateral anlage from the ultimobranchial body of the fourth pharyngeal pouch. Surgeons should keep in mind that multiple ectopic thyroid glands could be present in any thyroidectomy procedure.

Hemiagenesis of thyroid with dual thyroid ectopia: A rare case report

Developmental defects of the thyroid gland are very rare. The common developmental abnormalities are ectopic thyroid, hemiagenesis and agenesis of thyroid gland. These developmental defects may or may not be associated with deranged thyroid function tests. Ultrasonography (USG) is the initial modality of choice for thyroid hemiagenesis but further evaluation by computed tomography (CT) scan or nuclear scan should be done to look for ectopic thyroid tissue rest. Here, we report a rare case of a 9-year-old female having hemiagenesis of the right thyroid lobe and isthmus along with dual ectopic thyroid tissue at prehyoid and infrahyoid regions of the neck presenting as a midline neck swelling and subclinical hypothyroidism.

Hybrid SPECT/CT Helps Characterization and Localization of a Dual Thyroid Ectopia

The presence of ectopic thyroid tissue in 2 or more different sites is rare. A 12-year-old girl presented with midline anterior neck swelling in the infrahyoid region with subclinical hypothyroidism. Thyroid scanning with Tc-pertechnetate was performed, and SPECT/CT was ordered for further evaluation. Two hyperdense lesions demonstrating intense radiotracer uptake were seen in the midline at the base of the tongue and infrahyoid neck. We emphasis the role of hybrid SPECT/CT for characterization and localization of suspected ectopic thyroid tissue.

Normal variations of oral anatomy and common oral soft tissue lesions: evaluation and management

Examination of the oral cavity can provide significant diagnostic information regarding the general health of the patient. The oral cavity is affected by a multitude of pathologic conditions of variable cause and significance; however, there are numerous normal variations of oral soft tissue structures that may resemble a pathologic state. Understanding these variations assists practitioners to discriminate between normal versus abnormal findings and determine the appropriate course of management, if necessary.

Redefining anatomy in a case of midline subhyoid ectopic thyroid

Ectopic thyroid is an uncommon embryological aberration of the thyroid descent. Subhyoid median ectopic thyroid gland is a result of incomplete descent of the thyroid anlage and is characterized by a cosmetically unacceptable ovoid mass of thyroid tissue in the midline overlying the thyroid cartilage and thyrohyoid membrane. A normally placed thyroid gland is not detectable and in most cases all functioning thyroid tissue is located within the mass. Most of the ectopic thyroids are usually mistaken for a thyroglossal cyst and excised. Severe myxedema follows removal. Many cases have been reported in the literature, none of which was recognized prior to operation. All patients were operated upon for removal of a thyroglossal duct cyst. The diagnosis was missed at operation and in these cases severe myxedema was universal. The cause of the myxedema was not always immediately recognized. Therefore, many diagnostic tests including thyroid function test, ultrasound of the neck, and thyroid scanning had been recommended in the preoperative evaluation of a thyroglossal cyst. Here, we present a case of ectopic thyroid mass which was the only thyroid tissue present in the neck. So, division and repositioning of the thyroid mass thereby redefining the anatomy was done with good cosmetic results.

Scintigraphic detection of dual ectopic thyroid tissue: experience of a Chinese tertiary hospital

Purpose

To assess scintigraphic pattern, clinical indication and relevance of dual ectopic thyroid tissue (ETT). Literature is reviewed for such cases.

Methods

In this 5-year retrospective study, we reviewed all thyroid scintigraphies in our data base. Patients diagnosed with suspected ETT were identified. Literature is reviewed. Statistics were done by one-way analysis of variance and least significant difference test.

Results

From 11905 thyroid scintigraphies during the 5-year period, we retrieved 121 patients eligible for analysis. The top two indications were assessing a palpable front neck mass to determine whether it was an ETT, and primary hypothyroidism. Patients were divided into 3 groups. Group 1 with single ETT (83 cases); group 2 with dual ETT (6 cases) and group 3 with athyroid (32 cases). Age and thyroid hormones were highest in group 2, and lowest in group 3. Thyrotropin was highest in group 3, and lowest in group 2. Thyroxine was given to hypothyroid patients, while no surgery was performed. There were 42 published cases with dual ETT, most of whom were under 30 years old. 38.10% of them were euthyroid, 33.33% hypothyroid, and 21.43% subclinical hypothyroid. Most frequent ectopic positions included lingual (33.73%), sublingual (27.71%) and subhyoid (22.89%).

Conclusions

In our cohort, incidence of dual ETT was 0.05% if the denominator was total number of thyroid scintigraphies. The incidence was 4.96% if the denominator was the number of patients with suspected ETT. Important clinical indication is a front neck palpable mass suggestive of an ETT. Important clinical relevance of recognizing the dual ETT pattern is to avoid inappropriate surgery. After reviewing all published cases, we find dual ETT is often seen in young patients. Most of such patients are euthyroid or mildly hypothyroid. Thyroid ectopia often resides in lingual, sublingual and subhyoid areas.

A rare case of triple thyroid ectopia

Various anomalies of thyro-glossal duct have been described, in which the duct may form a cyst or may present as a solid nodule to form an ectopic gland. The ectopic gland can develop along the tract of the duct to give rise to ectopic lingual, sublingual (pre-hyoid) or sub-hyoid (pyramidal) gland, with or without normal pre-tracheal thyroid gland.There are a few reports of double ectopia of thyroid but triple ectopia of thyroid is extremely rare. We have come across a case of triple thyroid ectopia, i.e., thyroid tissue at three locations along the tract of descent of thyro-glossal duct on CT, which hast been rarely reported in the world literature, and hence this report.

Medical management of thyroid ectopia:report of three cases

Thyroid ectopia (TE) is an embryological aberration of the thyroid gland migration most commonly observed in the lingual region followed by the sublingual, hyoid, and mediastinal regions. TE is often complicated by local compressive symptoms resulting in dysphagia, dysphonia, and dyspnea. Surgical removal of TE is frequently complicated by difficulties in intubation, increased perioperative bleeding, and severe primary hypothyroidism; on the other hand, I131 ablation is limited by high doses needed and the concern for long-term effects especially in children. We report three children with TE who all presented with compressive symptoms and were managed conservatively with levothyroxine resulting in resolution of compressive symptoms and favorable outcomes. Levothyroxine supplementation is effective and has an important role in managing TE, not only in correcting the associated hypothyroidism but also in resolving the associated compressive symptoms by reducing the size of the ectopic thyroid tissue.

An accessory thyroid gland that presented tumor-like images

A 26-year-old woman presented with right breast pain and itching. Incidentally, a firm, non-tender, movable mass (3 cm in diameter) located in the lower right part of the neck was identified by palpation. Ultrasonography revealed a clearly demarcated dumbbell-shaped mass with homogenous hypo- (cranial side) and hyper-echogenicity (caudal side) compared with the thyroid gland. Computed tomography scan and magnetic resonance imaging presented images that were different from thyroid gland substance. The right thyroid lobe was strongly compressed by the mass. Hyperparathyroidism was ruled out by laboratory testing. The patient solicited resection of the mass despite recommendations for core needle biopsy, and it was removed surgically. The mass was surrounded by a thin capsule and was not connected with the thyroid gland. Pathological examinations revealed normal thyroid gland tissue. The final diagnosis was an accessory thyroid gland. Accessory thyroid glands should be considered as a possible diagnosis when nodules around the main thyroid gland are encountered.

Ectopic thyroid tissue: anatomical, clinical, and surgical implications of a rare entity

Ectopic thyroid tissue is a rare entity resulting from developmental defects at early stages of thyroid gland embryogenesis, during its passage from the floor of the primitive foregut to its final pre-tracheal position. It is frequently found around the course of the thyroglossal duct or laterally in the neck, as well as in distant places such as the mediastinum and the subdiaphragmatic organs. Although most cases are asymptomatic, symptoms related to tumor size and its relationship with surrounding tissues may also appear. Any disease affecting the thyroid gland may also involve the ectopic thyroid, including malignancy. The clinician must distinguish between ectopic thyroid and metastatic deposits emerging from an orthotopic gland, as well as other benign or malignant masses. Thyroid scintigraphy plays the most important role in diagnosing ectopy, but ultrasonography contributes as well. In cases of symptomatic disease, surgery is the treatment of choice, followed by radioiodine ablation and levothyroxine suppression therapy in more refractory cases. This review provides current understanding about the wide clinical spectrum of this rare condition, also referring to optimal diagnostic approach, differential diagnosis, and management strategies.

Rare developmental abnormalities of thyroid gland, especially multiple ectopia: A review and our experience

Background:

Developmental structural abnormalities of the thyroid gland are relatively rare. There are scanty reports of hemiagensis, dual and triple ectopia of the thyroid in the literature

Materials and Methods:

We did a retrospective analysis of 236 patients referred to us for Tc-99m Pertechnetate thyroid scan over period of four months (May 2010 to Sept 2010). Twenty of these 236 patients aged less than 20 years found to have developmental abnormality of the thyroid gland on thyroid scan. Diagnosis was correlated with anatomical imaging (USG/CT scan), fine needle aspiration cytology (FNAC) and histopathology.

Results:

Out of the 20 patients, 8 were diagnosed with thyroglossal cyst, 4 with ectopic thyroid gland, 4 with dual ectopia, two had agenesis of thyroid gland, one case each with hemiagenesis and triple ectopia.

Conclusion:

The study has emphasized the indispensable role of Tc-99m Pertechnetate thyroid scan in the evaluation of midline neck swellings of childhood and diagnosing developmental anomalies of thyroid gland.

Dual ectopic thyroid with normally located thyroid: a case report

Dual ectopic thyroid is a rare presentation of thyroid ectopia. Only a few cases have been reported in the world literature. Dual ectopic thyroid in the presence of a normally located thyroid is even rarer. We report a case of dual ectopic thyroid in the lingual and submandibular areas in a seventeen-year-old female with hypoplastic thyroid gland in its normal location. The patient presented with a midline swelling at the base of tongue with dysphagia. Thyroid function test revealed primary hypothyroidism. Ultrasonography of the neck showed hypoplastic thyroid in its normal location. A thyroid scan with Technetium-99 m pertechnate showed two intensely hyperfunctioning foci of ectopic thyroid tissue at a higher level in the midline consistent with dual ectopic thyroid, one at the base of tongue and the other in submental region. No uptake was seen in the normal bed.

Lateral ectopic thyroid goiter with a normally located thyroid

BACKGROUND

Midline ectopic thyroid tissue is a common pathological entity. In contrast, laterally located ectopic thyroid tissue with a normally located thyroid gland is a very rare condition in head and neck surgery.

SUMMARY

We report the association of laterally located multinodular thyroid tissue and a normally located multinodular goiter. A woman was seen in the otolaryngology clinic with a right submandibular mass. Clinical examination and investigations confirmed the presence of a multinodular goiter in an ectopic thyroid gland.

CONCLUSION

Laterally located ectopic thyroid tissue is a very rare condition. Ectopic thyroid tissues can undergo the same pathological changes as a normally located thyroid gland. Ectopic thyroid goiter together with a normally located multinodular goiter is a rare entity, and this is the first to be reported in North America.

Adenomatous hyperplasia arising from dual ectopic thyroid

Ectopic thyroid tissue is an uncommon embryologic aberration characterized by the presence of thyroid tissue in a site other than its usual pre-tracheal location. Single ectopic thyroid tissue is the most common variant, and the base of the tongue is the most frequent ectopic location. Dual ectopic thyroid is extremely rare, and only eleven cases have been reported in the English literature. Furthermore, adenomatous hyperplasia has never been reported to arise from dual ectopic thyroid. There has been only one reported case of adenomatous hyperplasia arising from a single intratracheal ectopic thyroid. We report a case of adenomatous hyperplasia arising from dual ectopic thyroid tissue that presented as a sublingual mass in a 37-yr-old woman. The diagnosis was made through pathologic examination after surgical resection. We also discuss the diagnosis and treatment of ectopic thyroid, along with a review of the literature.

Tireoide ectópica no mediastino anterior

A ectopia de tireoide é rara, e a sua localização no mediastino anterior é excepcional, estando descritos apenas 5 casos nos últimos 30 anos. Os autores apresentam 2 casos clínicos, além de uma revisão da literatura abordando a etiologia, a embriologia e manifestações clínicas de ectopia de tireoide.

[Papillary adenocarcinoma on ectopic thyroid tissue]

OBJECTIVES

To report a case of papillary adenocarcinoma occurring on ectopic thyroid tissue in the hyoid bone region.

MATERIAL AND METHODS

A 57-year-old patient consulted for a cervical mass appearing 1 year before, with no signs of compression. The thyroid function was normal.

RESULTS

The examination showed a firm tumefaction, fixed on the hyoid bone, with undetermined limits, measuring approximately 8 cm. The thyroid gland was in the normal pretracheal position. The cervical tomodensitometry objectified an osteolytic process centered on the hyoid bone with a fleshy zone of tissue density and calcifications. Cervical MRI provided a more precise assessment of the extension of the mass and confirmed the integrity of the other structures, in particular the endo-larynx. The tumor was totally resected via a cervical approach. The pathologic study suggested a papillary adenocarcinoma on ectopic thyroid tissue. The treatment was completed by a total thyroidectomy with normal histological results.

CONCLUSIONS

Papillary adenocarcinoma on ectopic thyroid is a very rare situation. Its diagnosis is histological. Its treatment is primarily surgical, sometimes associated with radioiodine I-131 therapy.

A case of dual ectopic thyroid accompanied by positive antithyroid antibodies

Ectopic thyroid tissue is an uncommon congenital aberration that is seldom present at two different sites simultaneously. The patient was a 32-year-old woman with dual ectopic thyroid accompanied by positive antithyroid antibodies. The simultaneous occurrence of dual ectopic thyroid and positive antithyroid antibodies has been documented in only two cases: the case discussed here and one previous case. The cervical ectopic thyroid was followed up by ultrasound, which showed an increase in the size of the lesion and an internal echo texture that became slightly heterogeneous after the patient had her second child. We speculated that these changes resulted from the changes in hormone demand brought on by pregnancy and parturition.

Case of thyroid hemiagenesis and ectopic lingual thyroid presenting as goitre

Objective:

We report an extremely rare case of thyroid hemiagenesis with ectopic lingual thyroid.

Method:

Case report and review of the world literature concerning thyroid hemiagenesis with ectopic lingual thyroid and heredity.

Results:

Ectopic thyroid is an uncommon embryological aberration characterised by the presence of thyroid tissue in a site other than its usual, pretracheal location. The lingual thyroid is the most common manifestation of benign ectopic thyroid tissue, but is still a rare clinical entity. Thyroid hemiagenesis is also a very rare abnormality, in which one thyroid lobe fails to develop. We report a case of left thyroid hemiagenesis and goitre in the right lobe in a 26-year-old woman with an ectopic lingual thyroid.

Conclusion:

To our knowledge, this is the first report in the world literature of thyroid hemiagenesis with ectopic lingual thyroid.

Dual ectopic thyroid: case series and review of the literature

Ectopic thyroid tissue is an uncommon congenital aberration. It is further unusual for ectopic thyroid to be present at 2 different sites simultaneously. Only 19 cases of dual ectopic thyroid have been reported in the English literature. Most of the patients were adolescents and presented with anterior neck swelling with or without altered metabolic status. Lingual/sublingual thyroid was the most common ectopic location. Subhyoid was the most common site of a second ectopic thyroid in these patients. The thyroid scan has been used successfully to diagnose ectopic thyroid tissue. We report 4 such cases in which ectopic thyroid tissue was simultaneously present at 2 different locations using thyroid scanning. The literature of already reported cases is reviewed in detail.

Ectopic intratracheal thyroid: an illustrative case report and literature review

A 19-year-old woman was treated with bronchodilators for new-onset dyspnea with exercise. Her symptoms progressively worsened, culminating 4 months later in acute shortness of breath at rest. Flow-volume loops suggested a fixed obstruction and a computed tomography scan of the neck revealed a large subglottic mass. The patient underwent emergent tracheostomy and laryngoscopy and a near-obstructing intratracheal mass was found. Biopsy showed ectopic thyroid tissue. Magnetic resonance imaging of the neck showed a 1.4-cm tracheal lesion and a normally located thyroid gland. The intratracheal mass was resected endoscopically. Pathology revealed hyperplastic ectopic thyroid tissue. The patient has been maintained on thyroid hormone suppression therapy for 2 years without growth of the residual intratracheal thyroid tissue. She recently underwent a surgical palate expansion. We present this case, along with a literature review of ectopic intratracheal thyroid, its epidemiology, possible etiologies, genetic underpinnings, presentation, and treatment. The co-occurrence of an ectopic thyroid, a functioning orthotopic gland, and a high arched palate is also discussed.

L’ectopie thyroïdienne : à propos de deux cas

Ectopic thyroid is a rare condition (1/4000 to 1/8000 among patients with hypothyroidism). The underlying etiological pathogenic mechanisms remain unknown. Diagnosis is established on the basis of imaging findings. We report two cases of hypothyroidism in adult females who had ectopic sublingual thyroid glands. The first patient was a 20-Year-old woman who had been treated for hypothyroidism since the age of 13 Years before the diagnosis of ectopic thyroid 7 Years later. In both patients, the thyroid gland was palpable. In the first patient the physical examination revealed an ectopic sublingual gland. Scintigraphy confirmed the diagnosis in both patients. The CT-scan and MRI were positive in the second patient. Hormonal substitution therapy using L-thyroixine was given.

Heterotopic Thyroid

Heterotopia of the thyroid gland is veryuncommon. Ectopic thyroid results from embryologicaberration characterized by the existence ofthyroid tissue in a site other than its usual locationanterior to the trachea. Ectopic thyroid tissue isusually found along the path of initial descent ofthe thyroid, representing a failure of the thyroidto descend completely. Thyroid ectopia mayalso be found in locations other than the typicalpathway of embryologic descent. It is importantto consider ectopic thyroid as a differentialdiagnosis when a mass is discovered in the neck,chest, or, rarely, other locations.