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Kakamad FH, Salih AM, Ahmed SF, Abdullah HO, Kakamad SH, Mustafa SM, Mohammed SH. Thyroid and parathyroid ectopia in the mediastinum; a case report. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2021.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cunha C, Ferrinho C, Saraiva C, Duarte JS. Graves' disease and recurrence in ectopic thyroid tissue after total thyroidectomy. BMJ Case Rep 2021; 14:14/7/e243313. [PMID: 34315743 PMCID: PMC8317112 DOI: 10.1136/bcr-2021-243313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 46-year-old woman who presented with a midline neck mass 2 years after total thyroidectomy for Graves' disease. Despite levothyroxine treatment withdrawal, she remained biochemically with subclinical hyperthyroidism. Her thyroid stimulating hormone receptor antibodies were consistently elevated. Neck ultrasonography revealed an infrahyoid solid nodule and pertechnetate scintigraphy confirmed an increased uptake at the same level, without any uptake in the thyroid bed. Treatment with methimazole 5 mg/day was initiated with clinical improvement and achievement of euthyroidism. After that, she received 10 mCi of radioactive iodine. Since then, she experienced regression of the neck mass and is doing well on a replacement dose of levothyroxine. Recurrence of Graves' disease in ectopic thyroid following total thyroidectomy is extremely rare. This diagnose should be considered in patients who underwent total thyroidectomy and remained with thyrotoxicosis despite decreasing the levothyroxine dose.
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Affiliation(s)
- Clara Cunha
- Endocrinology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
| | - Catia Ferrinho
- Endocrinology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
| | - Catarina Saraiva
- Endocrinology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
| | - João Sequeira Duarte
- Endocrinology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
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Camargo RY, Kanamura CT, Friguglietti CU, Nogueira CR, Iorcansky S, Tincani AJ, Bezerra AK, Brust E, Koyama FC, Camargo AA, Rego FOR, Galante PAF, Medeiros-Neto G, Rubio IGS. Histopathological Characterization and Whole Exome Sequencing of Ectopic Thyroid: Fetal Architecture in a Functional Ectopic Gland from Adult Patient. Int J Endocrinol 2018; 2018:4682876. [PMID: 29593791 PMCID: PMC5822907 DOI: 10.1155/2018/4682876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/16/2017] [Indexed: 12/17/2022] Open
Abstract
Ectopic thyroid results from a migration defect of the developing gland during embryogenesis causing congenital hypothyroidism. But it has also been detected in asymptomatic individuals. This study aimed to investigate the histopathological, functional, and genetic features of human ectopic thyroids. Six samples were histologically examined, and the expression of the specific thyroid proteins was assessed by immunohistochemistry. Two samples were submitted to whole exome sequencing. An oropharynx sample showed immature fetal architecture tissue with clusters or cords of oval thyrocytes and small follicles; one sample exhibited a normal thyroid pattern while four showed colloid goiter. All ectopic thyroids expressed the specific thyroid genes and T4 at similar locations to those observed in normal thyroid. No somatic mutations associated with ectopic thyroid were found. This is the first immature thyroid fetal tissue observed in an ectopic thyroid due to the arrest of structural differentiation early in the colloid stage of development that proved able to synthesize thyroid hormone but not to respond to TSH. Despite the ability of all ectopic thyroids to synthetize specific thyroid proteins and T4, at some point in life, it may be insufficient to support body growth leading to hypothyroidism, as observed in some of the patients.
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Affiliation(s)
- Rosalinda Yasato Camargo
- Thyroid Unit, Cellular and Molecular Endocrine Laboratory, LIM-25, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Avenida Doutor Arnaldo 455, Cerqueira César, 01246-904 São Paulo, SP, Brazil
| | - Cristina Takami Kanamura
- Adolfo Lutz Institute, São Paulo Public Health Service, Av. Dr. Arnaldo 355, Cerqueira César, 01246-000 São Paulo, SP, Brazil
| | | | - Célia Regina Nogueira
- Department of Internal Medicine, Botucatu School of Medicine, UNESP, Av. Prof. Montenegro, s/n Distrito de Rubião Junior, 18618-687 Botucatu, SP, Brazil
| | - Sonia Iorcansky
- Servicio de Endocrinología, Hospital de Pediatría Dr. Juan Garrahan, Combate de los Pozos 1881, C1245AAM Buenos Aires, Argentina
| | - Alfio José Tincani
- Departamento de Cirurgia na Disciplina de Cirurgia de Cabeça e Pescoço da Faculdade de Ciências Médicas da UNICAMP, R. Tessália Vieira de Camargo 126, 13083-887 Campinas, SP, Brazil
| | - Ana Karina Bezerra
- Medicine School, Universidade de Fortaleza (Unifor), Av. Washington Soares 1321, Edson Queiroz, 60811-905 Fortaleza, CE, Brazil
| | - Ester Brust
- Postgraduate Program in Biotechnology, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo 669, 040399-032 São Paulo, SP, Brazil
- Thyroid Molecular Sciences Laboratory, Universidade Federal de São Paulo, Departamento de Ciências Biológicas, Postgraduation Programs in Biotechnology and Structural and Functional Biology, UNIFESP, Pedro de Toledo 669, 040399-032 São Paulo, SP, Brazil
| | | | - Anamaria Aranha Camargo
- Molecular Oncology Center, Hospital Sírio-Libanés, Rua Prof. Daher Cutait 69, 01308-060 São Paulo, SP, Brazil
| | - Fernanda Orpinelli R. Rego
- Molecular Oncology Center, Hospital Sírio-Libanés, Rua Prof. Daher Cutait 69, 01308-060 São Paulo, SP, Brazil
| | | | - Geraldo Medeiros-Neto
- Thyroid Unit, Cellular and Molecular Endocrine Laboratory, LIM-25, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Avenida Doutor Arnaldo 455, Cerqueira César, 01246-904 São Paulo, SP, Brazil
| | - Ileana Gabriela Sanchez Rubio
- Postgraduate Program in Biotechnology, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo 669, 040399-032 São Paulo, SP, Brazil
- Thyroid Molecular Sciences Laboratory, Universidade Federal de São Paulo, Departamento de Ciências Biológicas, Postgraduation Programs in Biotechnology and Structural and Functional Biology, UNIFESP, Pedro de Toledo 669, 040399-032 São Paulo, SP, Brazil
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Manifestations buccodentaires des maladies thyroïdiennes. Presse Med 2017; 46:864-868. [DOI: 10.1016/j.lpm.2017.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/15/2017] [Accepted: 05/29/2017] [Indexed: 11/19/2022] Open
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Ectopic Thyroid Tissue in the Mediastinum Characterized by Histology and Functional Imaging with I-123 SPECT/CT. Case Rep Radiol 2017; 2017:9084207. [PMID: 28251012 PMCID: PMC5303849 DOI: 10.1155/2017/9084207] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/24/2016] [Accepted: 01/10/2017] [Indexed: 12/18/2022] Open
Abstract
Ectopic thyroid tissue is a rare entity and when discovered it is typically along the pathway of embryologic migration of the thyroid. We present a case of incidental finding of ectopic thyroid tissue within mediastinum in a 61-year-old female patient with a history of total thyroidectomy for thyroiditis and nodules. The patient presented to emergency room with cough and right chest pain and underwent a chest computed tomographic angiogram (CTA) to exclude pulmonary embolism as part of chest pain workup. One right paratracheal mediastinal soft tissue nodule was visualized on the images of CTA. This right paratracheal soft tissue mass was found to be ectopic benign thyroid tissue by histological analysis of the biopsied tissue samples. The function of this ectopic thyroid tissue was characterized by I-123 radioiodine uptake and single photon emission computed tomography/computed tomography (SPECT/CT) imaging. This case illustrates that ectopic thyroid tissue should be included for differential diagnosis of a hyperdense soft tissue mass located within mediastinum. I-123 SPECT/CT is useful for guiding tissue biopsy of ectopic thyroid tissue distant from orthotopic thyroid gland and functional and anatomic characterization of mediastinal ectopic thyroid tissue for surgical resection when it is medically necessary.
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Cunha FM, Rodrigues E, Oliveira J, Saavedra A, Vinhas LS, Carvalho D. Graves' disease in a mediastinal mass presenting after total thyroidectomy for nontoxic multinodular goiter: a case report. J Med Case Rep 2016; 10:70. [PMID: 27029843 PMCID: PMC4815244 DOI: 10.1186/s13256-016-0878-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thyrotoxicosis after total thyroidectomy is mostly iatrogenic. Rarely, a hyperfunctional thyroid remnant or ectopic tissue may be the cause. There are few cases of Graves' disease arising from thyroid tissue located in the mediastinum and none in which Graves' disease was diagnosed only after surgery. We report the case of a patient with Graves's disease in a mediastinal thyroid mass presenting 7 years after total thyroidectomy for nontoxic goiter. CASE PRESENTATION A 67-year-old Caucasian woman presented with palpitations, fatigue and weight loss. She had a history of total thyroidectomy for nontoxic multinodular goiter at the age of 60 without any signs of malignancy on microscopic examination. She had been medicated with levothyroxine 100 μg/day since the surgery without follow-up. She was tachycardic, had no cervical mass or eye involvement. Her thyroid-stimulating hormone levels were suppressed (0.000 μU/mL) and her free thyroxine (3.22 ng/dL) and free triiodothyronine (8.46 pg/mL) levels increased. Neither mediastinal enlargement nor trachea deviation was found on chest roentgenogram. Levothyroxine treatment was stopped but our patient showed no improvement on free thyroxine or free triiodothyronine 10 days later. Thyroglobulin was increased to 294 mg/mL. A cervical ultrasound scan revealed no thyroid remnant. Her anti-thyroid-stimulating hormone receptor antibodies were high (19.7 U/L). Corporal scintigraphy demonstrated increased intrathoracic radioiodine uptake. A computed tomography scan confirmed a 60 × 40 mm mediastinal mass. Methimazole 10 mg/day was started. Three months later, her thyroid function was normal and she underwent surgical resection. Microscopic examination showed thyroid tissue with no signs of malignancy. CONCLUSIONS Although thyrotoxicosis after total thyroidectomy is mostly due to excessive supplementation, true hyperthyroidism may rarely be the cause, which should be kept in mind. The presence of thyroid tissue after total thyroidectomy in our patient may correspond to a remnant or ectopic thyroid tissue that became hyperfunctional in the presence of anti- thyroid-stimulating hormone receptor antibodies.
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Affiliation(s)
- Filipe Manuel Cunha
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4202-451, Porto, Portugal. .,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - Elisabete Rodrigues
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4202-451, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Joana Oliveira
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4202-451, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Ana Saavedra
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4202-451, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Luís Sá Vinhas
- Serviço de Cirurgia Geral, Centro Hospitalar de São João, Porto, Portugal
| | - Davide Carvalho
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4202-451, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Szczepanek-Parulska E, Ruchala M, Hernik A. Unexpected conversion from hypothyroidism to an euthyroid state due to Graves' disease in a patient with an ectopic thyroid. Endocrine 2014; 46:684-5. [PMID: 24282039 PMCID: PMC4102823 DOI: 10.1007/s12020-013-0117-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 11/05/2013] [Indexed: 11/02/2022]
Abstract
A 15-year-old woman was diagnosed with hypothyroidism and unilateral ectopic thyroid. Levothyroxine treatment was introduced; however, the patient was non-compliant and took the medication irregularly. When she presented to an endocrinologist at the age of 30, she had not been using levothyroxine for at least 6 months. Surprisingly, she was clinically and biochemically euthyroid. Due to decreased echogenicity on ultrasound examination, enhanced vascularization on Color Doppler examination and increased concentration of anti-TSH receptor autoantibodies, she was diagnosed with Graves' disease. Eventually, she underwent total thyroidectomy due to diagnosis of follicular neoplasm in fine-needle aspiration biopsy of the focal lesion found in the thyroid gland. To our knowledge, our patient is the first described with ectopic thyroid, presenting a nodular variant of Graves' disease and no signs of orbitopathy, who was initially hypothyroid and became euthyroid in the course of autoimmune thyroid disease.
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Affiliation(s)
- Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Medicine, University of Medical Sciences, 49 Przybyszewskiego St., 60-355 Poznan, Poland
| | - Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, University of Medical Sciences, 49 Przybyszewskiego St., 60-355 Poznan, Poland
| | - Aleksandra Hernik
- Department of Endocrinology, Metabolism and Internal Medicine, University of Medical Sciences, 49 Przybyszewskiego St., 60-355 Poznan, Poland
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Guerra G, Cinelli M, Mesolella M, Tafuri D, Rocca A, Amato B, Rengo S, Testa D. Morphological, diagnostic and surgical features of ectopic thyroid gland: a review of literature. Int J Surg 2014; 12 Suppl 1:S3-11. [PMID: 24887357 DOI: 10.1016/j.ijsu.2014.05.076] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 02/06/2023]
Abstract
Ectopic thyroid tissue remains a rare developmental abnormality involving defective or aberrant embryogenesis of the thyroid gland during its passage from the floor of the primitive foregut to its usual final position in pre-tracheal region of the neck. Its specific prevalence accounts about 1 case per 100.000-300.000 persons and one in 4.000-8.000 patients with thyroid disease show this condition. The cause of this defect is not fully known. Despite genetic factors have been associated with thyroid gland morphogenesis and differentiation, just recently some mutation has been associated with human thyroid ectopy. Lingual region in the most common site of thyroid ectopy but ectopic thyroid tissue were found in other head and neck locations. Nevertheless, aberrant ectopic thyroid tissue has been found in other places distant from the neck region. Ectopic tissue is affected by different pathological changes that occur in the normal eutopic thyroid. Patients may present insidiously or as an emergency. Diagnostic management of thyroid ectopy is performed by radionuclide thyroid imaging, ultrasonography, CT scan, MRI, biopsy and thyroid function tests. Asymptomatic euthyroid patients with ectopic thyroid do not usually require therapy but are kept under observation. For those with symptoms, treatment depends on size of the gland, nature of symptoms, thyroid function status and histological findings. Surgical excision is often required as treatment for this condition.
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Affiliation(s)
- Germano Guerra
- Department of Medicine and Health Sciences, University of Molise, Via F. De Sanctis 1, 86100 Campobasso, Italy.
| | - Mariapia Cinelli
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Massimo Mesolella
- Department of Neuroscience Reproductive and Dentistry Sciences, Otholaryngology Unit, University of Naples "Federico II", Naples, Italy
| | - Domenico Tafuri
- Department of Sport Sciences and Wellness, University of Naples "Parthenope", Naples, Italy
| | - Aldo Rocca
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Sandro Rengo
- Department of Neuroscience Reproductive and Dentistry Sciences, Otholaryngology Unit, University of Naples "Federico II", Naples, Italy
| | - Domenico Testa
- Department of Anesthesiologic, Surgical and Emergency Sciences, Otolaryngology - Head and Neck Surgery Unit, Second University of Naples, Naples, Italy
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El Amine AM, Kamel C. Ectopic lingual thyroid. Indian J Endocrinol Metab 2013; 17:365-366. [PMID: 23776931 PMCID: PMC3683233 DOI: 10.4103/2230-8210.109695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Chikh Kamel
- Department of Ear, Nose and Throat, EHU, Oran, Algeria
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Jacob MJ, Ravina M. A rare case of lingual thyroid with hyperthyroidism: A case report and review of the literature. Indian J Endocrinol Metab 2012; 16:441-443. [PMID: 22629516 PMCID: PMC3354857 DOI: 10.4103/2230-8210.95708] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lingual thyroid is a rare embryological anomaly resulting from failure of normal thyroid tissue to descend from the foramen cecum at base of tongue to its orthotopic location in front of the lower neck. It is a rare anomaly with a reported incidence of 1 in 3000 of the thyroid disorders. Lingual thyroid is often asymptomatic but may cause local symptoms such as dysphagia, dysphonia with stomatolalia, upper airway obstruction, and often with hypothyroidism. Hyperthyroidism is extremely rare finding and till now there are very few case reports published. We present here a case of lingual thyroid with hyperthyroidism, which was treated successfully with radioiodine.
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Affiliation(s)
| | - Mudalsha Ravina
- Department of Nuclear Medicine, Army Hospital Research and Referral, Dhaula kuan, New Delhi, India
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