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Bontemps SH, Legagneur C, Guéant-Rodriguez RM, Remen T, Luc A, Renard E. Congenital hypothyroidism in children with eutopic gland or thyroid hemiagenesis: prognostic factors for transient vs. permanent hypothyroidism. J Pediatr Endocrinol Metab 2023; 36:353-363. [PMID: 36798001 DOI: 10.1515/jpem-2022-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 01/29/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES More than one third of children with congenital hypothyroidism (CH) and thyroid gland in situ (or eutopic gland) have transient hypothyroidism. It remains difficult to determine early on whether hypothyroidism will be transient which may cause overtreatment and its complications in these children. Our primary aim was to determine prognostic factors for transient hypothyroidism in children with congenital hypothyroidism and eutopic gland or thyroid hemiagenesis. METHODS We retrospectively reviewed medical records of 111 children, born between 1996 and 2017, diagnosed with congenital hypothyroidism and eutopic gland or hemiagenesis and treated at the Nancy Regional and University Hospital. RESULTS Fifty four infants (48.6%) had permanent congenital hypothyroidism (PCH) and 57 (51.4%) transient congenital hypothyroidism (TCH). Prognostic factors for TCH included prematurity, twin pregnancy, low birth weight and Apgar score <7, while low FT3 at diagnosis, maternal levothyroxine treatment, a family history of thyroid dysfunction and TSH ≥10 mUI/L while receiving treatment were associated with PCH. Knee epiphyses on X-ray at diagnosis were absent only in children with PCH. The median levothyroxine dose during follow-up was significantly lower in the TCH group compared to the PCH group. A levothyroxine dose of ≤3.95, ≤2.56, ≤2.19 and ≤2.12 μg/kg/day at 6 months, 1, 2 and 3 years of follow-up, respectively, had the best sensitivity-to-specificity ratio for predicting TCH. CONCLUSIONS Even though it remains difficult to predict the course of hypothyroidism at diagnosis, we were able to identify several prognostic factors for TCH including perinatal problems and lower levothyroxine requirements that can guide the physician on the evolution of hypothyroidism. Clinical Trial Registration Number: NCT04712760.
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Affiliation(s)
| | - Carole Legagneur
- Department of Pediatrics, University Hospital of Nancy, Vandoeuvre-Lès-Nancy, France
| | - Rosa-Maria Guéant-Rodriguez
- Department of Biochemistry, University Hospital of Nancy, Vandoeuvre-Lès-Nancy, France.,Institut national de la santé et de la recherche médicale 1256 [National Institute of Health and Medical Research], University of Lorraine, N-GERE Nutrition Genetics and Environmental Risks, Vandoeuvre-Lès-Nancy, France
| | - Thomas Remen
- MPI Department, Methodology, Data Management and Statistic Unit, Délégation à la Recherche Clinique et à l'Innovation [Delegation for Clinical Research and Innovation], University Hospital of Nancy, Vandœuvre-Lès-Nancy, France
| | - Amandine Luc
- MPI Department, Methodology, Data Management and Statistic Unit, Délégation à la Recherche Clinique et à l'Innovation [Delegation for Clinical Research and Innovation], University Hospital of Nancy, Vandœuvre-Lès-Nancy, France
| | - Emeline Renard
- Department of Pediatrics, University Hospital of Nancy, Vandoeuvre-Lès-Nancy, France.,Institut national de la santé et de la recherche médicale 1256 [National Institute of Health and Medical Research], University of Lorraine, N-GERE Nutrition Genetics and Environmental Risks, Vandoeuvre-Lès-Nancy, France
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Yoon DY, Kim ES, Lee CW, Seo YL, Lee Y, Kwon MJ, Lee SM. Computed tomography findings of thyroid hemiagenesis: differentiation from hemithyroidectomy. BMC Med Imaging 2023; 23:8. [PMID: 36627559 PMCID: PMC9832612 DOI: 10.1186/s12880-023-00961-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Thyroid hemiagenesis is a rare congenital anomaly characterized by the lack of development of one thyroid lobe. The purpose of this study was to evaluate computed tomography (CT) findings of thyroid hemiagenesis and to establish useful CT criteria for differentiating thyroid hemiagenesis from the hemithyroidectomy state. METHODS The CT images of 11 patients with thyroid hemiagenesis were retrospectively reviewed and compared with those of 100 (49 left and 51 right) patients in a hemithyroidectomy state. Image analysis was performed according to the following CT parameters: (a) side of thyroid hemiagenesis, (b) edge of the medial end of the remnant thyroid gland, (c) location of the medial end of the remnant thyroid gland, expressed as the angle of the medial end and (d) any other thyroid abnormality observed during the initial examination. RESULTS The missing lobe occurred more often in the left than in the right lobe (72.7% vs. 27.3%) as well as concomitant isthmus agenesis (100% vs. 37.5%). The sharp edge of the medial end of the remnant thyroid gland was more common in thyroid hemiagenesis (64%) than in hemithyroidectomy (26%) (P = 0.0153). In left thyroid hemiagenesis, the angle of the medial end (63%) was more frequently > + 30° than in hemithyroidectomy (0%) (P < 0.0001). Two patients presented with hypothyroidism; the remaining nine showed a normal thyroid function. The associated thyroid diseases were autoimmune thyroiditis (n = 1) and papillary thyroid carcinoma (n = 1). CONCLUSIONS The sharp edge of the medial end of the remnant thyroid gland and an angle of > + 30° for the medial end in cases wherein the left lobe is absent are useful CT features for distinguishing thyroid hemiagenesis from hemithyroidectomy.
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Affiliation(s)
- Dae Young Yoon
- grid.256753.00000 0004 0470 5964Department of Radiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Eun Soo Kim
- grid.256753.00000 0004 0470 5964Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do 14068 Republic of Korea
| | - Chae Woon Lee
- grid.256753.00000 0004 0470 5964Department of Radiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young Lan Seo
- grid.256753.00000 0004 0470 5964Department of Radiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Yul Lee
- grid.256753.00000 0004 0470 5964Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do 14068 Republic of Korea
| | - Mi Jung Kwon
- grid.256753.00000 0004 0470 5964Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea
| | - Sang Min Lee
- grid.410886.30000 0004 0647 3511Department of Radiology, Gangnam Medical Center, Cha University, Seoul, Republic of Korea
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Lesi OK, Thapar A, Appaiah NNB, Iqbal MR, Kumar S, Maharaj D, Saad Abdalla Al-Zawi A, Dindyal S. Thyroid Hemiagenesis: Narrative Review and Clinical Implications. Cureus 2022; 14:e22401. [PMID: 35371763 PMCID: PMC8942040 DOI: 10.7759/cureus.22401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2022] [Indexed: 12/24/2022] Open
Abstract
Thyroid Hemiagenesis (THA) is an uncommon, congenital anomaly defined by the absence of one thyroid lobe with or without the isthmus. Reports suggest it may be found more often in regions endemic for hypothyroidism. Genetic abnormalities are thought to have a role based on findings in monozygotic twins. Most cases are sporadic, however familiar clusters have also been documented. It is found more frequently in females. A majority of patients report no symptoms and THA is found incidentally during investigations or intraoperatively. THA is usually associated with normal thyroid function, but it can present with thyroid hypofunction. Since a majority of patients are asymptomatic, there are no specific recommendations for management. Ultrasound imaging and thyroid scintigraphy using technetium or iodine are useful in diagnosis. Its clinical importance occurs when the remnant thyroid lobe requires excision leading to the lifelong requirement for thyroxine supplementation. Published English literature (Medline, PubMed, and Embase databases) was searched. Medical subject headings (MeSH) terms used were “thyroid hemiagenesis,” “one thyroid lobe,” and “thyroid aplasia”. Case reports, case series, and original articles were selected to provide a framework for this review. Articles reviewed were published in the past 20 years. The association of THA with thyroid cancer was explored. In this group, the F:M ratio was 3.25:1. Left THA constituted 53% of cases, right THA in 29.4%, and isthmus absence in 17.6% of cases. Also, the authors investigated the link between THA and hyperparathyroidism, both left and right THA are seen in an equal number of cases in the hyperparathyroidism subgroup. In patients with THA and Grave’s disease, left THA was seen in a majority of cases (86.7%), while an equal number of left and right THA was observed in patients with Hashimoto’s thyroiditis. In addition, congenital abnormalities associated with THA were observed, the left THA was seen in 60% and right THA in 40% of cases of this subgroup. The summative review provided a detailed insight into the epidemiology, aetiopathogenesis, genetics, symptomatology, diagnosis, and treatment for THA by combining findings and results from almost a hundred research papers from around the world. THA remains a poorly understood, often incidentally detected, abnormality in euthyroid patients undergoing investigations and treatment for other thyroid disorders.
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Kartini D, Panigoro SS, Ham MF, Harahap AS, Rasyid SH, Marcevianto KV. Thyroid hemiagenesis associated with Hurthle cell carcinoma: A case report. Int J Surg Case Rep 2021; 86:106372. [PMID: 34507192 PMCID: PMC8433239 DOI: 10.1016/j.ijscr.2021.106372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/28/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance Thyroid hemiagenesis (TH) is a rare congenital anomaly where one lobe fails to develop, especially more frequently occurs on the left lobe. The exact mechanisms for thyroid morphogenesis remain unclear. In this paper, we report a rare case of right lobe TH associated with Hurthle cell carcinoma. Case presentation A 59 years old woman was admitted with a neck lump increasing in size in the last 20 years. There were no symptoms of hyperthyroidism and hypothyroidism. There was a palpable, painless 5 cm mass in the middle of the neck. Initial thyroid ultrasonography (USG) revealed an enlarged left lobe, with hypoechoic lesion with cystic component and calcification (TIRADS 4). However, the right lobe was non-visualized. Fine needle aspiration biopsy result tendency was a malignancy. Hence, isthmolobectomy was conducted. Pathology result was Hurthle cell carcinoma. On the ninth month, USG revealed fibrotic tissue in the right thyroid bed and bilateral lymphadenopathy. Due to discrepancy, the patient was planned for a neck exploration surgery and a right lobe incision. Intraoperatively, the right thyroid was absent. Intraoperative USG also confirmed no right thyroid lobe. Discussion Thyroid hemiagenesis can be visualized by using USG due to its practicality and cost effectiveness reasons. Follow up evaluations consisted of systematic monitoring of thyroid morphology and hormonal functions should follow the diagnosis of TH. Neck exploration surgery might need to be performed to clarify any discrepancy and confirm the diagnosis. Conclusion TH can be recognized through supporting examination; however, discrepancy may occur. History taking and physical examination is mandatory yet might not adequate to diagnose hemiagenesis accompanying thyroid diseases. Ultrasonography is easily performed, cost effective, and without any radiation exposure to identify thyroid hemiagenesis If discrepancy occur in ultrasonography examination, neck exploration surgery can clarify and confirm the diagnosis.
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Affiliation(s)
- Diani Kartini
- Surgical Oncology Division, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia.
| | - Sonar Soni Panigoro
- Surgical Oncology Division, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia
| | - Maria Fransisca Ham
- Department of Pathological Anatomy, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia
| | - Agnes Stephanie Harahap
- Department of Pathological Anatomy, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia
| | - Sani Hadiyan Rasyid
- Surgical Oncology Division, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia
| | - Kevin Varian Marcevianto
- Surgical Oncology Division, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia
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Mikosch P, Weixlbaumer V, Irrgang M, Aistleitner A, Trifina-Mikosch E. Hemiagenesis of the thyroid gland detected by coincidence-what is the clinical relevance? : Case report and review of the literature. Wien Med Wochenschr 2020; 170:403-409. [PMID: 33026543 PMCID: PMC7593389 DOI: 10.1007/s10354-020-00783-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 08/20/2020] [Indexed: 12/27/2022]
Abstract
Hemiagenesis of the thyroid gland (THA) represents a rare congenital anomaly. It is characterized by the absence of one thyroid lobe, and sometimes the isthmus as well. It can occur with all kinds of other thyroid pathologies that may be present in the remaining thyroid lobe. A case of a 21-year-old male patient is presented; he sought a thyroid consultation because of hair loss, fatigue, and problems concentrating, thus raising the suspicion of hypothyroidism. Thyroid function was normal, but sonography of the thyroid gland revealed THA of the left lobe and the isthmus. The current knowledge concerning the genesis and the clinical consequences of THA are discussed based on the current literature.
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Affiliation(s)
- Peter Mikosch
- Department of Internal Medicine 2, General Hospital Mistelbach-Gänserndorf, Mistelbach, Austria.
- University Teaching Unit, Medizinische Universität Wien/Medical University of Vienna, Vienna, Austria.
| | - Verena Weixlbaumer
- University Teaching Unit, Medizinische Universität Wien/Medical University of Vienna, Vienna, Austria
| | - Michael Irrgang
- University Teaching Unit, Medizinische Universität Wien/Medical University of Vienna, Vienna, Austria
| | - Adrian Aistleitner
- University Teaching Unit, Medizinische Universität Wien/Medical University of Vienna, Vienna, Austria
| | - Eva Trifina-Mikosch
- University Teaching Unit, Medizinische Universität Wien/Medical University of Vienna, Vienna, Austria
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Pediatric thyroid ultrasound: a radiologist's checklist. Pediatr Radiol 2020; 50:563-574. [PMID: 32166365 DOI: 10.1007/s00247-019-04602-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/26/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022]
Abstract
Ultrasonography (US) is the imaging method of choice for evaluating the pediatric thyroid gland, complemented by scintigraphy and thyroid function tests, especially when evaluating children with suspected congenital hypothyroidism, goiter, infectious or autoimmune diseases, or neoplasm. Diagnostic considerations in newborns with congenital hypothyroidism mainly include dysgenesis, dyshormonogenesis, transient hypothyroidism and central (hypophyseal) hypothyroidism. The midline of the neck should be scrutinized for thyroid tissue from the floor of the mouth to the thoracic inlet. Cystic and echogenic ultimobranchial remnants should not be misinterpreted as orthotopic thyroid tissue. Diffuse thyroid diseases affect older children; these comprise Hashimoto and Graves diseases and infectious thyroiditis and exhibit features similar to those in adults. It is important to note that the diffuse sclerosing variant of papillary thyroid cancer can complicate thyroiditis and should not be confused with Hashimoto disease. In children with solid nodules the threshold for fine-needle aspiration biopsy or surgery should be lower compared to adults because of a higher likelihood of malignancy compared with adults. Biopsy should be considered in nodules with suspicious ultrasonographic features, even when smaller than 1 cm. Adult classification systems of thyroid nodules, although useful, are not sufficient to safely discriminate the nodules' likelihood of malignancy in children. We describe key sonographic findings and suggest a standard checklist that might be considered while performing and interpreting thyroid US in neonates and children.
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Nakamura T, Ichii O, Sunden Y, Elewa YHA, Yoshiyasu T, Hattori H, Tatsumi O, Kon Y, Nagasaki KI. Slc:Wistar/ST rats develop unilateral thyroid dysgenesis: A novel animal model of thyroid hemiagenesis. PLoS One 2019; 14:e0221939. [PMID: 31465501 PMCID: PMC6715207 DOI: 10.1371/journal.pone.0221939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/19/2019] [Indexed: 11/18/2022] Open
Abstract
Developmental anomalies of the thyroid gland lead to congenital malformations such as thyroglossal duct cysts and thyroid dysgenesis. However, the pathogenesis of thyroid dysgenesis remains unclear due to the lack of suitable animal models. This study demonstrated that Slc:Wistar/ST rats frequently developed unilateral thyroid dysgenesis, including hemiagenesis, characterized by the absence of one lobe. In Wistar/ST rats, each thyroid lobe was frequently different in size, and approximately 27% and 20% of the rats presented with hemihypoplasia and hemiagenesis of the thyroid gland, respectively. Dysgenesis was predominant on the left side in both sexes, without sex differences. At a young age, thyroid hemiagenesis did not alter body weight. In rats of both sexes with thyroid hemiagenesis, plasma total triiodothyronine and total triiodothyronine levels remained unchanged while plasma thyroid-stimulating hormone levels were significantly elevated in young rats. The remaining thyroid lobes increased in weight, but the follicular epithelial cells appeared normal in terms of their height and proliferating activities. On the side of thyroid dysgenesis, the parathyroid glands were normally localized and were situated at the same location as the contralateral glands. The ultimobranchial body remnants were localized at the level of the thyroid gland along with the cranial thyroid artery and vein, forming cell clusters or cystic structures and containing calcitonin-positive C-cells. In conclusion, Wistar/ST rats developed unilateral thyroid dysgenesis and may be novel and useful animal models for thyroid hemiagenesis in humans and for morphogenesis of pharyngeal pouch-derived organs.
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Affiliation(s)
- Teppei Nakamura
- Section of Biomedical Science, Chitose Laboratory, Japan Food Research Laboratories, Chitose, Hokkaido, Japan
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Division of Veterinary Medicine, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
- * E-mail:
| | - Osamu Ichii
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Division of Veterinary Medicine, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yuji Sunden
- Laboratory of Veterinary Pathology, Faculty of Agriculture, Tottori University, Tottori, Japan
| | - Yaser Hosny Ali Elewa
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Division of Veterinary Medicine, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
- Department of Histology and Cytology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Tomoji Yoshiyasu
- Section of Biological Safety Research, Chitose Laboratory, Japan Food Research Laboratories, Chitose, Hokkaido, Japan
| | - Hideki Hattori
- Section of Biological Safety Research, Chitose Laboratory, Japan Food Research Laboratories, Chitose, Hokkaido, Japan
| | - Osamu Tatsumi
- Section of Biomedical Science, Chitose Laboratory, Japan Food Research Laboratories, Chitose, Hokkaido, Japan
| | - Yasuhiro Kon
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Division of Veterinary Medicine, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Ken-ichi Nagasaki
- Section of Biological Safety Research, Tama Laboratory, Japan Food Research Laboratories, Tama, Tokyo, Japan
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Faulkner J, Varadharajan K, Choudhury N. A UK reported case of Graves' disease with thyroid hemiagenesis. BMJ Case Rep 2019; 12:12/8/e228094. [PMID: 31377715 DOI: 10.1136/bcr-2018-228094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a rare case of a 31-year-old patient with Graves' disease with agenesis of the left thyroid lobe. The patient was managed with a right hemithyroidectomy and isthmusectomy as definitively treatment of Graves' disease. The patient had an uneventful postoperative outcome and the histology was benign and consistent with Graves' disease. This is a rare case in the literature of Graves' disease with unilateral thyroid agenesis, and to our knowledge is the first reported case from the UK.
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Adnan SH, Nobecourt P, Tran S, Radhakrishnan RS, Bowen-Jallow KA. Fourth branchial cleft cyst and congenital absence of the contralateral thyroid lobe. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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10
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Nakamura S, Masuda T, Ishimori M. Dual ectopic thyroid associated with thyroid hemiagenesis. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM180026. [PMID: 29732163 PMCID: PMC5931231 DOI: 10.1530/edm-18-0026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 04/12/2018] [Indexed: 12/29/2022] Open
Abstract
We report a case of a 15-year-old girl with a midline neck mass that was first noted 2 or 3 years previously. She had been treated with levothyroxine (L-T4) for congenital hypothyroidism until 11 years of age. Ultrasonography revealed an atrophic right thyroid (1.0 × 1.6 × 2.6 cm in size) and a mass (2.3 × 1.0 × 3.5 cm in size) in the upper part of the neck. No left lobe of the thyroid was detected. On further evaluation, Tc-99m pertechnetate thyroid scintigraphy and CT showed ectopic thyroid tissue in the lingual region and infrahyoid region. Thus, she was diagnosed as having dual ectopic thyroid and thyroid hemiagenesis. The atrophic right thyroid was thought be non-functional. Treatment with L-T4 was started to reduce the size of the dual ectopic thyroid tissue. This may be the first reported case of dual ectopic thyroid associated with hemiagenesis detected only by ultrasonography.
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Affiliation(s)
- Shigenori Nakamura
- Thyroid and Diabetic Division, Department of Internal Medicine, Japanese Red Cross Gifu Hospital, Gifu, Japan
| | - Teruyuki Masuda
- Thyroid and Diabetic Division, Department of Internal Medicine, Japanese Red Cross Gifu Hospital, Gifu, Japan
| | - Masatoshi Ishimori
- Thyroid and Diabetic Division, Department of Internal Medicine, Japanese Red Cross Gifu Hospital, Gifu, Japan
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Wang M, Hou L, Chen M, Ren L, Tang P, Zhang Y, Jiang J. Thyroid hemiagenesis and Hashimoto's thyroditis-diagnostic and treatment pitfalls. World J Surg Oncol 2017; 15:182. [PMID: 28985747 PMCID: PMC6389105 DOI: 10.1186/s12957-017-1250-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 09/26/2017] [Indexed: 11/15/2022] Open
Abstract
Background Thyroid hemiagenesis (TH) is a rare congenital disease with absence of a thyroid lobe; most patients have no clinical symptoms. The etiology of TH remains unclear. In this paper, we describe a rare case of TH and congenital absence of the ipsilateral parathyroid gland, found during the operation, combined with the autoimmune disease Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis. Case Presentation A 31-year-old woman was admitted to our hospital because of a mass in the right neck. Surgical exploration validated the absence of the left lobe of the thyroid and parathyroid glands, and pathological examination of the excised nodules confirmed Hashimoto’s thyroiditis. Patients with TH might show accompanying absence of the ipsilateral parathyroid gland. The case described here, in which TH was combined with Hashimoto’s thyroiditis, is rare in the medical literature. The operation should be ended at once if Hashimoto’s thyroiditis is diagnosed during surgery. Conclusions Absence of thyroid lobe may accompany with a congenital absence of the ipsilateral parathyroid gland and Hashimoto’s thyroiditis. Fine needle aspiration is essential to diagnosis and decision-making of the treatment.
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Affiliation(s)
- Minghao Wang
- Center of Breast Disease, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Lingmi Hou
- Center of Breast Disease, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.,Department of Breast and Thyroid Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, China
| | - Maoshan Chen
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, Sichuan, 629000, China
| | - Lin Ren
- Center of Breast Disease, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Peng Tang
- Center of Breast Disease, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Yi Zhang
- Center of Breast Disease, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
| | - Jun Jiang
- Center of Breast Disease, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
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Szczepanek-Parulska E, Zybek-Kocik A, Wartofsky L, Ruchala M. Thyroid Hemiagenesis: Incidence, Clinical Significance, and Genetic Background. J Clin Endocrinol Metab 2017; 102:3124-3137. [PMID: 28666345 DOI: 10.1210/jc.2017-00784] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/22/2017] [Indexed: 12/17/2022]
Abstract
CONTEXT Thyroid hemiagenesis (THA) constitutes a rare, congenital disorder that is characterized by an absence of one thyroid lobe. Because the pathogenesis and clinical significance of this malformation remain undefined, specific clinical recommendations are lacking, especially for asymptomatic cases. EVIDENCE ACQUISITION The PubMed database was searched (years 1970 to 2017), and the following terms were used to retrieve the results: "thyroid hemiagenesis," "thyroid hemiaplasia," "one thyroid lobe agenesis," and "one thyroid lobe aplasia." Subsequently, reference sections of the retrieved articles were searched. EVIDENCE SYNTHESIS There is a noticeable susceptibility of subjects with THA to develop additional thyroid and nonthyroidal pathologies. In pathogenesis of concomitant thyroid pathologies, a chronic elevation in thyroid-stimulating hormone values may play an important role. Thus far, genetic studies failed to find a common genetic background of the anomaly, and the potential underlying cause was identified in a minority of the cases. CONCLUSIONS Patients with THA are prone to develop additional thyroid pathologies and theoretically might benefit from l-thyroxine treatment to lower the thyrotropin levels to those observed in the normal population. However, further research should be done to ascertain whether such intervention early in life would prevent development of associated thyroid conditions. At least, increased vigilance should be maintained to reveal all of the concomitant disorders as soon as possible during follow-up examinations. Application of high-throughput technologies enabling a genome-wide search for novel factors involved in thyroid embryogenesis might be the next step to expand the knowledge on THA pathogenesis.
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Affiliation(s)
- Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Ariadna Zybek-Kocik
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Leonard Wartofsky
- Department of Medicine, Washington Hospital Center, Washington, District of Columbia 20010
| | - Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland
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Suzuki S, Midorikawa S, Matsuzuka T, Fukushima T, Ito Y, Shimura H, Takahashi H, Ohira T, Ohtsuru A, Abe M, Suzuki S, Yamashita S. Prevalence and Characterization of Thyroid Hemiagenesis in Japan: The Fukushima Health Management Survey. Thyroid 2017; 27:1011-1016. [PMID: 28657504 PMCID: PMC5564018 DOI: 10.1089/thy.2016.0662] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Thyroid hemiagenesis is a rare congenital variant characterized by the lack of development of one thyroid lobe with no clinical manifestations. METHODS This study was performed to determine the prevalence and characteristics of thyroid hemiagenesis in a normal Japanese population. This cross-sectional study was performed from October 9, 2011, to April 30, 2015. In total, 299,908 children and young adults in the Fukushima Health Management Survey were examined to determine the presence of thyroid agenesis or hemiagenesis. Thyroid width, thickness, and length were measured in 292,452 of these subjects. RESULTS Thyroid agenesis was diagnosed in 13 subjects, and hemiagenesis was detected in 67 subjects (0.02%; 22.3/100,000 individuals). Although there was no significant sex-related difference (p = 0.067), the female:male ratio was 1.67:1.00. Females were significantly dominant in right hemiagenesis, while there was no difference in left hemiagenesis between males and females. The thyroid volumes at the 2.5th and 97.5th percentiles for age and body surface area were determined for each sex. Multivariate regression analysis showed that a large hemithyroid volume was independently associated with the presence of contralateral hemiagenesis (p < 0.001). CONCLUSION The prevalence of thyroid hemiagenesis in the present study is in agreement with that reported in other countries. The prevalence of right hemiagenesis was higher in females, and the larger contralateral lobe in patients with rather than without hemiagenesis may have been caused by a compensatory feedback mechanism to prevent hypothyroidism. In addition, the prevalence of hemiagenesis, especially right hemiagenesis, may be affected by sex-related factors similar to those in patients with an ectopic thyroid gland.
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Affiliation(s)
- Satoru Suzuki
- Department of Thyroid and Endocrinology, Division of Internal Medicine, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
- Radiation Medical Science Center for the Fukushima Health Management Survey, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Sanae Midorikawa
- Radiation Medical Science Center for the Fukushima Health Management Survey, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
- Department of Radiation Health Management, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Takashi Matsuzuka
- Radiation Medical Science Center for the Fukushima Health Management Survey, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
- Department of Otolaryngology, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Toshihiko Fukushima
- Department of Thyroid and Endocrinology, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yuko Ito
- Radiation Medical Science Center for the Fukushima Health Management Survey, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
- Department of Laboratory Medicine, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hiroki Shimura
- Radiation Medical Science Center for the Fukushima Health Management Survey, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
- Department of Laboratory Medicine, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hideto Takahashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
- Department of Epidemiology, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Akira Ohtsuru
- Radiation Medical Science Center for the Fukushima Health Management Survey, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
- Department of Radiation Health Management, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Masafumi Abe
- Radiation Medical Science Center for the Fukushima Health Management Survey, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Shinichi Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
- Department of Thyroid and Endocrinology, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Shunichi Yamashita
- Radiation Medical Science Center for the Fukushima Health Management Survey, School of Medicine, Fukushima Medical University Hospital, Fukushima, Japan
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
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Szczepanek-Parulska E, Zybek-Kocik A, Woliński K, Czarnocka B, Ruchała M. Does TSH Trigger the Anti-thyroid Autoimmune Processes? Observation on a Large Cohort of Naive Patients with Thyroid Hemiagenesis. Arch Immunol Ther Exp (Warsz) 2016; 64:331-8. [PMID: 26975391 PMCID: PMC4939166 DOI: 10.1007/s00005-016-0393-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/10/2015] [Indexed: 11/25/2022]
Abstract
Thyroid hemiagenesis (THA) is a rare abnormality characterized by the absence of one thyroid lobe. Elevated thyroid stimulating hormone (TSH) level and higher incidence of thyroid diseases were reported in THA. The aim of the study is to evaluate the thyroid autoimmunity incidence in patients with THA and influence of higher than average TSH level on thyroid volume (TV) and its change with age. The study included a group of naive patients with THA and a control group of subjects with bilobate thyroid. All patients underwent clinical examination, thyroid ultrasound, scintiscan and laboratory tests. In the studied and control group the presence of thyroid autoantibodies (TAb) was evaluated. The THA group consisted of 65 patients. In THA group 53.85 % of patients were positive for TAb. Patients with positive TAb were older (46.0 ± 18.3 years) than those with negative (35.0 ± 19.8 years); p = 0.02. The incidence of TAb was lower in controls (13.85 %, p < 0.0001). In the study group, positive correlation between the age and TV (r = 0.46, p = 0.0001), and negative correlations between the age and TSH level (r = −0.31, p = 0.01), and TSH concentration and TV (r = −0.35, p = 0.004) were found. In a subgroup of 30 patients with THA negative for TAb, even stronger correlations were observed. The median single lobe volume and median TSH level were higher in patients with THA when compared to controls (13.60 vs 8.20 ml, p < 0.0001; 3.23 vs 1.48 µU/ml, p < 0.0001, respectively). Patients with THA constitute an in vivo model of long-term thyroid TSH overstimulation. Further studies are needed to reveal, whether TSH overstimulation may be the trigger for thyroid autoimmunity.
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Affiliation(s)
- Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland
| | - Ariadna Zybek-Kocik
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland
| | - Kosma Woliński
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland
| | - Barbara Czarnocka
- Department of Biochemistry and Molecular Biology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland.
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Maeda K, Asai R, Maruyama K, Kurihara Y, Nakanishi T, Kurihara H, Miyagawa-Tomita S. Postotic and preotic cranial neural crest cells differently contribute to thyroid development. Dev Biol 2015; 409:72-83. [PMID: 26506449 DOI: 10.1016/j.ydbio.2015.10.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 10/17/2015] [Accepted: 10/22/2015] [Indexed: 11/18/2022]
Abstract
Thyroid development and formation vary among species, but in most species the thyroid morphogenesis consists of five stages: specification, budding, descent, bilobation and folliculogenesis. The detailed mechanisms of these stages have not been fully clarified. During early development, the cranial neural crest (CNC) contributes to the thyroid gland. The removal of the postotic CNC (corresponding to rhombomeres 6, 7 and 8, also known as the cardiac neural crest) results in abnormalities of the cardiovascular system, thymus, parathyroid glands, and thyroid gland. To investigate the influence of the CNC on thyroid bilobation process, we divided the CNC into two regions, the postotic CNC and the preotic CNC (from the mesencephalon to rhombomere 5) regions and examined. We found that preotic CNC-ablated embryos had a unilateral thyroid lobe, and confirmed the presence of a single lobe or the absence of lobes in postotic CNC-ablated chick embryos. The thyroid anlage in each region-ablated embryos was of a normal size at the descent stage, but at a later stage, the thyroid in preotic CNC-ablated embryos was of a normal size, conflicting with a previous report in which the thyroid was reduced in size in the postotic CNC-ablated embryos. The postotic CNC cells differentiated into connective tissues of the thyroid in quail-to-chick chimeras. In contrast, the preotic CNC cells did not differentiate into connective tissues of the thyroid. We found that preotic CNC cells encompassed the thyroid anlage from the specification stage to the descent stage. Finally, we found that endothelin-1 and endothelin type A receptor-knockout mice and bosentan (endothelin receptor antagonist)-treated chick embryos showed bilobation anomalies that included single-lobe formation. Therefore, not only the postotic CNC, but also the preotic CNC plays an important role in thyroid morphogenesis.
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Affiliation(s)
- Kazuhiro Maeda
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Rieko Asai
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; Department of Physiological Chemistry and Metabolism, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kazuaki Maruyama
- Department of Physiological Chemistry and Metabolism, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yukiko Kurihara
- Department of Physiological Chemistry and Metabolism, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Hiroki Kurihara
- Department of Physiological Chemistry and Metabolism, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Sachiko Miyagawa-Tomita
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; Division of Cardiovascular Development and Differentiation, Medical Research Institute, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
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Thyroid Hemiagenesis Associated with Hyperthyroidism. Case Rep Otolaryngol 2015; 2015:829712. [PMID: 26185699 PMCID: PMC4491568 DOI: 10.1155/2015/829712] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/26/2015] [Accepted: 06/15/2015] [Indexed: 11/17/2022] Open
Abstract
Thyroid hemiagenesis (TH), very rare congenital anomaly, is generally asymptomatic. We report two cases of TH with hyperthyroidism. Case One. The patient presented with signs and symptoms of thyrotoxicosis. Physical examination revealed asymmetric nodular goitre at right lobe. Biochemical analysis revealed the diagnosis of hyperthyroidism. Ultrasound showed multinodular hypertrophy in the right lobe and absence of the left lobe. Nuclear scan, confirming absence of the left lobe, showed hot nodules in the right one. The diagnosis was toxic multinodular goitre. Case Two. The thyroid was not palpable in this patient presented with signs and symptoms of thyrotoxicosis. Biochemical analysis revealed the diagnosis of autoimmune thyrotoxicosis. Ultrasound showed mild diffuse hyperplasia of the right lobe and agenesis of the left lobe. Nuclear scan, confirming absence of the left lobe, showed increasing diffuse uptake of radiotracer in the right one. The diagnosis was Graves' disease in this patient. After antithyroid medication, the patients were surgically treated with total excision of the thyroid tissue. TH is sometimes associated with disorders of the thyroid. Hyperthyroidism makes TH cases symptomatic. During evaluation of patients, ultrasound and nuclear scan usually report agenesis of one lobe and establish the diagnosis of TH. The surgical treatment is total removal of hyperactive tissue and total excision of the remaining lobe.
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17
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Ultrasonographic and scintigraphic findings of thyroid hemiagenesis in a child: report of a rare male case. Case Rep Radiol 2015; 2015:917504. [PMID: 25785218 PMCID: PMC4345050 DOI: 10.1155/2015/917504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/01/2015] [Accepted: 02/03/2015] [Indexed: 11/17/2022] Open
Abstract
Thyroid hemiagenesis is a rare congenital anomaly in which one lobe of thyroid gland fails to develop. It is much rarer in males. There is a higher incidence of associated thyroid disorders in patients with thyroid hemiagenesis; therefore early and prompt diagnosis is important for children. We present the ultrasonographic and scintigraphic findings of thyroid hemiagenesis in an eight-year-old-boy. On ultrasonography (US), left lobe of the thyroid gland could not be demonstrated and the right lobe showed minimal hyperplasia. Its echogenicity was normal and no nodule was seen. On thyroid scintigraphy, left lobe of thyroid gland or any ectopic thyroid tissue could not be demonstrated, while the right lobe showed minimal hyperplasia. Without performing any invasive procedure, we enrolled the child in a follow-up program with the guidance of US and scintigraphy, which were effective both in making the final diagnosis of thyroid hemiagenesis and in evaluating the current status of the present thyroid tissue. In conclusion, if only one thyroid lobe is detected in a pediatric case initially with US or scintigraphy, the diagnosis of thyroid hemiagenesis should be suggested and, before any unnecessary or invasive attempt, the other complementary method (scintigraphy/US) should be performed.
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18
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Ferrari CC, Lorenz K, Dionigi G, Dralle H. Surgical strategy for primary hyperparathyreoidism with thyroid hemiagenesis. Langenbecks Arch Surg 2014; 399:1077-81. [PMID: 25078534 DOI: 10.1007/s00423-014-1228-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 07/09/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Thyroid hemiagenesis is a rare congenital anomaly, and still more rarely associated with primary hyperparathyroidism (pHPT). Due to the embryologic pathways of the thyroid and parathyroid glands, it remains unclear whether or not thyroid hemiagenesis may be linked to ipsilateral parathyroid agenesis, and consequently, surgical strategy for thyroid hemiagenesis associated pHPT (THAP) does not only depend on preoperative localization but also on the thyroid anomaly. METHODS Including the present case report, a total of nine cases with THAP retrieved from the literature were reviewed. Seven of nine cases had thyroid hemiagenesis on the left side, three out of nine showed a parathyroid adenoma on the contralateral side to the thyroid hemiagenesis. CONCLUSIONS Based on these cases, it can be concluded that the embryologic pathways of the thyroid and parathyroid glands are different, and in cases of THAP, parathyroid exploration should follow standard recommendations for pHPT surgery.
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Affiliation(s)
- Cesare Carlo Ferrari
- Division of General, Surgery Ospedale di Circolo, University of Insubria, Via Guicciardini, 21100, Varese, Italy,
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19
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Wang J, Gao L, Song C. Thyroid hemiagenesis associated with medullary or papillary carcinoma: report of cases. Head Neck 2014; 36:E106-11. [PMID: 24115043 DOI: 10.1002/hed.23501] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 04/08/2013] [Accepted: 09/10/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Thyroid hemiagenesis is a rare congenital anomaly in which 1 thyroid lobe fails to develop. Co-occurrence of hemiagenesis and thyroid carcinoma is extremely rare. Here, we report 2 cases of thyroid hemiagenesis with carcinoma. METHODS The first patient was referred with a left thyroid mass and absent right lobe. The frozen section examination revealed medullary thyroid carcinoma (MTC); therefore, a left thyroid lobectomy plus neck dissection was performed. Another patient was referred with a right thyroid mass and absent left lobe. Fine-needle aspiration biopsy was suspicious for papillary carcinoma. The patient underwent right thyroid lobectomy plus neck dissection. RESULTS The operative findings confirmed hemiagenesis of the right lobe and MTC in the left lobe for the first case, and hemiagenesis of the left lobe and papillary carcinoma in the right lobe for the second case. CONCLUSION Our case represents the first reported case of association between thyroid hemiagenesis and MTC.
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Affiliation(s)
- Jianbiao Wang
- Department of Head and Neck Surgery, Institute of Minimally Invasive Surgery of Zhejiang University, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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20
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Kaeser MA, Haun DW, Perillat MM, Kettner NW. Thyroid Hemiagenesis: A Sonographic Diagnosis. J Med Ultrasound 2012. [DOI: 10.1016/j.jmu.2012.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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21
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Oruci M, Ito Y, Buta M, Radisavljevic Z, Pupic G, Djurisic I, Dzodic R. Right thyroid hemiagenesis with adenoma and hyperplasia of parathyroid glands -case report. BMC Endocr Disord 2012; 12:29. [PMID: 23148717 PMCID: PMC3534513 DOI: 10.1186/1472-6823-12-29] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 10/29/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Thyroid hemiagenesis is a rare anomaly, more commonly seen on the left side (ratio 4:1) and in females (ratio 3:1). The first to describe this anomaly was Handfield Jones in 1852. CASE PRESENTATION We present a 66 year old female patient with right thyroid hemiagenesis, parathyroid adenoma on the side of hemiagenesis and parathyroid hyperplasia on the contralateral side. The patient had neck pain and was diagnosed as Hashimto thyroiditis with hyperparathyroidism. Parathyroid hormone, thyroglobulin antibodies (Tg-Ab) and thyroid peroxidase antibodies (TPO-Ab) were elevated. Neck ultrasound and technetium 99mTc-methoxyisobutyl isonitrile (MIBI) scintigraphy confirmed the right thyroid hemiagenesis, but not adenoma of parathyroid glands. Intraoperatively, right thyroid hemiagenesis was confirmed and left loboistmectomy was performed with removal of left inferior hyperplastic parathyroid gland. Postoperative PTH (parathyroid hormone) levels were within normal range. Five months after the operation PTH level was elevated again with calcium values at the upper limit. MIBI scintigraphy was performed again which showed increased accumulation of MIBI in the projection of the right parathyroid gland. Surgical reexploration of the neck and excision of the right upper parathyroid adenoma was performed which was located behind cricoid laryngeal cartilage. After surgery a normalization of calcium and PTH occured. CONCLUSION From available literature we have not found the case that described parathyroid adenoma on the side of thyroid hemiagenesis,with parathyroid hyperplasia on the contralateral side.
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Affiliation(s)
- Merima Oruci
- Surgical Oncology clinic, Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade, 11000, Serbia
- Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade, 11000, Serbia
| | - Yasuhiro Ito
- Department of Surgery, Kuma Hospital, 8-2-35, Shimoyamate-dori, Chuo-ku, Kobe, 650-0011, Japan
| | - Marko Buta
- Surgical Oncology clinic, Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade, 11000, Serbia
| | - Ziv Radisavljevic
- Department of Clinical Research, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Gordana Pupic
- Department of Pathology, Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade, 11000, Serbia
| | - Igor Djurisic
- Surgical Oncology clinic, Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade, 11000, Serbia
| | - Radan Dzodic
- Surgical Oncology clinic, Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade, 11000, Serbia
- University of Belgrade School of Medicine, Belgrade, 11000, Serbia
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Abstract
BACKGROUND Unilateral Graves' disease is a rare disease variant that can occur in a bilobar thyroid gland. We report the first documented case of unilateral Graves' disease in the left lobe of a bilobar thyroid gland and review the pertinent literature. PATIENT FINDINGS A 48-year-old man presented in June 2010 with thyrotoxicosis. I-131 radioisotope uptake was elevated at 33.4%, and scintigraphy revealed that uptake of the radioisotope was uniformly increased in the left lobe of the thyroid gland. Ultrasonography of the thyroid gland revealed a non-nodular, enlarged, and heterogeneous left lobe; Doppler investigation of the lobe showed hypervascularity classically seen in Graves' disease. The right lobe of the thyroid, on the other hand, appeared homogeneous and hypovascular on ultrasonography. Thyroid-stimulating immunoglobulin was significantly elevated at 191% (reference range <140%). Unilateral Graves' disease was the most likely diagnosis. SUMMARY As has occasionally been described in the literature, unilateral involvement of the thyroid gland is a rare presentation of Graves' disease. Pre-existing functional or structural differences (either congenital or acquired) between the two lobes may contribute to this rare presentation. To our knowledge, this is the first reported case of unilateral Graves' disease presenting in the left lobe of a bilobar thyroid gland. CONCLUSION Although the pathophysiology of unilateral Graves's disease has not been clearly elucidated, clinicians should be aware that Graves' disease can present unilaterally in either lobe of the thyroid gland.
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Affiliation(s)
- Louis C Chen
- Division of Endocrinology, Duke University Department of Medicine, Durham, North Carolina 27705, USA
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23
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Park JY, Kim SJ, Cho YU. Thyroid Hemiagenesis Associated with Micropapillary Thyroid Carcinoma. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.78.2.116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jae-Young Park
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Sei Joong Kim
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Young Up Cho
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
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Ruchala M, Szczepanek E, Szaflarski W, Moczko J, Czarnywojtek A, Pietz L, Nowicki M, Niedziela M, Zabel M, Köhrle J, Sowinski J. Increased risk of thyroid pathology in patients with thyroid hemiagenesis: results of a large cohort case-control study. Eur J Endocrinol 2010; 162:153-60. [PMID: 19846597 DOI: 10.1530/eje-09-0590] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Thyroid hemiagenesis (THA) is an anomaly resulting from the developmental failure of one thyroid lobe. Etiopathogenesis, clinical significance, and management of patients in whom THA is diagnosed are still a matter of debate. The aim of the study is to provide the first systematic analysis of a large cohort of subjects with THA. DESIGN Forty patients with THA are described in comparison to a control group of 80 subjects with fully developed thyroid gland. METHODS Serum concentrations of thyrotropin (TSH), free thyroxine (FT(4)), free triiodothyronine (FT(3)), and thyroid autoantibodies were measured. In 37 patients, thyroid ultrasonography and Tc-99m thyroid scintiscan were performed, followed by fine-needle aspiration biopsy if indicated. The remaining archival three cases were diagnosed with the use of I-131 scintiscan under basal conditions and after TSH stimulation. RESULTS Patients with THA, while usually clinically euthyroid, presented with significantly higher levels of TSH and FT(3) as well as with higher FT(3)/FT(4) concentration in comparison to the control group. Furthermore, a higher incidence of associated functional, morphological, and autoimmune thyroid disorders in patients with THA was observed when compared to subjects with bilobate thyroid (P<0.05). CONCLUSIONS Our results revealed that individuals with THA are more likely to develop thyroid pathology. The observed high incidence of associated pathologies is presumably due to long-lasting TSH overstimulation. Therefore, THA diagnosis should be followed by systematic observation and adequate levothyroxine treatment in patients with elevated TSH level.
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Affiliation(s)
- Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, University of Medical Sciences, Poznań, Poland.
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25
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Abstract
Congenital hypothyroidism is mainly due to structural defects of the thyroid gland, collectively known as thyroid dysgenesis. The two most prevalent forms of this condition are abnormal localization of differentiated thyroid tissue (thyroid ectopia) and total absence of the gland (athyreosis). The clinical picture of thyroid dysgenesis suggests that impaired specification, proliferation and survival of thyroid precursor cells and loss of concerted movement of these cells in a distinct spatiotemporal pattern are major causes of malformation. In normal development the thyroid primordium is first distinguished as a thickening of the anterior foregut endoderm at the base of the prospective tongue. Subsequently, this group of progenitors detaches from the endoderm, moves caudally and ultimately differentiates into hormone-producing units, the thyroid follicles, at a distant location from the site of specification. In higher vertebrates later stages of thyroid morphogenesis are characterized by shape remodeling into a bilobed organ and the integration of a second type of progenitors derived from the caudal-most pharyngeal pouches that will differentiate into C-cells. The present knowledge of thyroid developmental dynamics has emerged from embryonic studies mainly in chicken, mouse and more recently also in zebrafish. This review will highlight the key morphogenetic steps of thyroid organogenesis and pinpoint which crucial regulatory mechanisms are yet to be uncovered. Considering the co-incidence of thyroid dysgenesis and congenital heart malformations the possible interactions between thyroid and cardiovascular development will also be discussed.
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Gursoy A, Anil C, Unal AD, Demirer AN, Tutuncu NB, Erdogan MF. Clinical and epidemiological characteristics of thyroid hemiagenesis: ultrasound screening in patients with thyroid disease and normal population. Endocrine 2008; 33:338-41. [PMID: 19016002 DOI: 10.1007/s12020-008-9095-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 06/27/2008] [Indexed: 10/21/2022]
Abstract
Thyroid hemiagenesis is a rare form of thyroid dysgenesis, in which one thyroid lobe fails to develop. The true prevalence of this rare abnormality is about 0.05-0.2% in normal population. We aimed to determine prevalence of thyroid hemiagenesis in patients with various thyroid disorders and a normal population in a mild to moderate iodine-deficient area. The clinical and thyroid ultrasonography records of 4,833 patients who presented with various thyroid disorders were reviewed. In addition, ultrasonographic data of two large surveys carried out for the community screening of iodine status of children (n = 4,772) and thyroid disorders of adult subjects (n = 2,935) were analyzed. In patients with thyroid disorders, we found 12 cases with thyroid hemiagenesis (0.25%). Thyroid hemiagenesis was due to the agenesis of the left lobe in all cases. The underlying thyroid diseases were Hashimoto's thyroiditis (n = 4), euthyroid multinodular goiter (n = 4), and toxic adenoma (n = 1). Three subjects have no underlying thyroid disease. In ultrasonography screening of normal population, altogether, the absence of the left lobe was detected in only two cases, indicating a true prevalence of thyroid hemiagenesis of 0.025%. None of the reviewed patients had thyroid dysfunction. Our community-based data is in accordance with previous studies in terms of prevalence and male-to-female ratio.
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Affiliation(s)
- Alptekin Gursoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Baskent University, 5. cadde No: 48, Bahcelievler, Ankara 06490, Turkey.
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