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Gurleyik E, Gonullu E, Yekenkurul E, Gursoy F. Retrosternal thyrothymic remnant affects completeness of thyroidectomy: A case report. Int J Surg Case Rep 2024; 120:109862. [PMID: 38851069 DOI: 10.1016/j.ijscr.2024.109862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 06/10/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE The majority of surgical thyroid disorders are treated by thyroidectomy (total or hemithyroidectomy). Anatomical variants of embryologic origin may threaten the effectiveness of thyroid surgery and complete removal of thyroid tissue. CASE PRESENTATION A female patient who underwent a total thyroidectomy, postoperatively had normal serum thyroid-stimulating hormone (TSH) levels without hormone replacement. Serum TSH and thyroglobulin levels were within normal range. A thyroid nuclear scan and chest magnetic resonance imaging (MRI) indicated a large retrosternal thyroid remnant. Clinical discussion: Separated thyroid remnant in the thyrothymic tract, forgotten during primary surgery, was the source of hormone production. Total thyroidectomy was not achieved due to embryologic remnant, and complete resection of thyroid tissue was affected by separated retrosternal thyrothymic rest. CONCLUSION Surgeon awareness of anatomic variants of embryological origin undoubtedly improves thyroid surgery outcomes. Beside the anatomically based approach, total thyroidectomy could be achieved by an embryologically based approach.
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Affiliation(s)
- Emin Gurleyik
- Department of Surgery, Duzce University, Faculty of Medicine, Duzce, Turkey.
| | - Emin Gonullu
- Department of Surgery, Duzce University, Faculty of Medicine, Duzce, Turkey
| | - Erman Yekenkurul
- Department of Surgery, Duzce University, Faculty of Medicine, Duzce, Turkey
| | - Fatih Gursoy
- Department of Surgery, Duzce University, Faculty of Medicine, Duzce, Turkey
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2
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Carsote M, Ciobica ML, Sima OC, Ciuche A, Popa-Velea O, Stanciu M, Popa FL, Nistor C. Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach. Cancers (Basel) 2024; 16:1868. [PMID: 38791947 PMCID: PMC11120123 DOI: 10.3390/cancers16101868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
We aimed to analyze the management of the ectopic mediastinal thyroid (EMT) with respect to EMT-related cancer and non-malignant findings related to the pathological report, clinical presentation, imaging traits, endocrine profile, connective tissue to the cervical (eutopic) thyroid gland, biopsy or fine needle aspiration (FNA) results, surgical techniques and post-operatory outcome. This was a comprehensive review based on revising any type of freely PubMed-accessible English, full-length original papers including the keywords "ectopic thyroid" and "mediastinum" from inception until March 2024. We included 89 original articles that specified EMTs data. We classified them into four main groups: (I) studies/case series (n = 10; N = 36 EMT patients); (II) malignant EMTs (N = 22 subjects; except for one newborn with immature teratoma in the EMT, only adults were reported; mean age of 62.94 years; ranges: 34 to 90 years; female to male ratio of 0.9). Histological analysis in adults showed the following: papillary (N = 11/21); follicular variant of the papillary type (N = 2/21); Hürthle cell thyroid follicular malignancy (N = 1/21); poorly differentiated (N = 1/21); anaplastic (N = 2/21); medullary (N = 1/21); lymphoma (N = 2/21); and MALT (mucosa-associated lymphoid tissue) (N = 1/21); (III) benign EMTs with no thyroid anomalies (N = 37 subjects; mean age of 56.32 years; ranges: 30 to 80 years; female to male ratio of 1.8); (IV) benign EMTs with thyroid anomalies (N = 23; female to male ratio of 5.6; average age of 52.1 years). This panel involved clinical/subclinical hypothyroidism (iatrogenic, congenital, thyroiditis-induced, and transitory type upon EMT removal); thyrotoxicosis (including autonomous activity in EMTs that suppressed eutopic gland); autoimmune thyroiditis/Graves's disease; nodules/multinodular goiter and cancer in eutopic thyroid or prior thyroidectomy (before EMT detection). We propose a 10-item algorithm that might help navigate through the EMT domain. To conclude, across this focused-sample analysis (to our knowledge, the largest of its kind) of EMTs, the EMT clinical index of suspicion remains low; a higher rate of cancer is reported than prior data (18.8%), incident imagery-based detection was found in 10-14% of the EMTs; surgery offered an overall good outcome. A wide range of imagery, biopsy/FNA and surgical procedures is part of an otherwise complex personalized management.
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Affiliation(s)
- Mara Carsote
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Clinical Endocrinology V, “C.I. Parhon” National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Mihai-Lucian Ciobica
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Internal Medicine I and Rheumatology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania
| | - Oana-Claudia Sima
- PhD Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Adrian Ciuche
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military University Emergency Hospital, 010242 Bucharest, Romania
| | - Ovidiu Popa-Velea
- Department of Medical Psychology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Mihaela Stanciu
- Department of Endocrinology, Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania;
| | - Florina Ligia Popa
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania;
| | - Claudiu Nistor
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military University Emergency Hospital, 010242 Bucharest, Romania
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Menon LP, Naqvi S, Maradana J, Edem D. Recurrent Graves' Disease Following Near-Total Thyroidectomy: A Case Report and Literature Review. Cureus 2024; 16:e52260. [PMID: 38352081 PMCID: PMC10861850 DOI: 10.7759/cureus.52260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 02/16/2024] Open
Abstract
Recurrent Graves' disease due to regrowth of thyroid tissue is a rare complication of near-total thyroidectomy, which can be challenging to recognize and manage. Here, we present the case of a 30-year-old woman with Graves' disease and thyroid eye disease who underwent near-total thyroidectomy with resultant hypothyroidism. Her levothyroxine dose requirement gradually decreased and thyroglobulin level increased, which led to the diagnosis of recurrent Graves' disease. A neck ultrasound showed regrowth of thyroid tissue. The treatment options in such cases are repeat thyroid surgery and radioactive iodine ablation. The patient had moderate-severe active thyroid eye disease, so radioactive iodine ablation was contraindicated. Repeat surgery was deemed high risk due to the location of the residual thyroid tissue near the recurrent laryngeal nerve. Watchful waiting with serial thyrotropin (TSH) receptor antibody monitoring was chosen, and her levothyroxine dose was adjusted based on her thyroid function tests. There was a normalization of her TSH receptor antibody level over the next two and half years and stabilization of levothyroxine dose requirement. Recurrent Graves' disease must be considered when there is an ongoing decrease in the levothyroxine dose requirement associated with a rise in the serum thyroglobulin level following near-total thyroidectomy. Conservative management with medical therapy can induce remission in the case of recurrent Graves' disease following near-total thyroidectomy, without the need for radioactive iodine ablation or repeat thyroid surgery.
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Affiliation(s)
- Lakshmi P Menon
- Endocrinology, Diabetes and Metabolism, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Syeda Naqvi
- Endocrinology, Diabetes and Metabolism, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jhansi Maradana
- Endocrinology, Diabetes and Metabolism, Mass General Brigham Wentworth-Douglass Hospital, Dover, USA
| | - Dinesh Edem
- Endocrinology, Diabetes and Metabolism, University of Arkansas for Medical Sciences, Little Rock, USA
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4
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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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5
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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: 0] [Impact Index Per Article: 0] [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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6
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Stewart BD, VandenBussche CJ, Leon ME. Benign lesions of the mediastinum: A review with emphasis on cytology and small biopsy specimens. Semin Diagn Pathol 2020; 37:199-210. [PMID: 32534865 DOI: 10.1053/j.semdp.2020.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/01/2020] [Indexed: 01/03/2023]
Abstract
This review focuses on the diagnosis of select benign processes, ranging from reactive entities to heterotopic tissues to neoplasms, which may occur in the mediastinum. Currently, the mediastinum can be evaluated and biopsied with endoscopic procedures. Therefore, cytopathology specimens, fine needle aspirations, and small biopsies play an important role in the diagnosis of these lesions. In this review, an emphasis is given to relevant clinical presentations, histologic and cytologic findings, differential diagnoses, ancillary testing, and interpretation. Pitfalls are reviewed and discussed in each section. It is important for both surgical pathologists and cytopathologists to be familiar with these entities and their cytologic and histologic features that may be helpful in reaching a diagnosis.
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Affiliation(s)
- Brian D Stewart
- University of Florida College of Medicine Department of Pathology, Immunology and Laboratory Medicine P.O. Box 100275 1600 SW Archer Road Gainesville, FL 32610-0275.
| | - Christopher J VandenBussche
- Johns Hopkins University School of Medicine, Department of Pathology, 600 N. Wolfe Street Baltimore, MD 21287
| | - Marino E Leon
- University of Florida College of Medicine Department of Pathology, Immunology and Laboratory Medicine P.O. Box 100275 1600 SW Archer Road Gainesville, FL 32610-0275
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7
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Gurleyik E, Gurleyik G. Separate thyrothymic thyroid remnant; clinically crucial anatomic variation. Ann Surg Treat Res 2020; 98:111-115. [PMID: 32158730 PMCID: PMC7052395 DOI: 10.4174/astr.2020.98.3.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/28/2019] [Accepted: 01/04/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose The anatomical variations of the thyroid gland including separate thyroidal remnant at the thyrothymic area are of significance during thyroid surgery for “total” thyroidectomy, and for recurrent goitre. In the present study, we aimed to detect the separate rests of thyroidal tissue in the thyrothymic region. Methods The thyrothymic region was explored for identification, dissection, and excision of separate thyroidal remnants in 134 patients who underwent primary thyroid surgery. In this series, we studied the incidence and anatomical features of the thyrothymic remnant and its relation with other embryologic remnants. Results Overall, 222 sides of the thyroid were explored in this study. An entirely separate thyrothymic remnant of the thyroid was identified and excised in 8 of 134 patients (6%). Mean size of removed remnants was 36.4 mm (range, 29–45 mm) in diameter. The incidences of pyramidal lobe (PL) and Zuckerkandl's tubercle (ZT) were 71.6% and 59.7%, respectively. The thyrothymic remnant coexisted with PLs in 4 patients. Four patients had all 3 embryologic remnants: thyrothymic remnant, PLs, and ZTs. Conclusion An entirely separate thyroidal remnant at the thyrothymic area is not a rare variation. The considerably large size of a remnant may threaten the completeness of thyroidectomy and may result in recurrence if it is left behind after thyroid surgery. Awareness, identification, and excision of the separate remnant at the thyrothymic area and the other embryologic remnants are critical for ensuring completeness of thyroidectomy and preventing recurrences.
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Affiliation(s)
- Emin Gurleyik
- Department of Surgery, Duzce University Medical Faculty, Duzce, Turkey
| | - Gunay Gurleyik
- Department of Surgery, Haydarpasa Numune Teaching Hospital, Health Sciences University, Istanbul, Turkey
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8
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Gaschen P, Cordero J, Peiris AN. Recurrent thyrotoxicosis following near-total thyroidectomy. Proc (Bayl Univ Med Cent) 2020; 33:36-37. [PMID: 32063761 DOI: 10.1080/08998280.2019.1656012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/07/2019] [Accepted: 08/12/2019] [Indexed: 10/25/2022] Open
Abstract
Total thyroidectomy for hyperthyroidism is usually curative. We report the unusual recurrence of thyrotoxicosis following a near-total thyroidectomy. The patient, a 27-year-old woman, elected to have a total thyroidectomy and began levothyroxine after the procedure. Approximately 2 years later, recurrent thyrotoxicosis was evident off levothyroxine. Vascularized thyroid tissue was noted on ultrasound, and a radioactive iodine scan indicated increased uptake in the right thyroid region. She began antithyroid medication and was subsequently treated with radioactive iodine once a euthyroid state was achieved. We discuss the implications of this rare scenario-recurrence of thyrotoxicosis after near-total thyroidectomy.
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Affiliation(s)
- Paul Gaschen
- School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Joehassin Cordero
- Department of Otolaryngology, Texas Tech University Health Sciences CenterLubbockTexas
| | - Alan N Peiris
- Department of Internal Medicine and Clinical Research Institute, Texas Tech University Health Sciences CenterLubbockTexas
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9
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Agrawal K, Sradha Patro PS, Behera KK. Graves' Disease in Eutopic Thyroid with Ectopic Mediastinal Thyroid Tissue: Role of Single Photon Emission Computed Tomography-Computed Tomography. Indian J Nucl Med 2019; 34:230-232. [PMID: 31293306 PMCID: PMC6593940 DOI: 10.4103/ijnm.ijnm_64_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ectopic thyroid is a rare embryological aberration due to defective migration. Most patients with ectopic thyroid tissue have absent thyroid gland in normal anatomical position and present with hypothyroidism. We present a patient with Graves' disease in the eutopic thyroid with ectopic thyroid tissue in the mediastinum and usefulness of single-photon emission computed tomography-computed tomography.
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Affiliation(s)
- Kanhaiyalal Agrawal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - P Sai Sradha Patro
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kishore Kumar Behera
- Department of Endocrinology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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10
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Submental Ectopic Thyroid Cyst: An Atypical Presentation. Indian J Otolaryngol Head Neck Surg 2018; 71:712-715. [PMID: 31742048 DOI: 10.1007/s12070-018-1515-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022] Open
Abstract
It is very unusual of an ectopic thyroid to be presented as a submental swelling, clinically mimicking a submental cyst. Suspicious of the disease with complete clinical, biochemical and radiological correlation is the mainstay of diagnosis as the first FNAC is not confirmatory of the ectopic thyroid especially in cases of dysgenesis of thyroid tissue in an unusual location. Here we have presented a rare case of an ectopic thyroid gland presented with a submental swelling successfully managed with the conservative treatment.
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11
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99mTc Sodium Pertechnetate Uptake in Ectopic Mediastinal Thyroid Tissue on Hybrid Thyroid Scintigraphy. Clin Nucl Med 2018; 43:820-822. [PMID: 30015662 DOI: 10.1097/rlu.0000000000002201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ectopic thyroid is a rare/incidental imaging finding. When discovered, 90% of ectopic thyroid is found typically along the pathway of embryologic migration of thyroid tissue, whereas around 10% have been discovered in other anatomical locations including the mediastinum and the heart. Thyroid scintigraphy with Tc sodium pertechnetate (TcO4) is peculiar for thyroid tissue uptake. The current case, clinically euthyroid, had heterogeneous uptake in multinodular goiter with uptake in the ectopic thyroid tissue in right paratracheal location on functional imaging with TcO4. Subsequent single photon emission computed tomography/computed tomography (SPECT/CT) imaging confirmed the ectopic thyroid tissue.
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12
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Jakibchuk K, Ali S, Samantray J. Recurrence of Graves' disease in ectopic thyroid tissue. BMJ Case Rep 2018; 2018:bcr-2017-221566. [PMID: 29367360 DOI: 10.1136/bcr-2017-221566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 40-year-old woman with a history of Graves' disease status postorbital decompression for severe ophthalmopathy underwent total thyroidectomy by a high volume thyroid surgeon in July 2013 with a benign final pathology. Eight months later, she presented with a mass on the right anterior neck that showed minimal growth over time. Her thyroid stimulating immunoglobulin and thyroid-stimulating hormone receptor antibody levels were consistently elevated and increasing. She underwent removal of the neck mass in September 2016. Final pathology showed benign thyroid tissue with diffuse hyperplasia and lymphoid follicles, consistent with Graves' disease. We present an unusual recurrence of Graves' disease post-total thyroidectomy that recurred secondary to ectopic thyroid tissue in the right upper anterior neck deep to the strap muscles.
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Affiliation(s)
- Kalyna Jakibchuk
- Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
| | - Sophia Ali
- Department of Endocrinology, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
| | - Julie Samantray
- Department of Endocrinology, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
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13
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Consalvo V, Barbieri G, Rossetti ARR, Romano M, Contieri R, Tramontano S, Rescigno C, Infranzi M, Lombardi D. Follicular adenoma in ectopic thyroid. A case-report. Int J Surg Case Rep 2017; 40:94-96. [PMID: 28946030 PMCID: PMC5614748 DOI: 10.1016/j.ijscr.2017.09.008] [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: 05/25/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 11/25/2022] Open
Abstract
Ectopic thyroid is thyroidal tissue located far from its anatomic place. A patient under our observation displayed left submandibular swelling. The FNAC test report described a follicular adenoma. Based on the FNAC diagnosis, we surgically removed the mass. The post-operative follow-up was uneventful.
Introduction The term ectopic thyroid refers to the presence of thyroid tissue located far from its usual anatomic placement and with no vascular connection to the main gland. The presence of swelling in atypical locations is diagnostically differentiated from other pathologies like pleomorphic adenoma or carcinoma, inflammatory lesions like sialadenitis, neurogenic tumors, paraganglioma, fibrolipoma and lymphadenopaties of diverse etiologies. Presentation of case Here we present the case of a submandibular ectopic thyroid in a 67 year old woman. She came to our attention for a left submandibular swelling. The anamnesis did not show related pathologies, as well as blood tests. Diagnostic image studies and a FNAC were performed. The mass was surgically removed and histopatology showed a follicular adenoma in the contest of the capsulated lesion. Discussion It is important to not underestimate these types of lesions and procede with hematochemical, instrumental tests and above all surgery that can eliminate any diagnostic uncertainty and on the whole be therapeutic. Conclusion It should not be forgotten that ectopic thyroid tissue can be a site for adenoma or papillary carcinoma and thus any watch and wait strategy should be avoided.
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Affiliation(s)
- Vincenzo Consalvo
- Università degli Studi di Salerno, Italy; Collaborator of Clinique du Parc Montpellier, France.
| | | | | | | | | | | | | | | | - Domenico Lombardi
- Hospital of Cava de' Tirreni, Università degli studi di Salerno, Italy.
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Chopra A, Singh Y, Kaushal M, Taneja A, Kulshreshtha B. Simultaneous Occurrence of Thyroiditis in Ectopic and Eutopic Thyroid Masquerading as Thyroglossal Cyst. J Clin Diagn Res 2017; 11:OD17-OD19. [PMID: 28658835 DOI: 10.7860/jcdr/2017/25192.9897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/16/2017] [Indexed: 11/24/2022]
Abstract
Ectopic thyroid gland is a rare condition usually presenting with neck swelling or hypothyroidism. In most cases, ectopic thyroid tissue is the only functioning thyroid tissue, but it may rarely be associated with normal thyroid gland. Thyroiditis in an ectopic thyroid gland is very rare. Here, we describe a 13-year-old girl who was initially suspected, as a having a thyroglossal cyst. Thyroid functions were suggestive of thyrotoxicosis. She was diagnosed to have simultaneous occurrence of thyroiditis in the ectopic and eutopic thyroid glands. This case was exceedingly rare since this patient presented with thyrotoxicosis unlike previous reported cases who were either euthyroid or hypothyroid.
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Affiliation(s)
- Aditi Chopra
- Senior Resident, Department of Endocrinology, PGIMER, Dr RML Hospital, Delhi, India
| | - Yogendra Singh
- Senior Resident, Department of Endocrinology, PGIMER, Dr RML Hospital, Delhi, India
| | - Manju Kaushal
- Professor, Department of Pathology, Dr RML Hospital, New Delhi, India
| | - Anil Taneja
- Professor, Department of Radiology, Dr RML Hospital, Delhi, India
| | - Bindu Kulshreshtha
- Associate Professor, Department of Endocrinology, PGIMER, Dr RML Hospital, Delhi, India
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15
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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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