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Tao WC, Kang O, Russo R, Mansberg R. Accessory Thyroid Tissue Detected Using 131 I SPECT/CT Imaging. Clin Nucl Med 2022; 47:900-903. [PMID: 35485858 DOI: 10.1097/rlu.0000000000004255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Thyroid ectopia has been described as a rare congenital anomaly, characterized by the presence of a thyroid gland in locations other than the orthotopic pretracheal location. The prevalence of accessory thyroid tissue in patients undergoing postablative radioiodine therapy in a 12-month period at a tertiary hospital nuclear medicine department was assessed. Fifty-seven patients were treated between September 2020 and September 2021. Retrospective analysis identified the presence and location of all accessory thyroid tissue separate from the orthotopic pretracheal thyroid gland. Accessory thyroid tissue was present in 21.1% (12/57) of the patients. Accessory thyroid tissue was most commonly located in the lingual region.
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Affiliation(s)
- Wilson Chun Tao
- From the Faculty of Medicine and Health, University of Sydney
| | - Owen Kang
- Department of Nuclear Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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Kumar A, Singhal T, Krishna SM, Narayan ML. Dual thyroid ectopia: A pictorial case series and review of literature. World J Nucl Med 2020; 19:336-340. [PMID: 33623501 PMCID: PMC7875023 DOI: 10.4103/wjnm.wjnm_44_20] [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: 07/04/2020] [Revised: 04/27/2020] [Accepted: 05/10/2020] [Indexed: 11/08/2022] Open
Abstract
Ectopic thyroid (ET) is a developmental anomaly of the thyroid gland with the presence of thyroid tissue at sites other than the normal cervical location anterior to second and third tracheal ring due to abnormal migration of the gland. It may be found along the path of descent of the developing thyroid primordium from the foramen caecum to the isthmus of the thyroid and up to the base of the diaphragm. Dual thyroid ectopia, where ET tissue is simultaneously present at two different abnormal locations, is a very rare developmental defect. Only a few cases have been reported worldwide. ET is predominantly seen in females and during puberty when the hormonal demand is high. Patients with ET may remain asymptomatic or present with swelling in the neck, symptoms such as dysphagia, dysphonia, dyspnea, and features of hypothyroidism. The diagnosis is usually made on clinical examination, laboratory tests, imaging studies, and cytology. Careful clinical evaluation is essential as ET may be the only functioning thyroid tissue. Thyroid scintigraphy is an important imaging tool and the gold standard for the diagnosis of ET tissue, as it has high sensitivity and specificity. Early and accurate diagnosis of ET is essential to start hormone replacement and avoid unnecessary surgery. The authors report here a series of four patients with dual ET tissue, diagnosed on thyroid scintigraphy.
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Affiliation(s)
- Ashok Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Rishikesh, Uttrakhanad, India
| | - Tejasvini Singhal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Rishikesh, Uttrakhanad, India
| | - Sai Mohan Krishna
- Department of Nuclear Medicine, Sri Venkateshwara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Manishi L Narayan
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Rishikesh, Uttrakhanad, India
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3
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Abstract
Ectopic thyroid gland tissue can occur either as the only detectable thyroid gland tissue or in addition to a normotopic thyroid gland. After a total thyroidectomy thyroid-stimulating hormone (TSH) can induce a compensatory volume increase of previously asymptomatic ectopic tissue. This hyperplastic ectopic tissue can occur as an unclear cervical space-occupying lesion. Prior to surgical exploration of an unclear cervical mass the possibility of ectopic thyroid tissue should be included in the differential diagnostic considerations.
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Affiliation(s)
- D Seitz
- Klinikum Bielefeld Mitte, Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Teutoburger Str. 50, 33604, Bielefeld, Deutschland.
| | - I Todt
- Klinikum Bielefeld Mitte, Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Teutoburger Str. 50, 33604, Bielefeld, Deutschland
| | - E Boga
- Klinikum Bielefeld Mitte, Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Teutoburger Str. 50, 33604, Bielefeld, Deutschland
| | - A Yasin
- Klinikum Bielefeld Mitte, Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Teutoburger Str. 50, 33604, Bielefeld, Deutschland
| | - H Sudhoff
- Klinikum Bielefeld Mitte, Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Teutoburger Str. 50, 33604, Bielefeld, Deutschland
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Chen Cardenas SM, Duan D, Rooper LM, Santhanam P, Cooper DS, Ladenson PW. Misdiagnosis of Paraganglioma by 123I-mIBG Without Stable Iodine Blockade of Thyroidal Radioiodine Uptake. J Endocr Soc 2020; 4:bvaa099. [PMID: 32793847 PMCID: PMC7414919 DOI: 10.1210/jendso/bvaa099] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/13/2020] [Indexed: 01/02/2023] Open
Abstract
Iodine-123/iodine-131 (123I/131I)-metaiodobenzylguanidine (mIBG) scan is an established tool for the localization and treatment of neuroendocrine tumors such as paragangliomas (PGL). To minimize thyroid irradiation by the radioactive iodine in the mIBG preparation, blockade of thyroidal iodine uptake with high doses of stable iodine used to be given routinely as part of all mIBG protocols. As 123I is now more frequently utilized than 131I, concern about thyroid radiation has lessened and thyroid blockade is often considered unnecessary. However, in certain situations, the lack of thyroid blockade can significantly impact treatment decisions. This report describes 2 patients who had mediastinal masses incidentally discovered on CT scans, and on further evaluation were found to have symptoms suggesting catecholamine excess with mildly elevated plasma normetanephrine levels. 123I-mIBG scans were performed without thyroid blockade, which demonstrated accumulation of tracer in the masses that were therefore deemed positive for PGL. Both patients underwent surgical resection of the masses with their surgical pathology revealing ectopic thyroid tissue (ETT). These cases illustrate that if appropriate thyroid blockade is not performed, ETT concentrating radioiodine from mIBG can lead to falsely positive mIBG scans and unnecessary surgical procedures. We conclude that in the setting of a mass suspicious for PGL in a location potentially representing ETT, such as the mediastinum, thyroid blockade should be employed for mIBG protocols to avoid false positive scans caused by ETT.
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Affiliation(s)
- Stanley M Chen Cardenas
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daisy Duan
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa M Rooper
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Prasanna Santhanam
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul W Ladenson
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Matta-Coelho C, Donato S, Carvalho M, Vilar H. Dual ectopic thyroid gland. BMJ Case Rep 2018; 2018:bcr-2018-225506. [PMID: 30279251 DOI: 10.1136/bcr-2018-225506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Sara Donato
- Deparment of Endocrinology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisboa, Portugal
| | - Manuel Carvalho
- Department of Nuclear Medicine, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisboa, Portugal
| | - Helena Vilar
- Deparment of Endocrinology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisboa, Portugal
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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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Hybrid SPECT/CT Helps Characterization and Localization of a Dual Thyroid Ectopia. Clin Nucl Med 2017; 42:855-856. [PMID: 28872553 DOI: 10.1097/rlu.0000000000001824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The presence of ectopic thyroid tissue in 2 or more different sites is rare. A 12-year-old girl presented with midline anterior neck swelling in the infrahyoid region with subclinical hypothyroidism. Thyroid scanning with Tc-pertechnetate was performed, and SPECT/CT was ordered for further evaluation. Two hyperdense lesions demonstrating intense radiotracer uptake were seen in the midline at the base of the tongue and infrahyoid neck. We emphasis the role of hybrid SPECT/CT for characterization and localization of suspected ectopic thyroid tissue.
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Kocova M, Zdraveska N, Zdravkovska M, Anastasovska V, Pop Gjorceva D. Submental thyroid ectopy might cause subclinical hypothyroidism in early childhood. SAGE Open Med Case Rep 2016; 4:2050313X16683623. [PMID: 27994873 PMCID: PMC5153024 DOI: 10.1177/2050313x16683623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 11/15/2016] [Indexed: 11/29/2022] Open
Abstract
Objective: Thyroid ectopy is a rare condition resulting from abnormal embryologic development and migration of the gland. Sublingual is the most common thyroid ectopy; all other ectopic thyroid locations occur very rare. There are no reports in the literature that describe the clinical course of patients with congenital hypothyroidism due to thyroid ectopy. Methods and Results: We present a child with congenital hypothyroidism detected on neonatal screening which had a subclinical course during follow-up. Scintigraphy revealed submental thyroid ectopy, a rare ectopic location and no orthotopic thyroid gland. Conclusion: Our case is unique because of the rare ectopic thyroid location but also of the unexpected clinical course; however, further thyroid monitoring is required for the therapy adjustment and detection of any changes in the ectopic tissue.
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Affiliation(s)
- Mirjana Kocova
- Department for Endocrinology and Genetics, University Children's Hospital, Skopje, Republic of Macedonia
| | - Nikolina Zdraveska
- Department for Endocrinology and Genetics, University Children's Hospital, Skopje, Republic of Macedonia
| | - Maja Zdravkovska
- Institute of Pathophysiology and Nuclear Medicine, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of Macedonia
| | - Violeta Anastasovska
- Department for Endocrinology and Genetics, University Children's Hospital, Skopje, Republic of Macedonia
| | - Daniela Pop Gjorceva
- Institute of Pathophysiology and Nuclear Medicine, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of Macedonia
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Wong KK, Gandhi A, Viglianti BL, Fig LM, Rubello D, Gross MD. Endocrine radionuclide scintigraphy with fusion single photon emission computed tomography/computed tomography. World J Radiol 2016; 8:635-655. [PMID: 27358692 PMCID: PMC4919764 DOI: 10.4329/wjr.v8.i6.635] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/09/2015] [Accepted: 03/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the benefits of single photon emission computed tomography (SPECT)/computed tomography (CT) hybrid imaging for diagnosis of various endocrine disorders.
METHODS: We performed MEDLINE and PubMed searches using the terms: “SPECT/CT”; “functional anatomic mapping”; “transmission emission tomography”; “parathyroid adenoma”; “thyroid cancer”; “neuroendocrine tumor”; “adrenal”; “pheochromocytoma”; “paraganglioma”; in order to identify relevant articles published in English during the years 2003 to 2015. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved manuscripts (case reports, reviews, meta-analyses and abstracts) concerning the application of SPECT/CT to endocrine imaging were analyzed to provide a descriptive synthesis of the utility of this technology.
RESULTS: The emergence of hybrid SPECT/CT camera technology now allows simultaneous acquisition of combined multi-modality imaging, with seamless fusion of three-dimensional volume datasets. The usefulness of combining functional information to depict the bio-distribution of radiotracers that map cellular processes of the endocrine system and tumors of endocrine origin, with anatomy derived from CT, has improved the diagnostic capability of scintigraphy for a range of disorders of endocrine gland function. The literature describes benefits of SPECT/CT for 99mTc-sestamibi parathyroid scintigraphy and 99mTc-pertechnetate thyroid scintigraphy, 123I- or 131I-radioiodine for staging of differentiated thyroid carcinoma, 111In- and 99mTc- labeled somatostatin receptor analogues for detection of neuroendocrine tumors, 131I-norcholesterol (NP-59) scans for assessment of adrenal cortical hyperfunction, and 123I- or 131I-metaiodobenzylguanidine imaging for evaluation of pheochromocytoma and paraganglioma.
CONCLUSION: SPECT/CT exploits the synergism between the functional information from radiopharmaceutical imaging and anatomy from CT, translating to improved diagnostic accuracy and meaningful impact on patient care.
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Gandhi A, Wong KK, Gross MD, Avram AM. Lingual Thyroid Ectopia: Diagnostic SPECT/CT Imaging and Radioactive Iodine Treatment. Thyroid 2016; 26:573-9. [PMID: 26864253 DOI: 10.1089/thy.2015.0396] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lingual thyroid is a rare abnormality of thyroid development that is usually treated conservatively with levothyroxine replacement. Rarely, it becomes large enough to cause obstructive symptoms in the oral cavity, requiring definitive treatment. PATIENT FINDINGS This study reports on three patients with lingual thyroid treated with radioactive iodine-131 ((131)I) with successful radioablation of their ectopic thyroid tissues. Measurement of 24-hour radioactive iodine uptake within thyroidal tissues and hybrid single-photon emission computed tomography/computed tomography imaging using either iodine-123 or technetium-99m pertechnetate scans were performed in all patients demonstrating the location and size of lingual thyroid and absence of an orthotopic thyroid gland. SUMMARY The aim of this study was to describe nonsurgical management of obstructive lingual thyroid tissue with (131)I therapy for lingual thyroid radioablation. Patients were prepared with a low-iodine diet and levothyroxine withdrawal prior to radioablation for optimizing (131)I uptake in ectopic thyroid tissues. Hybrid single-photon emission computed tomography/computed tomography measurement of anatomic size of lingual thyroid tissue and radioactive iodine uptake guided the selection of therapeutic doses, resulting in administration of 10.7, 17.5, and 15.4 mCi of (131)I, respectively. There were no post-therapy complications, and clinical follow-up demonstrated resolution of obstructive oropharyngeal symptoms. CONCLUSIONS Ectopic lingual thyroid tissue is rarely associated with obstructive oropharyngeal symptoms due to progressive enlargement. Radioiodine therapy with (131)I is an effective treatment modality for ablation of ectopic thyroid tissue as an alternative to surgery.
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Affiliation(s)
- Arpit Gandhi
- 1 Nuclear Medicine/Radiology, University of Michigan , Ann Arbor, Michigan
| | - Ka Kit Wong
- 1 Nuclear Medicine/Radiology, University of Michigan , Ann Arbor, Michigan
- 2 Nuclear Medicine Service , Department of Veterans Affairs Health System, Ann Arbor, Michigan
| | - Milton D Gross
- 1 Nuclear Medicine/Radiology, University of Michigan , Ann Arbor, Michigan
- 2 Nuclear Medicine Service , Department of Veterans Affairs Health System, Ann Arbor, Michigan
| | - Anca M Avram
- 1 Nuclear Medicine/Radiology, University of Michigan , Ann Arbor, Michigan
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Jain TK, Meena RS, Bhatia A, Sood A, Bhattacharya A, Mittal BR. Dual thyroid ectopia-role of thyroid scintigraphy and neck ultrasonography. Indian J Nucl Med 2015; 30:338-40. [PMID: 26430320 PMCID: PMC4579621 DOI: 10.4103/0972-3919.164023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Ectopic thyroid tissue (ETT) is a rare developmental anomaly of the thyroid tissue where the thyroid gland is not located in its usual position. Dual thyroid ectopia is far rarer. This case of a 5-year-old euthyroid girl with thyroglossal cyst was planned for surgery. Presurgical ultrasonography (USG) of the neck followed by thyroid scintigraphy was performed. There was absent normal thyroid gland with single ETT in neck swelling on USG. However, thyroid scintigraphy revealed two ectopic foci of thyroid tissue; one was corresponding to neck swelling, and other was superior to it at the base of the tongue along with absent eutopic thyroid gland. The repeat neck USG could demonstrate the same. The present case emphasizes that, if the thyroid gland is not visible by USG; ETT should be evaluated with thyroid scintigraphy in case of thyroid dysgenesis.
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Affiliation(s)
- Tarun Kumar Jain
- Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Singh Meena
- Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anmol Bhatia
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kim MS, Kong YH, Lee DY. A Case of Subclinical Hypothyroidism with Lingual and Right Pretracheal Ectopic Thyroid. J Clin Res Pediatr Endocrinol 2015; 7:148-50. [PMID: 26316439 PMCID: PMC4563188 DOI: 10.4274/jcrpe.1791] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Ectopic thyroid tissue is most commonly located in a single location, this being the lingual area. Presentation with two ectopic thyroid foci is quite unusual. A girl patient aged 7 years who presented with complaints of two masses in the right anterior neck and submandibular area is reported. Her growth pattern and development were normal. The masses were detected to be dual ectopic thyroid glands by ultrasonography, computed tomography and 99m-technetium pertechnetate thyroid scan. The patient also had subclinical hypothyroidism. She was treated with oral levothyroxine and the masses slightly decreased in size. The repeated thyroid function tests were within the normal limits. Thyroid function tests and imaging studies need to be conducted in all patients with anterior neck masses.
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Affiliation(s)
- Min Sun Kim
- Chonbuk National University Medicine School, and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Institute of Chonbuk National University Hospital, Department of Pediatrics, Jeonju, Korea
| | - Young Hwa Kong
- Chonbuk National University Medicine School, and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Institute of Chonbuk National University Hospital, Department of Pediatrics, Jeonju, Korea
| | - Dae-Yeol Lee
- Chonbuk National University Medicine School, and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Institute of Chonbuk National University Hospital, Department of Pediatrics, Jeonju, Korea
,* Address for Correspondence: Chonbuk National University Chonbuk National University Medicine School, and Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Institute of Chonbuk National University Hospital, Department of Pediatrics, Jeonju, Korea Phone: +82 63 250 1469 E-mail:
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