A Case of Subclinical Hypothyroidism with Lingual and Right Pretracheal Ectopic Thyroid

Case report: surgical management of symptomatic pretracheal thyroid gland in a patient with dual ectopic thyroid

BACKGROUND

Dual ectopic thyroid, a very rare condition, is defined as the simultaneous presence of ectopic thyroid tissue in two abnormal locations. Here, we report the surgical management of a patient with dual ectopic thyroid.

CASE PRESENTATION

The patient was a 12-year-old boy with right para-midline swelling for 2 months. On physical examination of the upper anterior neck, there was a 4 cm × 3 cm mass that was soft, mobile, smooth, and painless. Blood examination showed euthyroidism. Neck ultrasonography showed a well-circumscribed multilocular cyst. We followed up by observation only because the patient had no local symptoms or malignancy. After 2 years, the mass gradually enlarged, so we performed surgery to improve cosmetic outcomes. Preoperative neck CT revealed both a high-density solid mass at the base of the tongue and a central low-density region surrounded by a high-density area at the pretracheal region below the hyoid. The infrahyoid mass was surgically removed, and the sublingual mass was left intact. Pathological findings showed the growth of multiple-size follicles, leading to a diagnosis of adenomatous goiter. Postoperative 123-I scintigraphy showed radioactive iodine uptake in the sublingual lesion, but none in the normal thyroid bed despite the extirpation of thyroid tissue. Postoperative thyroid hormone replacement was started for subclinical hypothyroidism. One year postoperatively, the patient became euthyroid.

CONCLUSION

Surgical excision was used to manage a symptomatic cervical infrahyoid mass related to dual ectopic thyroid. Postoperatively, thyroid hormone replacement was required both to prevent enlargement of the remaining sublingual thyroid and to maintain adequate thyroid hormone levels.

Ectopic thyroid carcinoma in the mandible with normally located goiterous thyroid gland: A case report

BACKGROUND

The presence of ectopic thyroid tissue is a developmental disorder that affects about one per 100,000-300,000 people. It is extraordinarily rare for ectopic thyroid to be out of the lines of its descent. This case is the first to report a cancerous ectopic thyroid in the mandibular bone with a goitrous orthotopic thyroid gland.

CASE PRESENTATION

80-year-old female of free medical background presented to our clinic with painless left mandibular swelling that recent increase in size after tooth extraction. Surprisingly the diagnosis of ectopic thyroid tissue with cancerous follicular cells was reached upon histological analysis. The goitrous thyroid gland was found in its expected cervical location, and the patient was euthyroid.

CONCLUSION

Because this diagnosis extremely rare, the possibility of ectopic thyroid carcinoma in cases of a pathological mass in the mandible must always be carefully thought out. A high degree of suspicion is essential as the unusual presentation could take.

Incidental Solitary Adrenal Metastasis as the Initial Manifestation of a Solid Variant of Papillary Thyroid Carcinoma, With Emphasis on Pathologic Diagnosis and Clinical Management

Objective

Distant metastases from papillary thyroid carcinoma (PTC) are relatively rare and may be associated with a poor prognosis. The adrenal gland is a highly unusual site of metastasis in the natural course of PTC. Herein, we describe a case of an incidentally detected metastatic solid variant of PTC in the adrenal gland of an asymptomatic patient as the initial presentation.

Case Report

A 67-year-old male patient was evaluated for a 4.7-cm adrenal incidentaloma discovered during a workup for nephrolithiasis. Biochemical evaluation revealed a nonfunctioning adrenal mass. The patient underwent adrenalectomy, which revealed metastatic PTC. A subsequent thyroid ultrasound revealed an isthmic nodule. Fine needle aspiration of the nodule was cytologically suspicious for a follicular neoplasm, and gene expression analysis revealed an HRAS c.182A>G sequence variation. The patient subsequently underwent total thyroidectomy, which revealed a 1.2-cm solid variant of PTC in the thyroid isthmus. Postoperatively, the patient underwent radioactive iodine ablation.

Discussion

Our case illustrates an exceedingly rare and challenging situation-a metastatic solid variant of PTC in the adrenal gland of a patient with no prior history of PTC. When confronted with a PTC in the adrenal gland in the absence of a previously identified primary tumor, our experience suggests that the next step in management should be total thyroidectomy followed by radioactive iodine ablation.

Conclusion

A solid variant of PTC is a rare cause of an incidentally detected adrenal lesion. Multidisciplinary care team coordination is essential for accurate diagnosis and treatment plan formulation.

The hormonal suppression as first-line treatment of lingual thyroid: A case report

Ectopic thyroid gland is a rare anomaly in the development of the thyroid gland. It is defined as any thyroid tissue that is not found on its usual topography. We present the case of a 62-year-old patient with difficulty swallowing solid food, occasional sore throat, hoarse voice, and difficulty speaking. The patient was in hypothyroid status. Thyroid scintigraphy and magnetic resonance imaging visualized a nodular mass on the base of the tongue, suprahyoid, and mediosagittal. The pathohistological finding revealed normal thyroid tissue with few colloidal changes, ruled out tumour infiltration and specific inflammatory process. She received hormonal suppression treatment as a first-line treatment. The patient showed significant improvement in symptoms with reduction of the dyspnea and the dysphagia and normalization of thyroid hormone tests.

Mediastinal ectopic thyroid tissue, an imitator of an enlarged lymph node with metastatic pulmonary neoplasia

The prevalence of ectopic thyroid tissue, based on autopsy studies, is between 7% and 10%, but there are rare cases reported in the thoracic region. Here, we encountered a case of thoracic ectopic thyroid tissue presenting as a presumed enlarged mediastinal lymph node. A 50-year-old female with a history of lung adenocarcinoma, status post resection, presented with complaints of headache, dizziness, and nausea. Magnetic resonance imaging found two brain lesions consistent with metastasis. Computed tomography scan showed enlarged mediastinal lymph nodes and thyroid nodules. Fine-needle aspiration (FNA) of one thyroid nodule was positive for papillary thyroid carcinoma. FNA of the mediastinal lymph nodes were negative for metastatic carcinoma but revealed thyroid tissue in the 2.9 × 1.6 cm presumed 2 L lymph node. The morphological features and immunohistochemical stains confirmed thyroid tissue, and there were no cytological features of thyroid carcinoma. In patients with a history of a pulmonary tumor (such as adenocarcinoma, low-grade neuroendocrine tumor), ectopic thyroid tissue, although a rare event, could represent a pitfall in the cytologic evaluation of mediastinal lymph nodes aspirates obtained from staging procedures. Careful morphologic examination with a panel of immunohistochemical studies are useful in making the correct diagnosis, leading to appropriate patient management.

Graves' disease and recurrence in ectopic thyroid tissue after total thyroidectomy

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.

Submental thyroid ectopy might cause subclinical hypothyroidism in early childhood

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.

Ectopic Thyroid at the Base of the Tongue of a Young Patient

Lingual thyroid is defined as an ectopic thyroid gland tissue located in the midline of the tongue base and it is uncommonly observed in clinical practice and is rare in children. This paper describes the surgical treatment of ectopic thyroid at the base of the tongue in a child. The chief complaint of the 12-year-old, melanodermic female patient was the difficulty to swallow for 15 days. The intraoral physical examination barely showed a nodular lesion at tongue base. The CT scan showed a round, well defined hyperdense lesion of approximately 25.8 mm at its largest diameter, with infiltrative growth in the posterior region of the base of the tongue. The proposed treatment was complete resection of the lesion. The histopathological diagnosis was lingual thyroid. After the diagnosis was established, the patient was referred to an endocrinologist for exams and medical follow-up. Lingual thyroid is a rare condition and its diagnosis in children is even rarer. Its approach should be transdisciplinary and should take into consideration the hormonal aspects of the patient in addition to the clinical condition of the lesion. In the presented case, the removal of the alteration was performed via conservative surgical procedure followed by immediate referral of the patient to the endocrinologist for a follow-up.