Ectopic thyroid gland. A clinical study of 30 children and review

Of 108 children being treated at our Institute for primary (nongoitrous) hypothyroidism, tests with radioactive iodine 131I uptake showed that 26 of them (24%) had an ectopic thyroid gland. Four euthyroid children also had anterior swellings of the neck which, in each case, proved to be an ectopic thyroid gland. Of the 30 children studied, 20 were girls and 10 were boys. Nine patients were diagnosed within the first year of life. Growth retardation, manifest in 20 patients, was the most common clinical finding at the time of diagnosis. Delayed bone age was a feature in all of them. Growth, after diagnosis was within normal limits in 83% of the infants who were treated within the first two years of life; only 50% of the children diagnosed later grew within normal limits. Similarly, mental function was best preserved in those patients in whom treatment was initiated within the first two years of life.

Suprainguinal ectopic scrota of TS inbred rats

A new rat line (TS inbred rats) showing uni- or bilateral ectopic scrota in about 70% of the males was established. Ectopic scrota were elongated pouches of the thin muscle layer under the suprainguinal body skin, in which hypoplastic testes and epididymides were seen. Genetic analysis revealed that the ectopic scrotum was controlled by multiple genes. Groups of 5 normal, uni- and bilaterally affected rats were killed at 25 weeks of age. Histologically, ectopic testes of uni- and bilaterally affected rats showed arrest of spermatogenesis at the primary spermatocyte stage. Contralateral testes of unilaterally affected rats were normally descended and showed normal spermatogenesis. No abnormality was seen in the urinary system. Plasma concentrations of FSH were significantly elevated in bilaterally affected rats but plasma concentrations of testosterone and LH were unchanged in uni- and bilaterally affected rats. Pituitary contents of LH and FSH were significantly elevated in bilaterally affected rats. The endocrinological status of TS inbred rats was therefore similar to that of experimentally induced cryptorchid rats.

Ectopic pituitary adenoma in the suprasellar cistern: case report

The case of a 56-year-old man with an ectopic pituitary adenoma is reported. Neurological examinations, neurodiagnostic imaging, surgical observation, endocrinological evaluation, histological examination, and immunohistological study demonstrated evidence of ectopic prolactinoma in the suprasellar cistern and the presence of a normal pituitary in the sella turcica. The patient underwent total removal of the suprasellar mass by a pterional approach, leading to a surgical and endocrinological cure.

Hormonal, pituitary magnetic resonance, LHX4 and HESX1 evaluation in patients with hypopituitarism and ectopic posterior pituitary lobe

OBJECTIVE

LHX4 and HESX1 are important in early stages of pituitary development and their mutations can be associated with an ectopic posterior lobe (EPL) in the pituitary of patients with hypopituitarism. The EPL can be located at the median eminence or at the path of the pituitary stalk. The aim of this study was to analyse LHX4 and HESX1 and characterize the hormonal deficiency profiles, establishing relationships with magnetic resonance imaging (MRI) findings in these patients.

PATIENTS AND DESIGN

Sixty-two patients with hypopituitarism associated with EPL were submitted to evaluation of pituitary function, analysis of MRI with EPL location and molecular analysis of LHX4 and HESX1 using polymerase chain reaction (PCR), digestion with restriction enzyme and automatic sequencing.

RESULTS

Forty-two patients had a nonvisualized pituitary stalk (NPS), and 20 a visualized pituitary stalk (VPS). Most patients (95%) with NPS had combined pituitary hormone deficiency (CPHD), with ACTH deficiency in 85%. In patients with VPS, CPHD was found in 50% and ACTH deficiency occurred in only 20%. The frequency of the location of EPL was similar in patients with VPS and NPS: 35% at median eminence and 65% at the path of the stalk. No mutations in LHX4 and HESX1 were identified. Three new polymorphisms in LHX4 were found.

CONCLUSIONS

ACTH deficiency is frequent in patients with hypopituitarism and NPS (85%), the location of EPL at the median eminence was not predictive of the hormonal profile [isolated GH deficiency (IGHD) or CPHD], and LHX4 and HESX1 genes mutations remain rare causes of hypopituitarism associated with EPL.

Control of thyroglobulin secretion in patients with ectopic thyroid gland

Serum thyroglobulin (Tg) measurements were performed in 17 children with congenital hypothyroidism due to an ectopic thyroid gland before therapy and during follow-up. Data were analysed in four periods according to duration of therapy and compared to results obtained in a group of 51 normal children aged 1 month to 6 yr. At diagnosis serum Tg was higher than the mean normal value measured at a similar age. We observed a rapid and parallel decrease of both Tg and thyroid-stimulating hormone during the early weeks of therapy. However, Tg was always detectable in the serum of treated (euthyroid) patients. After 34 months of therapy serum Tg was 11.4 +/- 1 ng/ml, a value significantly different (p less than 0.001) from that obtained in normal controls of similar age (23.5 +/- 3 ng/ml). In nine treated children aged more than 2 yr, thyroid-stimulating hormone and Tg were increased after a brief period of decreased L-thyroxine dosage. These data indicate that ectopic thyroid tissue does not involute during thyroxine therapy and, in response to elevations of serum thyroid-stimulating hormone, can be stimulated to secrete Tg.

Torsion of an ectopic liver in a young child

A large ectopic liver nodule connected to the greater omentum had undergone infarction and separation because of torsion of its connecting stalk and was the cause of acute abdominal pain and elevated liver enzymes in a young female child. At laparotomy for a suspected perforated appendicitis, a hemorrhagic peritoneal fluid was found, together with an intraperitoneal solid mass lying freely in the right iliac fossa. The definitive diagnosis was obtained by histopathology. This is the first known such reported case.

Lingual thyroid presenting as acquired hypothyroidism in the adulthood

There are numerous reported cases of lingual thyroid with an obvious prevalence in pediatric age. Such ectopic thyroid glands are probably quantitatively deficient and thyroid function may be low or at a low normal level. Apparently, most cases of ectopic thyroid tissue develop congenital hypothyroidism, the so-called cretinism. In this report, we describe a very rare adult male case of lingual thyroid who developed hypothyroidism in adulthood; the anomaly remained undiscovered, being without local common symptoms, and permitted a normal life.

Investigating a lingual thyroid

During a 15-year-period, in a thyroid investigation centre in Sri Lanka comprising 16,593 cases, 8 lingual thyroids were seen. All patients were female. Radioisotope studies and scintiscanning performed during the investigations of these cases are presented. All subjects were euthyroid at presentation and the clinical courses of 5 cases during follow-up are discussed.

Frequency and characteristics of lingual thyroid not detected by screening

Four patients with lingual thyroid glands presenting beyond the neonatal period have been evaluated at the Hospital for Sick Children, Toronto since the advent of neonatal TSH screening. All were female, clinically euthyroid at diagnosis and presented with symptoms of a lingual mass. We estimate that 1.6% of lingual thyroids are missed by this TSH based thyroid screening program and approximately 1/600,000 live births present in childhood or adolescence with a lingual thyroid. Physicians should still include lingual thyroid in the differential diagnosis of a mass at the base of the tongue.

Lateral neck imaging for spatial localization of parathyroid tissue

Two patients with an ectopic parathyroid adenoma are described. In both cases the lesions were clearly demonstrated in an anterior view on T1-201/Tc-99m scintigraphy, but were not identified during the first surgical exploration. Failure to identify the ectopic adenoma at surgery in the second patient led to oblique and lateral views being obtained. These views permitted correct depth localization. We, therefore, believe that lateral and oblique views can be of assistance in improving preoperative localization of an ectopic parathyroid adenoma.

Supernumerary ovary found by ultrasonogram and FSH measurement after an extensive operation for a yolk sac tumor of the ovary

A rare case of supernumerary ovary found by a transvaginal ultrasonogram and follicle-stimulating hormone (FSH) measurement is presented. The patient was a 32-year-old female who underwent an extensive operation for a yolk sac tumor of the ovary. An asymptomatic cystic tumor was found during follow-up. There was no evidence of recurrence or metastasis of the yolk sac tumor. Although histological confirmation was not possible because the patient refused removal of the mass, a diagnosis of supernumerary ovary was made because changes in the shape of the cystic mass completely correlated with changes in the serum FSH level.

Repeated 131I treatment of a residual ovarian teratoma containing malignant thyroid tissue

A 49-year-old woman with ovarian teratoma received 131I treatment three times for an unresectable mass containing malignant thyroid tissue after surgery. Repeated 131I treatment effectively reduced serum thyroglobulin (Tg) level and tumour uptake of 131I, despite absence of any change in size of the treated tumour. Treatment did not inhibit the increase of serum CA-125 and tumour 201Tl uptake, associated with progression of a radioresistant intratumoral hyper-perfused tissue component, detected by colour Doppler ultrasound. Serum CA-125 level and tumour 201Tl uptake were not significantly changed despite temporary increases in serum Tg level after each 131I treatment. These observations indicate the importance of diagnostic measures using combined functional imaging and tumour markers in managing this rare tumour.

Influence on psychological development of early treatment of congenital hypothyroidism detected by neonatal screening: a controlled study

It has been shown that early diagnosis and treatment of congenital hypothyroidism based on neonatal screening will improve outcome. To test this hypothesis, we performed standard psychological tests (Gesell, Stanford-Binet, or Wechsler) in three groups of children with treated hypothyroidism: 14 were discovered by neonatal screening and 24 (15 with thyroid agenesis and 9 with ectopic thyroid) were diagnosed prior to institution of screening. Age (weeks) at initial treatment differed among the three groups (mean values +/- SE: screened 4.6 +/- 0.8, thyroid agenesis 19.3 +/- 4.0, ectopic thyroid 46.4 +/- 8.0). Age at testing averaged 3.3 years in all three groups. The global developmental quotient (DQ) or IQ score was lowest in the thyroid agenesis group (82 +/- 6, range 52 to 142), intermediate in the ectopic thyroid group (93 +/- 10, range 56 to 141) and highest in the screening group (104 +/- 4, range 75 to 127). Neonatal screening for congenital hypothyroidism results in earlier diagnosis than does use of the clinical criteria, and the consequent early treatment results in improved psychomental development.

[Mediastinal parathyroidectomy]

In most patients the postoperative persistent or recurrent hyperparathyroidism is sustained by parathyroid tissue localized in the mediastinum. A careful preoperative imaging and intraoperative hormone assays are key to reducing the possibility of disease recurrence.