Triple ectopic thyroid-a rare case report

The ectopic tissue of the thyroid gland along the descent of thyroglossal duct is a rare congenital aberration with or without the presence of normal thyroid gland. Single or dual ectopic thyroid has been reported. Three ectopic focuses at different locations are extremely rare. We present a rare case report of twenty years old female who presented with swelling over the anterior aspect of the neck mimicking thyroglossal cyst. Up on imaging evaluation ectopic thyroid at three different levels were diagnosed by computed tomography (CT) neck. Hence surgery was avoided and patient was managed with thyroxine supplement and follow up.

Thyroid ectopia: a case series

Ectopic thyroid is a form of thyroid dysgenesis and is defined as the presence of thyroid tissue in an abnormal location. Its prevalence is about 1 per 1,00, 000-3,00,000 people, rising to 1 per 4,000-8,000 patients with thyroid diseases. The most common sites of ectopic thyroid are lingual (90%) and anterior neck (10%). They are usually diagnosed with hypothyroidism with a mass with, or without pressure symptoms in the 2nd or 3rd decade of life when there is increased demand of thyroid hormone. Presence of two ectopic foci of thyroid tissue simultaneously is rare, and very few such cases of dual thyroid ectopia have been reported. We present a case series of 3 ectopic thyroid with 3 different clinical presentation. The first case is a 19-year-old boy who presented with clinical and biochemical overt hypothyroidism and was discovered to have only a sublingual ectopic thyroid gland. The second case is a 16-year-old girl who presented with dysphagia and on evaluation was found to have a dual ectopic thyroid gland in the lingual and sub lingual region. The third case is a 28-year-old women who presented with a sub hyoid swelling which on evaluation was diagnosed as a dual ectopic thyroid in the lingual and sub lingual region.

MON-466 Dual Ectopic Thyroid with Normally Located Thyroid Gland in a Patient Presenting with Subclinical Hypothyroidism: A Case Report

Background: Ectopic thyroid involves the presence of thyroid tissue in sites other than its normal anatomic location. Dual ectopic thyroid with normally located thyroid gland is extremely rare with only a few cases reported in the literature. Clinical Case: A 24-year-old female presented to the clinic with subclinical hypothyroidism (TSH of 10.54 uIU/ml [ref, 0.27–4.2] and free T4 of 12.96 pmol/L [ref, 12–22]). She noted a gradually enlarging submental mass during the preceding year, which had been present since her adolescent years. Examination was notable for a 2-cm firm, non-tender mass at the submental region that slightly moved with deglutition. The thyroid was not palpable in its normal location. The relaxation phase of the deep tendon reflex was prolonged. Repeat laboratory testing showed persistently elevated TSH of 13.3 uIU/ml and normal free T4 of 13.39 pmol/L. TPO antibody was normal. Thyroid ultrasonography showed a hypoplastic thyroid measuring 2.7 x 0.7 x 0.4 cm on the right and 3.0 x 0.7 x 0.4 cm on the left. A well-circumscribed complex nodule measuring 2.7 x 3.2 x 2.1 cm was noted on the submental region corresponding to the patient’s submental mass. Computed tomography of the neck with contrast showed two hyperdense foci - measuring 3.0 x 2.4 cm at the submental region and 1.4 x 1.2 cm at the base of the tongue. No enhancing thyroid tissue was seen anterior to the thyroid cartilage. 99mTechnetium-pertechnetate scan showed absent focal tracer uptake in the anterior neck and thorax. There were foci of increased tracer activity in the submental and lingual regions. Ultrasound-guided biopsy of the submental area showed cytomorphologic features of a colloid nodule with cystic degeneration (Bethesda Category II). The patient was started on levothyroxine and remained biochemically euthyroid afterwards. The submental neck mass reduced in size. Conclusion: Dual ectopic thyroid with normally located (eutopic) thyroid gland could present with subclinical hypothyroidism. There is no single diagnostic modality that would best identify dual ectopic thyroid; thus, thyroid scan, ultrasonography, CT scan and biopsy are recommended to be used complementarily. For patients with dual ectopic thyroid and hypothyroidism, levothyroxine replacement is recommended to reduce the size of ectopic thyroid and render the patient euthyroid.

Lingual and Mediastinal Ectopic Thyroid with No Normal Thyroid Gland – A Very Rare Occurrence

Introduction Ectopic thyroid is a rare congenital condition. Dual ectopic thyroid is rarer still with only 30 cases reported in literature. The most common location is the lingual or sublingual region followed by the hyoid region. Instances of dual ectopic thyroid with one in lingual region and the other in mediastinum are very few. Case Report A case of dual ectopic thyroid is presented with absent normal thyroid in a girl of 14 years who presented with difficulty in swallowing and lump sensation in throat. Ultrasound, MRI scan and Technetium 99m pertechnetate thyroid scan were done. She showed lingual thyroid and thyroid tissue in upper mediastinum and no thyroid tissue in the normal anatomical location. Discussion The discovery of mediastinal ectopic thyroid was incidental. She had subclinical hypothyroidism and was treated with thyroxine replacement therapy.

Dual ectopic thyroid associated with thyroid hemiagenesis

Summary 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. Learning points: Ultrasonography can confirm the presence or absence of orthotopic thyroid tissue in patients with ectopic thyroid. The cause of congenital hypothyroidism should be examined. Clinical manifestation of ectopic thyroid may appear when the treatment with L-T4 is discontinued. Annual follow-up is needed in all children when their thyroid hormone replacement is stopped.

Incidental Finding of Dual Ectopic Thyroid on Computed Tomography Angiography

The presence of simultaneous two ectopic foci of thyroid tissue (dual ectopic thyroid) is rare, and few cases have been reported in the literature. The ectopic thyroid tissue is an extremely uncommon embryological aberration due to the alterations occurring during the embryological development with incomplete migration of thyroid precursors. Commonly ectopic thyroid tissue is a midline structures, but the lateral location is possible but very rare. Ectopic thyroid is common in women and can vary in size from a microscopic focus to a few centimeters. The normal process of migration of the thyroid can be interrupted at various levels determining a lingual ectopy, a sublingual ectopic, prelaryngeal ectopy, or mediastinic ectopy. Intrathoracic and subdiaphragmatic organs are other sites where the ectopic thyroid tissue may be present. In most of the cases, ectopic tissue is a lingual thyroid and this condition can be totally asymptomatic, discovered incidentally, or occurs with symptoms such as dysphonia, dysphagia, dyspnea, and hemoptysis. Sublingual or suprahyoid ectopia is rare and even rarer are the cases of two foci of ectopic thyroid tissue simultaneously present. On imaging, the ectopic tissue shows the same characteristics of orthotopic thyroid tissue and similarly can undergo goiterous and cancerous transformation. We report a case of incidental dual ectopic thyroid in lingual and suprahyoid level in a 72-year-old female patient, asymptomatic and with normal thyroid function, who underwent computed tomography (CT) angiography before vascular surgery for the treatment of carotid stenosis. The presence of a lingual thyroid can lead to a difficult and dangerous intubation, with possible fatal consequences. For this reason, the discovery of these abnormalities has totally changed the patient management who has been subjected to endovascular treatment, instead to the classical surgery.