Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
Home Print this page Email this page
Users Online: 3080



 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 10  |  Issue : 2  |  Page : 78-79

Recurrent thyrotoxicosis due to hyperfunction of multiple ectopic thyroid tissue and residual thyroid lobes 15 years after thyroidectomy: Evaluation using technetium scanning and hybrid single-photon emission computed tomography/CT


1 Department of Nuclear Medicine and Therapy, Amala Institute of Medical Sciences, Amalanagar, Thrissur, Kerala, India
2 Department of Radiodiagnosis, Amala Institute of Medical Sciences, Amalanagar, Thrissur, Kerala, India

Date of Web Publication16-Apr-2013

Correspondence Address:
Chidambaram N. B. Harisankar
Department of Nuclear Medicine, Amala Institute of Medical Sciences, Amalanagar, Thrissur, Kerala
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-0354.110592

Rights and Permissions
  Abstract 

Ectopic thyroid tissue (ETT) refers to all cases in which the thyroid gland is present at a location other than its usual site. Hyperthyroidism in ETT is very rare with only a few cases reported in literature. We report a 48-year-old female, a case of relapse of hyperthyroidism 15 years after thyroidectomy. Technetium scanning with hybrid single-photon emission computed tomography (SPECT)/CT showed increased trapping function in residual orthotopic thyroid lobes. Increased trapping function was also noted in two other ectopic sites. The patient was treated with radioiodine.

Keywords: Ectopic thyroid, hyperthyroidism, multiple ectopic, radioiodine ablation


How to cite this article:
Harisankar CN, Preethi GR. Recurrent thyrotoxicosis due to hyperfunction of multiple ectopic thyroid tissue and residual thyroid lobes 15 years after thyroidectomy: Evaluation using technetium scanning and hybrid single-photon emission computed tomography/CT. Thyroid Res Pract 2013;10:78-9

How to cite this URL:
Harisankar CN, Preethi GR. Recurrent thyrotoxicosis due to hyperfunction of multiple ectopic thyroid tissue and residual thyroid lobes 15 years after thyroidectomy: Evaluation using technetium scanning and hybrid single-photon emission computed tomography/CT. Thyroid Res Pract [serial online] 2013 [cited 2019 Dec 8];10:78-9. Available from: http://www.thetrp.net/text.asp?2013/10/2/78/110592


  Introduction Top


The thyroid gland develops from the foregut. At about 4 weeks of gestational age, an evagination appears between the first and second pharyngeal pouches which lengthens to form a tube, and descends inferiorly and anteriorly to pass anterior to the hyoid bone. It then loops round and behind the hyoid before continuing its descent in the neck to finally form two lateral buds; these will become the lateral lobes. [1] Most ectopic thyroid glands are asymptomatic. It is unusual for multiple ectopic thyroid tissues (ETTs) to be present simultaneously. Hyperthyroidism in ETT is extremely rare. [2],[3],[4],[5]


  Case Report Top


A 48-year-old female presented with palpitations, breathlessness, and tremors. She had history of thyroid surgery before 15 years for hyperthyroidism, the details of which are not known. Presently, she had a globular swelling in the upper part of the neck, which was gradually enlarging in size over the past 18 months. The swelling, on clinical examination, moved with deglutition and protrusion of the tongue. A thyroidectomy scar was noted and there was fullness in the suprasternal region. On clinical and biochemical examination, she was overtly hyperthyroid. Ultrasonogram of the neck showed residual right and left lobes of thyroid gland in the neck with hypoechoic and granular parenchyma. The residual right lobe measured 4.0 × 2.0 × 2.5 cm and the left lobe measured 2.0 × 0.9 × 0.9 cm. Two lesions with similar morphology separate from the residual thyroid lobes were also noted in the infrahyoid region (size: 2.6 × 2.3 × 1.4 cm) and suprasternal region (size: 3.4 × 1.6 cm), respectively. Technetium scanning showed multiple sites of intense tracer uptake in the neck [Figure 1]. Fine needle aspiration cytology from the subhyoid swelling and right lobe of thyroid showed thyroid tissue without any evidence of malignancy. Patient was treated with 555 MBq (15 mCi) of iodine-131 and was on regular follow-up.
Figure 1: (a) Planar technetium thyroid scan done after intravenous injection of 99mTc-NaTcO4 shows intense tracer uptake in multiple sites in the neck. The technetium uptake in the lesions was significantly increased. On hybrid SPECT/CT, the lesions were localized to the clinically palpable swelling in (b) thyroid remnants, (c) the infrahyoid region, (d) a soft tissue lesion in suprasternal region. Sagittal image (e) shows the location of the functioning thyroid tissues

Click here to view



  Discussion Top


The original position of thyroid gland is marked by the foramen cecum at the junction of anterior two-thirds and posterior one-third of the tongue. The pathway from the pharynx to the anterior neck is marked by the thyroglossal duct. [1] ETT may be located anywhere in the path of descent of the normal thyroid gland and may be imaged using fusion imaging. Multiple thyroid ectopia are very rare. [1],[6],[7] Hyperthyroidism in ETT is extremely rare. [2],[3],[4],[5] Recurrence of hyperthyroidism after thyroidectomy due to stimulation of ectopic thyroid has been previously described. [8],[9] It is possible that the circulating thyroid stimulating immunoglobulin can influence the thyroid cells present in ectopic locations. [9] Under the influence of these antibodies, the ETT hypertrophy and cause hyperthyroidism.

Another differential diagnosis of such presentation is functioning thyroid metastases causing hyperthyroidism. [10] Functioning thyroid cancer metastases are extremely rare and are usually well-differentiated follicular carcinomas. [10]

 
  References Top

1.Jain A, Pathak S. Rare developmental abnormalities of thyroid gland, especially multiple ectopia: A review and our experience. Indian J Nucl Med 2010;25:143-6.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Gorur GD, Isgoren S, Tan YZ, Utkan Z, Demir H, Berk F. Graves' disease in a patient with ectopic mediastinal thyroid. Clin Nucl Med 2011;36:1039-40.  Back to cited text no. 2
    
3.Eli SU, Marnane C, Peter R, Winter S. Ectopic, submandibular thyroid causing hyperthyroidism. J Laryngol Otol 2011;125:1091-3.  Back to cited text no. 3
    
4.Kumar R, Gupta R, Bal CS, Khullar S, Malhotra A. Thyrotoxicosis in a patient with submandibular thyroid. Thyroid 2000;10:363-5.  Back to cited text no. 4
    
5.Kisakol G, Gonen S, Kaya A, Dikbas O, Sari O, Kiresi D, et al. Dual ectopic thyroid gland with Graves' disease and unilateral ophthalmopathy: A case report and review of the literature. J Endocrinol Invest 2004;27:874-7.  Back to cited text no. 5
    
6.Chawla M, Kumar R, Malhotra A. Dual ectopic thyroid: Case series and review of the literature. Clin Nucl Med 2007;32:1-5.  Back to cited text no. 6
    
7.Harisankar CN, Preethi GR, George M. Hybrid SPECT/CT evaluation of dual ectopia of thyroid in the absence of orthotopic thyroid gland. Clin Nucl Med 2012;37:602-3.  Back to cited text no. 7
    
8.Winters R, Christian RC, Sofferman R. Thyrotoxicosis due to ectopic lateral thyroid tissue presenting 5 years after total thyroidectomy. Endocr Pract 2011;17:70-3.  Back to cited text no. 8
    
9.Basili G, Andreini R, Romano N, Lorenzetti L, Monzani F, Naccarato G, et al. Recurrence of Graves' disease in thyroglossal duct remnants: Relapse after total thyroidectomy. Thyroid 2009;19:1427-30.  Back to cited text no. 9
    
10.Haq M, Hyer S, Flux G, Cook G, Harmer C. Differentiated thyroid cancer presenting with thyrotoxicosis due to functioning metastases. Br J Radiol 2007;80:e38-43.  Back to cited text no. 10
    


    Figures

  [Figure 1]


This article has been cited by
1 A case report of 131I therapy for Gravesí disease patient with hemiagenesis
Xuehui Liu,Jianping Zhang,Zhaowei Meng,Hongxu Yu,Zhimin Gao,Hongjun Li,Na Liu
Medicine. 2019; 98(8): e14606
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed1900    
    Printed81    
    Emailed0    
    PDF Downloaded193    
    Comments [Add]    
    Cited by others 1    

Recommend this journal