engleski

Ectopic Thyroid Glands - Presentation of Six Cases with Diagnostic and Therapeutic Approach

Aim Ectopic thyroid gland is a rare entity. It may be located anywhere from the base of the tongue to the mediastinum. Other locations are rare. Six patients (pts) with ectopic thyroid glands are presented: four with lingual and two with submandibular ectopic thyroid tissue. M&M Median pts age at the time of presentation of lingual thyroid was 24 (15 - 36) years, while ectopic thyroid tissue in right submandibular region was recorded in 49-year old male and 57- year old female patient. Diagnostic approach included serum thyroid hormones and thyrotropin (TSH), thyroid scintigraphy with 99m-TcO4- or I-131 SPECT/CT, neck ultrasound (US), magnetic resonance imaging (MRI), fine needle aspiration biopsy (FNAB) and endoscopy. Results Patients with lingual thyroid presented with swelling at the base of the tongue and dysphagia while pts with submandibular thyroid tissue presented with swelling in submandibular region. All pts with lingual thyroid and a male patient with submandibular thyroid had subclinical hypothyroidism at the time of diagnosis and L- thyroxine (L-T4) was introduced. A 25-year old female patient with large lingual thyroid and dysphagia was treated with laser surgery. A 28- year old female patient with lingual and pre-hyoid thyroid tissue and no symptoms is under follow up on L- T4 therapy during the last 5 years. Two male pts with lingual thyroid aged 15 and 36 years and dysphagia were referred to surgery. A 49- year old male patient with ectopic thyroid tissue in right submandibular region had previous diagnosis of congenital hypothyroidism. However, he stopped L- T4 before presentation. Ectopic thyroid was surgically removed and pathohistology revealed normal thyroid tissue. A 77-year old euthyroid female patient with ectopic thyroid tissue in right submandibular region has normally located right thyroid lobe while left lobe was surgically removed due to nodular goiter. Ectopic submandibular thyroid tissue was diagnosed 20 years ago and followed-up with US without progression in size. Thyroid scintigraphy with SPECT/CT diagnosed ectopic thyroid tissue in all pts. FNAB was performed in submandibular and pre- hyoid ectopic thyroid tissue locations. MRI was performed to reveal anatomic relations with other structures. Patients were followed- up with US and TSH. Conclusion Subclinical hypothyroidism was common finding in pts with ectopic thyroid gland. Surgery is the preferred treatment of choice in pts with symptoms. However, pts without symptoms and signs of malignancy can be followed-up on L-T4 therapy. Ectopic thyroid tissue was diagnosed in adult age in almost all patients.

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