Recurrent Graves’ Disease in Thyroglossal Duct Following Total Thyroidectomy

Introduction: A 46-year-old female with a past medical history of Graves’ disease refractory to medical management, thus requiring total thyroidectomy presented to clinic for recurrence of her hyperthyroidism and an increasing midline neck mass two years after her index operation. Case Description: CT imaging of the neck mass revealed a locally extensive enhancing abnormality immediately anterior to the hyoid bone within the infrahyoid muscles measuring 1.4x.1.9x4.0 cm. This was consistent with an exceedingly rare proliferation of a thyroglossal duct remnant secondary to recurrence of the patient’s Graves’ disease. The patient was treated with surgical resection of the neck mass shown to be ectopic Graves’ activated thyroid tissue by pathology. The patient was restarted on thyroid hormone replacement therapy and has remained euthyroid to date following surgical resection. Conclusion: The incidence of this event is estimated to be approximately one per a million persons and thus is a rare occurrence in endocrinology. This case highlights the potential shortcomings of surgical management of Graves’ disease. Following surgical resection, the autoimmune status of the patient remains unchanged. Ectopic thyroid tissue can be found anywhere along the embryologic descent of the thyroid gland and as low as the mediastinum. Thus, patients treated with total thyroidectomy should still be monitored regularly for recurrence of Graves’ disease secondary to ectopic thyroid tissue.

Ectopic thyroid tissue in the iris: a case report

Background Ectopic thyroid tissue in the iris, also known as a thyroid glandular epithelial choristoma of the iris, has only been described twice in the literature. In both cases it remained asymptomatic. Case presentation A 67-year-old female patient presented for the first time in mid-2017 with corneal endothelial decompensation, with a history of complicated cataract surgery and IStent® implantation. Slit lamp microscopy showed endothelial decompensation, pseudophakia, anterior synechiae and a whitish iris tumour adhering to the endothelium. The latter had existed since childhood. Given these findings, reduced visual acuity of hand movement perception and an intraocular pressure of 23 mmHg, we performed a keratoplasty combined with an en bloc resection of the iris tumour at 9 o’clock and sector iridectomy at the end of 2019. Histological and immunohistological examination of the iris tumour unexpectedly revealed thyroid tissue. After the procedure described above, the patient had an increase in visual acuity while the graft stayed clear and the eye showed no evidence of tumour recurrence or other complications. Conclusions We report a third case of ectopic thyroid tissue in the iris. Both previous cases remained asymptomatic, whereas in our case, size and location of the ectopic thyroid tissue contributed to a more complex cataract surgery resulting in endothelial decompensation. Therefore, in such cases appropriate patient information should be provided prior to cataract surgery. Furthermore, careful histological examination and examination of the thyroid is important to exclude malignant diagnoses such as a metastasis of a follicular thyroid carcinoma.

Submandibular ectopic thyroid gland: an uncommon presentation

Background Ectopic thyroid is a developmental anomaly of the thyroid gland of embryological origin. Instead of having a pretracheal situation, thyroid tissue is elsewhere, most commonly in the median cervical line along the course of the thyroglossal duct. Lingual thyroid is the most common presentation. Ectopic thyroid tissue in the submandibular region has been rarely reported. Case presentation We report herein a case of a 65-year-old man admitted to our department with a complaint of a painless swelling in the left submandibular region. Conclusions Thyroid gland ectopia should be considered among the differential diagnoses of submandibular swelling. Ectopic thyroid tissue can present with the same pathology affecting the normal thyroid gland such as malignancy and hyperthyroidism.

Chronic thyroiditis in lateral ectopic thyroid mimicking cervical metastasis of thyroid cancer

Summary We present the case of a 45-year-old Caucasian woman who attended the Endocrinology Unit for a left cervical mass discovered during follow-up for autoimmune chronic thyroiditis. The ultrasound-guided fine-needle aspiration biopsy of the lesion was consistent with a metastasis of follicular thyroid carcinoma. The sonographic neck evaluation revealed no thyroid nodules but three markedly hypoechoic and highly vascularized areas, with irregular margins and hyperechoic spots. In the clinical suspicion of primary thyroid neoplasm, ultrasound-guided fine-needle aspiration biopsy of two of the three areas was performed, but both cytological reports were non-diagnostic, revealing only colloid and blood. Subsequently, the patient underwent surgical removal of the cervical mass, with the intra-operatory consultation with frozen section examination suggesting follicular-like neoplasia. For this reason, thyroidectomy with both central and lateral neck dissection was performed. Surprisingly, the final histologic examination revealed chronic thyroiditis in the thyroid specimen and no evidence of metastasis in the left neck mass. Consequently, the pathological revision of the frozen section assessment led to the final diagnosis of chronic thyroiditis on the lateral ectopic thyroid. This case represents an uncommon example of lateral ectopic thyroid tissue with coexisting normally located thyroid tissue both affected by chronic thyroiditis. Learning points Ectopic thyroid must be considered in the diagnostic work-up of lateral neck mass. Even if rare, ectopic thyroid tissue can be found lateral to the carotid sheath and with coexisting normally located thyroid tissue. As the orthotopic tissue, lateral ectopic thyroid tissue can be affected by chronic thyroiditis, which may complicate the diagnosis both on ultrasound and cytology.

Thyroglossal Duct Cyst Papillary Carcinoma With Airway Compromise

Thyroglossal duct cysts are typically benign and usually asymptomatic. Malignant transformation is uncommon. Intralaryngeal extension is rare and results in dysphonia or dyspnea. There is no literature nowadays reporting the thyroglossal duct cyst carcinoma combining the clinical features of intralaryngeal extension. The authors present a case of progressive hoarseness and midline neck mass for 2 years. The laryngoscope and computed tomography revealed a 6-cm thyroglossal duct cyst containing ectopic thyroid tissue with intralaryngeal extension and causing airway obstruction. Complete excision with Sistrunk operation revealed papillary thyroid carcinoma. The patient resumed normal phonation after the surgery. There was no evidence of tumor recurrence and no hoarseness or dyspnea at 6 months follow up. This is the first reported case of a huge thyroglossal duct cyst carcinoma with intralaryngeal extension causing airway compromise. Complete excision of tumor is essential and vital to the symptom relief. A thyroglossal duct cyst carcinoma with endolaryngeal involvement should be considered in the differential diagnosis when the case has a massive midline neck mass with ectopic thyroid tissue and develops dyspnea or hoarseness concurrently.