Ectopic thyroid glands generally appear in the midline due to abnormal median migration; their presence lateral to the midline is rare. We report the case of a 42-year-old female who presented with symptoms of thyrotoxicosis and an expanding submandibular swelling. Tc-99m-sodium pertechnetate scanning showed thyroid tissue in the left submandibular region, while no thyroid tissue was seen in the normal site. The patient was treated with 10 mCi of 131I and subsequently became euthyroid. Literature review revealed seven cases of lateral aberrant thyroid tissue. The theories to explain lateral aberrant thyroid are presented.

The remodeling process in bone yields numerous cytokines and chemokines that mediate crosstalk between osteoblasts and osteoclasts and also serve to attract and support metastatic tumor cells. The metastatic tumor cells disturb the equilibrium in bone that manifests as skeletal complications. The Hedgehog (Hh) pathway plays an important role in skeletogenesis. We hypothesized that the Hh pathway mediates an interaction between tumor cells and osteoblasts and influences osteoblast differentiation in response to tumor cells. We have determined that breast tumor cells have an activated Hh pathway characterized by upregulation of the ligand, IHH and transcription factor GLI1. Breast cancer cells interact with osteoblasts and cause an enhanced differentiation of pre-osteoblasts to osteoblasts that express increased levels of the osteoclastogenesis factors, RANKL and PTHrP. There is sustained expression of osteoclast-promoting factors, RANKL and PTHrP, even after the osteoblast differentiation ceases and apoptosis sets in. Moreover, tumor cells that are deficient in Hh signaling are compromised in their ability to induce osteoblast differentiation and consequently are inefficient in causing osteolysis. The stimulation of osteoblast differentiation sets the stage for osteoclast differentiation and overall promotes osteolysis. Thus, in the process of developing newer therapeutic strategies against breast cancer metastasis to bone it would worthwhile to keep in mind the role of the Hh pathway in osteoblast differentiation in an otherwise predominant osteolytic phenomenon.

A 53-year-old man was found serendipitously to have increased blood-pool uptake in the right lobe of the thyroid during a radionuclide ventriculography study for left ventricular function. Primary thyroid hemangioma is a rare condition, with only two cases reported in the literature. Secondary hemangioma may occur as a result of fine-needle aspiration. This technique may cause hematoma formation, which generally resolves normally, but on rare occasions it can lead to cavernous hemangioma formation. In patients with a thyroid swelling who have a cold nodule on a thyroid scan and only blood on repeated fine-needle aspiration, Tc-99m erythrocyte blood-pool imaging may be performed to diagnose hemangioma.

Dual ectopic thyroid glands rarely occur, and only six cases have been reported in the literature. The authors describe a 14-year-boy who had a midline neck swelling for 8 to 9 years. The swelling increased gradually, but he had no pressure symptoms. The thyroid hormone profile showed a moderately increased thyroid-stimulating hormone value and normal T3 and T4 levels. A Tc-99m sodium pertechnetate thyroid scan showed dual ectopic thyroid glands in the sublingual and subhyoid regions.