Mediastinal ectopic benign colloid goitre detected using iodine-131 whole body scintigraphy and single-photon emission computed tomography-computed tomography

Kamaleshwaran, Koramadai Karuppusamy; Rajan, Firoz; Asokumar, Premkumar; Mohanan, Vyshak; Shinto, Ajit

doi:10.4103/0972-3919.152989

Cited by 5 publications

(71 citation statements)

References 7 publications

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“…The patient was euthyroid in the postoperative period probably due to this hidden thyroid. In the literature, there are a few case reports demonstrating radioiodine (I-131) uptake in incidental mediastinal thyroid tissue and thyroid scintigraphy with I-131 has been reported to be of diagnostic value in intrathoracic goiter [13]. I-131 can be a better agent to evaluate retrosternal pathologies with higher energy and less amount of photons attenuated by sternum, but in this case, we were able to demonstrate the function of the mediastinal mass by Tc-99m pertechnetate probably because the patient was hyperthyroid and the activity uptake was very high in the ectopic thyroid gland.…”

Section: Discussionmentioning

confidence: 99%

Unexpected Appearance of Ectopic Mediastinal Toxic Nodulary Thyroid Hyperplasia in a Case of Recurrent Hyperthyroidism

Araz¹

2016

Int. J. Nucl. Medi. Res.

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Ectopic mediastinal thyroid is a rare entity. Patients are usually euthyroid and symptoms due to mediastinal compression are cautionary to investigate intratoracic mass. We represent a female patient who had undergone subtotal thyroidectomy 12 years ago and had recurrent hyperthyroidism following an euthyroid period. Antithyroid antibodies were negative. Thyroid ultrasonography showed residual thyroid tissue in both sides and multiple nodules on the right side. Thyroid scintigraphy showed a nonhomogenously increased tracer uptake on the right thyroid lobe and left lobe was rather suppressed. Additionally, a large mass of nonhomogenously increased activity located in the mediastinum which was totally seperate from the thyroid gland was detected. MRI images supported that the thoracic mass was an ectopic thyroid tissue and surgical excision confirmed benign nodulary hyperplasia.The case is intereseting in the way that the patient had a recurrent hyperthyroidism due to toxic nodular hyperplasia of the mediastinal ectopic thyroid gland and the pathology was first realised by Technetium-99m (Tc-99m) pertechnetate thyroid scan.

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Section: Discussionmentioning

confidence: 99%

Unexpected Appearance of Ectopic Mediastinal Toxic Nodulary Thyroid Hyperplasia in a Case of Recurrent Hyperthyroidism

Araz¹

2016

Int. J. Nucl. Medi. Res.

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“…and thymectomy in a patient with a prior history of thyroidectomy for cervical thyroid cancer [123]; left hemi-thyroidectomy and isthmectomy plus median sternotomy [129]; partial sternotomy and total thyroidectomy associated with a selective parathyroidectomy via mediastinal and cervical exploration [115].…”

Section: Sample-focused Analysismentioning

confidence: 99%

“…There are current gaps in EMT man approach: a low index of suspicion; no sp resected through the chest with robotic assistance (2/7) or posterolateral thoracotomy (2/7) Motlaghzadeh (*) 2023 [9] cancer [123]; left hemi-thyroidectomy and isthmectomy plus median sternotomy [129]; partial sternotomy and total thyroidectomy associated with a selective parathyroidectomy via mediastinal and cervical exploration [115].…”

Section: Proposed 10-item Algorithm Of Emt Apmentioning

confidence: 99%

“…The longest period of follow-up sinc reported data is up to one to two years [ showed that EMTs remained stable for a that were not removed upon cytological c 1/7 patient had a post-operatory complication: chyle leak & phrenic nerve injury (conservative approach) Gao 2023 [7] Cancers 2024, 16, x FOR PEER REVIEW 37 of 55 and thymectomy in a patient with a prior history of thyroidectomy for cervical thyroid cancer [123]; left hemi-thyroidectomy and isthmectomy plus median sternotomy [129]; partial sternotomy and total thyroidectomy associated with a selective parathyroidectomy via mediastinal and cervical exploration [115].…”

Section: Outcome After Identification Of Emtsmentioning

confidence: 99%

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Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach

Carsote,

Ciobica,

Sima

et al. 2024

Cancers

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We aimed to analyze the management of the ectopic mediastinal thyroid (EMT) with respect to EMT-related cancer and non-malignant findings related to the pathological report, clinical presentation, imaging traits, endocrine profile, connective tissue to the cervical (eutopic) thyroid gland, biopsy or fine needle aspiration (FNA) results, surgical techniques and post-operatory outcome. This was a comprehensive review based on revising any type of freely PubMed-accessible English, full-length original papers including the keywords “ectopic thyroid” and “mediastinum” from inception until March 2024. We included 89 original articles that specified EMTs data. We classified them into four main groups: (I) studies/case series (n = 10; N = 36 EMT patients); (II) malignant EMTs (N = 22 subjects; except for one newborn with immature teratoma in the EMT, only adults were reported; mean age of 62.94 years; ranges: 34 to 90 years; female to male ratio of 0.9). Histological analysis in adults showed the following: papillary (N = 11/21); follicular variant of the papillary type (N = 2/21); Hürthle cell thyroid follicular malignancy (N = 1/21); poorly differentiated (N = 1/21); anaplastic (N = 2/21); medullary (N = 1/21); lymphoma (N = 2/21); and MALT (mucosa-associated lymphoid tissue) (N = 1/21); (III) benign EMTs with no thyroid anomalies (N = 37 subjects; mean age of 56.32 years; ranges: 30 to 80 years; female to male ratio of 1.8); (IV) benign EMTs with thyroid anomalies (N = 23; female to male ratio of 5.6; average age of 52.1 years). This panel involved clinical/subclinical hypothyroidism (iatrogenic, congenital, thyroiditis-induced, and transitory type upon EMT removal); thyrotoxicosis (including autonomous activity in EMTs that suppressed eutopic gland); autoimmune thyroiditis/Graves’s disease; nodules/multinodular goiter and cancer in eutopic thyroid or prior thyroidectomy (before EMT detection). We propose a 10-item algorithm that might help navigate through the EMT domain. To conclude, across this focused-sample analysis (to our knowledge, the largest of its kind) of EMTs, the EMT clinical index of suspicion remains low; a higher rate of cancer is reported than prior data (18.8%), incident imagery-based detection was found in 10–14% of the EMTs; surgery offered an overall good outcome. A wide range of imagery, biopsy/FNA and surgical procedures is part of an otherwise complex personalized management.

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“…There are circumstances in which thyroid tissue may be found outside the gland due to faulty embryogenesis related to genetic factors, mechanical implantation secondary to surgical intervention or trauma, a sequestered thyroid nodule adjacent to the gland but without anatomic connection, or thyroid tissue as a component of a teratoma [ 1 – 4 ]. The lingual area is the most common location of ectopic thyroid tissue [ 3 , 5 , 6 ], and ectopic thyroid tissue is occasionally localized within mediastinum [ 7 – 13 ]. Most of patients with ectopic thyroid presented with symptoms of hypothyroidism, and rare cases of hyperthyroidism with histological features similar to Graves' disease have been reported [ 14 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

Ectopic Thyroid Tissue in the Mediastinum Characterized by Histology and Functional Imaging with I-123 SPECT/CT

Hummel

Wachsmann

Carrick

et al. 2017

Case Reports in Radiology

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Ectopic thyroid tissue is a rare entity and when discovered it is typically along the pathway of embryologic migration of the thyroid. We present a case of incidental finding of ectopic thyroid tissue within mediastinum in a 61-year-old female patient with a history of total thyroidectomy for thyroiditis and nodules. The patient presented to emergency room with cough and right chest pain and underwent a chest computed tomographic angiogram (CTA) to exclude pulmonary embolism as part of chest pain workup. One right paratracheal mediastinal soft tissue nodule was visualized on the images of CTA. This right paratracheal soft tissue mass was found to be ectopic benign thyroid tissue by histological analysis of the biopsied tissue samples. The function of this ectopic thyroid tissue was characterized by I-123 radioiodine uptake and single photon emission computed tomography/computed tomography (SPECT/CT) imaging. This case illustrates that ectopic thyroid tissue should be included for differential diagnosis of a hyperdense soft tissue mass located within mediastinum. I-123 SPECT/CT is useful for guiding tissue biopsy of ectopic thyroid tissue distant from orthotopic thyroid gland and functional and anatomic characterization of mediastinal ectopic thyroid tissue for surgical resection when it is medically necessary.

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Mediastinal ectopic benign colloid goitre detected using iodine-131 whole body scintigraphy and single-photon emission computed tomography-computed tomography

Cited by 5 publications

References 7 publications

Unexpected Appearance of Ectopic Mediastinal Toxic Nodulary Thyroid Hyperplasia in a Case of Recurrent Hyperthyroidism

Unexpected Appearance of Ectopic Mediastinal Toxic Nodulary Thyroid Hyperplasia in a Case of Recurrent Hyperthyroidism

Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach

Ectopic Thyroid Tissue in the Mediastinum Characterized by Histology and Functional Imaging with I-123 SPECT/CT

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