Thyroid Hemiagenesis Associated with Graves' Disease: A Case Report and Review of the Literature

Abstract

Introduction. Thyroid hemiagenesis (TH) is a congenital developmental disorder. Most cases are euthyroid although hyperthyroidism, hypothyroidism, and malignancy may develop. We present a case of hemiagenesis with Graves' disease (GD) and review the literature about the association. Case report. A 45-year-old female patient was admitted to the endocrinology department due to nausea and diarrhea. Her past medical history revealed hyperthyroidism diagnosed a year ago. On thyroid examination, right thyroid lobe was palpable, but left lobe and isthmus were not. Physical examination involving other organ systems was unremarkable except for fine tremor of the hands. Thyroid function tests revealed a high level of free T4 and T3 with a low serum TSH. Thyroid antibodies were all positive. Left lobe and isthmus were invisible on thyroid ultrasonography (US) and the right thyroid lobe measuring 44x18x12 mm was diffusely heterogeneous in echo texture. Thyroid scan using Technetium-99m showed increased homogeneous tracer uptake in the right lobe. The patient was diagnosed with TH and GD. Discussion. In case of unilateral increased uptake on scintiscan, GD with hemiagenesis must be kept in mind in the differential diagnosis of autonomous solitary adenoma, postinflammatory atrophy of thyroid in Hashimoto's disease, focal or unilateral subacute thyroiditis, and primary or metastatic carcinoma. It is prudent to do thyroid ultrasound along with scintigram. US is a valuable tool for the quick diagnosis of TH and differential diagnosis from other causes.

Thyroid hemiagenesis with a TI-RADS 2 nodule in the contralateral lobe

“…However, large Fig. 1 Ultrasound of the thyroid gland with high frequency linear probe demonstrating a Absent left thyroid lobe b The right thyroid lobe normal tissue volume, and c Isthmus in situ both in longitudinal and transverse planes case-control studies observed a significantly higher incidence of concomitant thyroid disorders such as Gravesʼ disease, Hashimotoʼs thyroiditis, subacute thyroiditis, nodular goiter, hyperfunctioning adenoma, primary carcinoma, and metastatic carcinoma, in patients with THA than in those with bilobate thyroid glands, the most frequent disorders being thyroid nodules and autoimmune thyroid diseases [8,11]. We found a solitary thyroid nodule in the present case of THA as a reason to seek medical attention.…”

Parathyroid Carcinoma in a Patient With Secondary Hyperparathyroidism and Thyroid Hemiagenesis: A Case Report and Review of the Literature

“…Thyroid hemiagenesis is an extremely rare developmental disorder of the thyroid, 10 but it may become apparent during surveillance for thyroid diseases such as thyroid tumor, carcinoma, or Graves' disease. [9][10][11] Thyroid hemiagenesis is caused by one side of the thyroid not developing embryologically, rather than a failure of glandular tissue descent or migration, as seen in ectopic thyroid. 7,30 Regarding laterality, past reports have shown many cases of thyroid hemiagenesis are on the left side.…”

“…Defects on the right side, as in this case, are rare. 10 The incidence of thyroid hemiagenesis is estimated to be approximately 0.02%. 30 It tends to be more common in women.…”

“…[5][6][7] Thyroid hemiagenesis is a rare congenital anomaly that could be revealed a thorough examination for thyroid disease. 8 There have been several reports of thyroid hemiagenesis with conditions such as thyroid tumor, 9 Graves' disease, 10 and primary hyperparathyroidism, 11 but there have been no reports of SHPT and PC. We report an extremely rare case of PC in a patient with SHPT and thyroid hemiagenesis as well as a review of the literature.…”

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

“…Another very rare scenario involves the concomitant diagnosis of PHP and giant-goitre-associated thyrotoxicosis; in this situation, hypercalcaemia-related hyperthyroidism may mask the biological recognition of PHP and 99m-Tc sestamibi scintigraphy might be found as false negative at baseline [74]. Also, 99m-Tc scintigraphy has been used for thyroid hemi-agenesis, showing an increased unilateral uptake amid this interesting developmental disease of the gland [75,76].…”