Buckingham Heidi, Sauerwein Tom J, Golding Allan C
Division of Endocrinology, Wright-Patterson Air Force Base, Dayton, Ohio 45433-5529, USA.
Endocr Pract. 2006 Jul-Aug;12(4):401-5. doi: 10.4158/EP.12.4.401.
To describe a patient with a rare presentation of Graves' disease in the cervical thyroid and thyroglossal duct remnant.
We present a detailed case report, including initial manifestations, laboratory findings, and radiologic evaluation of a patient with Graves' disease. A review of the relevant medical literature is included. A search for articles in the MEDLINE database from 1966 to November 2003 was performed with use of the following key words: thyroglossal duct remnant, thyroglossal duct cyst, thyrotoxicosis, Graves' disease, hyperthyroidism, and ectopic thyroid tissue. The reference lists from the articles obtained from the MEDLINE database were then reviewed for other pertinent articles. English abstracts of non-English articles were also reviewed.
A 63-year-old woman presented with thyrotoxicosis. Examination of her neck was notable for a 3.5-cm soft, mobile midline mass overlying the thyroid cartilage. She had no extrathyroidal manifestations of Graves' disease. The rest of the physical examination was unremarkable. Laboratory studies revealed a thyrotropin (thyroid-stimulating hormone) level of 0.01 microIU/mL (normal range, 0.3 to 6.6) and free thyroxine level of 4.7 ng/dL (normal range, 0.6 to 1.5). An ultrasound study showed a normal-appearing thyroid and an infrahyoidal neck mass (3.0 by 1.7 cm). A radioiodine (123I) thyroid scan demonstrated diffuse homogeneous uptake throughout the gland in conjunction with 66.6% uptake at 24 hours. In addition, a large rounded area of increased activity slightly left of the midline was noted. The left anterior oblique image showed that this area was not continuous with the left upper pole. We thought that this finding represented a hyperfunctioning thyroglossal duct cyst or remnant tissue. Our patient subsequently underwent radioiodine therapy with 15.56 mCi of 131I. A review of the English-language literature revealed only rare case reports of thyrotoxicosis in ectopic thyroid tissue.
Although the occurrence of thyrotoxicosis is common, to the best of our knowledge this is only the second case of Graves' disease involving the thyroglossal duct remnant reported in the English literature.
描述1例甲状腺位于颈部且合并甲状舌管残余的格雷夫斯病罕见病例。
我们呈现一份详细的病例报告，包括1例格雷夫斯病患者的初始表现、实验室检查结果及影像学评估。同时纳入了相关医学文献综述。使用以下关键词在1966年至2003年11月的MEDLINE数据库中检索文章：甲状舌管残余、甲状舌管囊肿、甲状腺毒症、格雷夫斯病、甲状腺功能亢进症及异位甲状腺组织。随后查阅从MEDLINE数据库获取文章的参考文献列表以查找其他相关文章。还查阅了非英文文章的英文摘要。
一名63岁女性出现甲状腺毒症。其颈部检查发现甲状腺软骨上方有一个3.5厘米的柔软、可活动的中线肿块引人注目。她没有格雷夫斯病的甲状腺外表现。其余体格检查未见异常。实验室检查显示促甲状腺素水平为0.01微国际单位/毫升（正常范围为0.3至6.6），游离甲状腺素水平为4.7纳克/分升（正常范围为0.6至1.5）。超声检查显示甲状腺外观正常，舌骨下颈部有一肿块（3.0×1.7厘米）。放射性碘（123I）甲状腺扫描显示整个腺体弥漫性均匀摄取，24小时摄取率为66.6%。此外，在中线左侧发现一个大的圆形活性增强区域。左前斜位图像显示该区域与左上极不连续。我们认为这一发现代表一个功能亢进的甲状舌管囊肿或残余组织。我们的患者随后接受了15.56毫居里的131I放射性碘治疗。对英文文献的综述显示，仅有罕见的异位甲状腺组织甲状腺毒症病例报告。
尽管甲状腺毒症很常见，但据我们所知，这是英文文献中报道的第二例涉及甲状舌管残余的格雷夫斯病病例。
