Sanker Vivek, Mohamed Azeem, Pranala Maanasi, Tharakan Varghese
Surgery, Noorul Islam Institute of Medical Science (NIMS) Medicity, Trivandrum, IND.
General Surgery, Noorul Islam Institute of Medical Science (NIMS) Medicity, Trivandrum, IND.
Cureus. 2022 Sep 3;14(9):e28717. doi: 10.7759/cureus.28717. eCollection 2022 Sep.
Ectopic thyroid is a rare clinical presentation to encounter in day-to-day clinical practice. It occurs due to developmental defects in the early stages of the thyroid gland embryogenesis during its descent from the floor of the primitive foregut to its final pre-tracheal position. It is usually present along the extent of the thyroglossal duct as well as in distant locations such as sub-diaphragmatic or mediastinal spaces. The diverse clinical presentation of this rare entity often causes a diagnostic dilemma. A thyroid scintigraphy scan is pivotal in the diagnosis of ectopy, but ultrasonography is done more frequently. Surgical management is preferred for symptomatic cases, followed by radioactive iodine ablation and levothyroxine supportive therapy for refractory cases. We present a case of a 62-year-old female patient who presented with pain and swelling of the right submandibular region. On ultrasonography, a 5*4 cm firm mobile swelling of the right submandibular region was found, suggestive of right submandibular sialadenitis. Fine needle aspiration cytology (FNAC) was subsequently done, and it showed features of basaloid neoplasm like pleomorphic adenoma, and as the thyroid tissue was in an ectopic location, it must have been misdiagnosed. The patient was then taken up for right submandibular sialoadenectomy, and the histopathological examination of the operative specimen showed nodular colloidal goiter and mild chronic sialadenitis. Ectopic thyroid can present at various anatomical locations and thereby has varied clinical presentations which makes it a diagnostic dilemma for clinicians. The usual radiological investigations done include USG and CT scan, whereas thyroid scintigraphy is more precise in reaching the diagnosis of ectopic thyroid. The confirmatory diagnostic method is the histopathological examination of the excised specimen. Most cases of ectopic thyroid are asymptomatic and require regular follow-up. Symptomatic cases are managed by surgical excision followed by periodic monitoring and adequate thyroxine replacement.
异位甲状腺是日常临床实践中少见的临床表现。它是由于甲状腺在胚胎发育早期从原始前肠底部下降至气管前最终位置的过程中出现发育缺陷所致。它通常出现在甲状舌管走行的范围内，也可出现在如膈下或纵隔等较远的部位。这种罕见疾病多样的临床表现常导致诊断困难。甲状腺闪烁扫描在异位甲状腺的诊断中起关键作用，但超声检查更为常用。有症状的病例首选手术治疗，难治性病例则采用放射性碘消融及左甲状腺素支持治疗。我们报告一例62岁女性患者，她因右下颌下区疼痛和肿胀前来就诊。超声检查发现右下颌下区有一个5×4cm质地硬、可活动的肿物，提示右下颌下涎腺炎。随后进行了细针穿刺细胞学检查（FNAC），结果显示为基底样肿瘤特征，如多形性腺瘤，由于甲状腺组织位于异位位置，之前肯定被误诊了。该患者随后接受了右下颌下涎腺切除术，手术标本的组织病理学检查显示为结节性胶样甲状腺肿和轻度慢性涎腺炎。异位甲状腺可出现在不同的解剖位置，因此有多种临床表现，这给临床医生带来了诊断难题。通常进行的影像学检查包括超声检查（USG）和CT扫描，而甲状腺闪烁扫描在诊断异位甲状腺方面更为精确。确诊的诊断方法是对切除标本进行组织病理学检查。大多数异位甲状腺病例无症状，需要定期随访。有症状的病例通过手术切除治疗，随后进行定期监测和适当的甲状腺素替代治疗。
