Gurleyik Emin, Gonullu Emin, Yekenkurul Erman, Gursoy Fatih
Department of Surgery, Duzce University, Faculty of Medicine, Duzce, Turkey.
Department of Surgery, Duzce University, Faculty of Medicine, Duzce, Turkey.
Int J Surg Case Rep. 2024 Jul;120:109862. doi: 10.1016/j.ijscr.2024.109862. Epub 2024 Jun 6.
The majority of surgical thyroid disorders are treated by thyroidectomy (total or hemithyroidectomy). Anatomical variants of embryologic origin may threaten the effectiveness of thyroid surgery and complete removal of thyroid tissue.
A female patient who underwent a total thyroidectomy, postoperatively had normal serum thyroid-stimulating hormone (TSH) levels without hormone replacement. Serum TSH and thyroglobulin levels were within normal range. A thyroid nuclear scan and chest magnetic resonance imaging (MRI) indicated a large retrosternal thyroid remnant. Clinical discussion: Separated thyroid remnant in the thyrothymic tract, forgotten during primary surgery, was the source of hormone production. Total thyroidectomy was not achieved due to embryologic remnant, and complete resection of thyroid tissue was affected by separated retrosternal thyrothymic rest.
Surgeon awareness of anatomic variants of embryological origin undoubtedly improves thyroid surgery outcomes. Beside the anatomically based approach, total thyroidectomy could be achieved by an embryologically based approach.
大多数外科甲状腺疾病通过甲状腺切除术（全甲状腺切除术或半甲状腺切除术）进行治疗。胚胎起源的解剖变异可能会威胁到甲状腺手术的效果以及甲状腺组织的完全切除。
一名接受全甲状腺切除术的女性患者，术后血清促甲状腺激素（TSH）水平正常，无需激素替代治疗。血清TSH和甲状腺球蛋白水平在正常范围内。甲状腺核素扫描和胸部磁共振成像（MRI）显示有一个巨大的胸骨后甲状腺残余组织。临床讨论：位于甲状腺胸腺管内的分离甲状腺残余组织，在初次手术时被遗漏，是激素产生的来源。由于胚胎残余组织，未能实现全甲状腺切除术，而胸骨后分离的甲状腺胸腺残余组织影响了甲状腺组织的完全切除。
外科医生对胚胎起源的解剖变异的认识无疑会改善甲状腺手术的结果。除了基于解剖学的方法外，全甲状腺切除术还可以通过基于胚胎学的方法来实现。
