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Introduction and Importance: The mediastinal ectopic thyroid gland is rare and usually asymptomatic. Ectopic thyroid tissue has malignant potential, but ectopic thyroid cancers are extremely rare, particularly mediastinal thyroid cancer, with only five cases reported in the literature., Case Presentation: A 73 years-old male patient diagnosed with multinodular goitre with two FLUS cytology was summited to an uneventful total thyroidectomy. Pathology revealed 8 synchronous papillary carcinomas in both thyroid lobes. Follow-up identified persistent elevation of thyroglobulin. A cervical ultrasound and cervical and thoracic CT scan were performed, identifying a mediastinal tumour of 6 × 3 cm. Resection was performed by video-assisted thoracic surgery (VATS). Pathology identified an ectopic mediastinal thyroid with a 4 mm papillary microcarcinoma. Recovery was uneventful and the patient is currently asymptomatic., Clinical Discussion: There is no consensus on the best treatment strategy for mediastinal ectopic thyroid, but surgical resection is advised as being the only method allowing for a complete cure. Although both thoracotomy and sternotomy approaches have been usually used for mediastinal thyroid tumours resection, the thoracoscopic approach has been used with good results in recent years. Thoracoscopy has better visualization, less morbimortality, and faster recovery. Giant masses (>10 cm) are the only limitation for VATS., Conclusion: Ectopic mediastinal thyroid is extremely rare, and its malignant transformation is even rarer. There is no consensus on the best treatment strategy, but surgical resection of the mediastinal thyroid is advised. VATS is a safe and feasible minimally invasive technique with good outcomes., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Functional imaging using radionuclide Tc99m pertechnetate is routinely used in the evaluation of the problems related to the thyroid gland. Scintiscan has been useful in the visualization of thyroid tissue in ectopic sites due to congenital developmental anomalies. Similarly, the scan helps in establishing the diagnosis of autonomously functioning nodule when the nodule being evaluated appears "hot" with suppression of rest of the gland activity. Here, we present a very rare case of autonomously functioning thyroid adenoma in an ectopic focus of accessory thyroid tissue in the mediastinum.