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Objective: Ectopic thyroid tissue (ETT) is a rare entity resulting from thyroid gland dysembryogenesis. We present a case of ETT confirmed by histopathology that was misdiagnosed clinically as a carotid body tumor. Methods: A 34-year-old female with a history of thyroidectomy for a goiter presented with 1 year of worsening tachycardia (heart rate ranging from 82 to 111 beats per minute), anxiety, hot flashes, and intolerance to heat. For further evaluation, we obtained imaging of her neck, including a thyroid ultrasound, a computed tomography (CT) scan, and an octreotide scan. We also performed laboratory studies including fractionated 24-hour urine meta-nephrines and thyroid function tests. Results: Her thyroid ultrasound showed a mass at the right carotid bifurcation, which was confirmed on CT as well as on an octreotide scan. Her free thyroxine was 0.6 ng/dL (normal, 0.7 to 1.5 ng/dL) and her thyroid-stimulating hormone was 4.51 mIU/L (normal, 0.45 to 4.5 mIU/L). Her fractionated 24-hour total urine metanephrines were 1,502 mcg/24-hour (normal, 149 to 535 mcg/24-hour). She underwent resection of a vascular mass from the carotid bifurcation. Histologic examination revealed ETT with dilated follicles filled with colloid with no evidence of paraganglioma/carotid body tumor. Conclusion: The somatostatin receptor is typically present in paragangliomas; however, there are reports of octreotide uptake within thyroid goiters. It has been demonstrated that psychoactive medications can increase urine metanephrines. Given the patient's psychiatric history and that no other tumors were identified on imaging, it was felt that the elevated urine normetanephrine in this case was most likely due to psychoactive medication use. This case demonstrates the preoperative imaging findings and postoperative pathologic confirmation of an unusual presentation of ETT.

Introduction Ectopic thyroid tissue can be found in many sites. Ectopic thyroid tissue may also be involved in the same processes as normal thyroid gland. These processes include tumors, inflammation and hyperplasia. The appearance of such tissue in rare locations may lead to diagnostic and therapeutic dilemmas. Presentation of Ccase We report a rare case of primary papillary carcinoma in an ectopic thyroid in the jugulocarotid regionbased on the bifurcation of the carotid artery, in a 62-year-old woman with history of diabetes and high blood pressure, with a normal thyroid gland. Discussion The origin of lateral ectopic thyroid tissue is not fully understood and controversial.The lateral localisation is a rare entity and debated extensively in the literature. Conclusion Though rare, the possibility of an ectopic thyroid carcinoma must always be considered by the surgeon in cases of a pathological mass in the neck.

Highlights • A separate substernal goitre is an unusual entity, which may have embryological origin as ectopic thyroid tissue, or residual cervical thyroid tissue following prior thyroid resection. • Pre-operative imaging via a thyroid nuclear scan and computer tomography (CT) imaging aids in determining its characteristics and for pre-operative planning. • A trans-cervical resection is preferred due to lower morbidity. • A trans-cervical resection is achievable when the lesion is accessible and delivered through the thoracic inlet according to CT characteristics., Introduction A separate substernal goitre which is not continuous with the main cervical thyroid proves a unique challenge for resection. A trans-cervical approach is preferred but may be hazardous due to the possibility of ectopic thyroid tissue with alternate blood supply. Presentation of case A 72 year old female who had a previous left hemithyroidectomy presents with a symptomatic central substernal thyroid mass. Following radiological work-up, the separate goitre was carefully removed via a trans-cervical approach and avoidance of sternotomy. She had a rapid recovery without complication. Discussion The anatomy and embryology of substernal masses need to be carefully considered particularly if the mass is ectopic thyroid tissue. Careful pre-operative assessment may determine its nature and anatomical features. Intra-operative dissection requires consideration of blood supply and surrounding structures, but often may be and is best completed via a cervical approach to minimise morbidity. Review of the literature affirms the preference for a trans-cervical approach and offers criteria for successful resection via this method. Conclusion Confirming the nature and anatomy of a separate substernal goitre enables successful removal of the mass via a trans-cervical approach with minimal morbidity.

Highlights • Ectopic Thyroid Tissue in the mediastinum is very rare. • ETT can be associated with normal thyroid function and normal thyroid anatomical location. • ETT should be differentiated from substernal goiter., Introduction Mediastinal Ectopic Thyroid Gland is a rare entity, accounting for 1% of all mediastinal tumours. Here, we present a rare case of mediastinal mass that was proved to be an ectopic thyroid with normal thyroid function tests and normal thyroid gland in the cervical location. Case Presentation A 32-year-old lady had a road traffic accident, with the incidental discovery of a mediastinal mass on chest radiography. Thyroid function tests were normal. CT scans of the neck and chest revealed a large mediastinal mass compressing the trachea from the left side and extending to the superior part of the anterior mediastinum with normal thyroid gland in the cervical position. Midline Partial Sternotomy was done with complete surgical excision of the mass. It was well circumscribed, multinodular, had firm inconsistency, and grossly looked like a thyroid tissue. Histopathology revealed ectopic thyroid tissue negative for malignancy. Postoperative thyroid ultrasound showed normal thyroid lobes in the neck. Discussion Ectopic thyroid tissue (ETT) occurs due to failure of the thyroid gland to migrate from foramen ceacum to its normal position in the cervical region in front of the trachea. The most common site of ETT is lingual thyroid and accounts for about 90% of all cases reported in the literature. ETT in the mediastinum is very rare, with only a few cases reported in the literature. Conclusion ETT in the mediastinum is very rare and can be associated with normal thyroid function and normal thyroid anatomical location. It should be differentiated from substernal goiter.

Ectopic thyroid is a rare developmental abnormality resulting from defects at early stages of thyroid gland embryogenesis in which thyroid tissue is located elsewhere than the normal pre tracheal region. Ectopic thyroid tissues most commonly are located in the midline in the cervical area. The presence of ectopic thyroid tissue in the lateral neck region is very rare. The simultaneous appearance of the orthotopic thyroid gland with lateral ectopic thyroid is extremely rare. We report a rare case of ectopic thyroid in the lateral cervical area in a patient with a normally located multinodular goiter. Although lateral ectopic thyroid tissue is rarely seen, it should be considered in the differential diagnosis of lateral neck swellings.

Highlights • A mediastinal thyroid mass discovered years after total thyroidectomy is presented. • The history, etiology, and optimal surgical approach are discussed. • The “forgotten goiter” can be safely approached through a cervical incision., Introduction A mediastinal thyroid mass discovered years after a total thyroidectomy represents an unusual and uncommon clinical situation. Few cases have been reported and controversy exists regarding the etiology of this ectopic thyroid tissue as well as the optimal surgical approach for resection. We herein describe a case of a mediastinal thyroid goiter discovered five years after a total thyroidectomy. Presentation of case A 54-year-old Hispanic female was diagnosed with a diffuse cervical goiter secondary to Hashimoto’s Thyroiditis and subsequently underwent a total thyroidectomy. Five years later the patient had a chest X-ray as part of a preoperative evaluation for an unrelated and elective surgical procedure. Significant tracheal deviation was identified. A computed tomography scan was obtained and demonstrated a well encapsulated mass in the superior mediastinum resulting in tracheal deviation and compression. This “forgotten” goiter was successfully resected utilizing a standard cervical approach and the patient recovered uneventfully. Discussion A thyroid mass within the mediastinum following a total thyroidectomy is a condition often referred to as “forgotten goiter”. Prior reported cases are few, and data is limited, with some uncertainty remaining as to the exact origin of this ectopic thyroid tissue. Possible etiologies include an incomplete removal of the thyroid gland during initial cervical thyroidectomy, or perhaps an autonomous intrathoracic goiter (AIG) – a thyroid gland located in the mediastinum, independent and with no parenchymatous or vascular connection with the cervical thyroid gland. Conclusion A trans-thoracic or sternal splitting approach is generally not required for resection of a mediastinal goiter and our experience confirms that the case of the “forgotten goiter” can be safely approached through a cervical incision as well.

Highlights • Anaplastic carcinoma arising in ectopic thyroid tissue is extremely rare. • Another possibility that should be taken into account in appearance of thyroid tissue in the lateral cervical region is the presence of a thyroid carcinoma metastasis. • FNA can contribute significantly to the accurate preoperative assessment of ectopic thyroid tissue, particularly if malignancy is suspected. • The presence of anaplastic carcinoma in the submandibular region without any evidence of primary tumor at the orthotopic thyroid gland may pose diagnostic difficulties., Introduction Thyroid carcinoma arising in an extrathyroid area is a rare entity. Presentation of case We report a case of anaplastic carcinoma in the submandibular region occurring in a 70-year-old woman. Discussion The location of the mass along with no evidence of primary tumor at the orthotopic thyroid gland posed a diagnostic dilemma: was this an ectopic thyroid carcinoma or rather a case of occult differentiated thyroid carcinoma metastasis that transformed to anaplastic carcinoma? Based on the histopathological findings we concluded that the tumor arised in ectopic thyroid tissue. Although the mass was completely resected, the patient died 10 months after diagnosis due to pulmonary metastases. Conclusion Conclusively, the possibility of ectopic thyroid tissue, with or without disease, should be considered in cases of a mass in the submandibular region.

Resume Objectifs Rapporter un cas d’adenocarcinome papillaire survenu sur tissu thyroidien ectopique siegeant au niveau de l’os hyoide avec une revue de la litterature. Materiel et methodes Un patient de 57 ans consultait devant une masse cervicale anterieure, evoluant depuis environ un an, sans signes de compression locoregionale, ni signes de dysthyroidie. Resultats A l’examen, la tumefaction etait de consistance ferme, faisant corps avec l’os hyoide, mobile par rapport aux differents plans, mais de limites imprecises, mesurant environ 8 cm de diametre dans son grand axe. La glande thyroide eutopique etait en place, en position pretracheale. La tomodensitometrie cervicale a objective un processus lesionnel osteolytique centre sur l’os hyoide avec une zone charnue de densite tissulaire et des calcifications. L’IRM cervicale a permis de realiser un bilan d’extension plus precis de la masse en confirmant que cette derniere respecte les structures de voisinage, notamment l’endolarynx. Nous avons realise chez ce patient un abord cervical de la tumeur qui a permis une exerese totale. L’etude anatomopathologique de la piece operatoire etait en faveur d’un adenocarcinome papillaire sur tissu thyroidien ectopique. Le traitement a ete complete par une thyroidectomie totale dont l’etude histologique etait normale. Conclusions La survenue d’un adenocarcinome papillaire sur un tissu thyroidien ectopique est une situation tres rare. Son diagnostic est avant tout histologique. Son traitement est essentiellement chirurgical, associe eventuellement a une iratherapie.

This case report includes a rare case of laryngo-tracheal ectopic thyroid tissue (ETT) in a 47-year-old woman who presented with shortness of breath that was initially diagnosed as asthmatic bronchitis. Endoscopic examination revealed a subglottic mass extending to the upper trachea; computed tomography (CT) confirmed the endoscopic findings, and showed pre-contrast density, and post-i.v. contrast enhancement pattern similar to thyroid. Biopsy of the subglottic mass was taken via direct laryngoscopy and histopathology report revealed ETT. The patient was operated through tracheolaryngeofissure with sub-mucosal dissection of the mass. Both clinical and endoscopic follow up showed that the patient had been free of disease for more than 2 years now following surgery.

Ectopic thyroid tissue can be found anywhere from foramen cecum and the normal cervical position of the thyroid gland. It occurs most commonly at the base of tongue, known as lingual, followed by sublingual and the anterior midline of neck. We present the patient with dual ectopic thyroid, one of them is at the base of tongue and the other is in the left submandibular region. The purpose of this report is to demonstrate the findings of ultrasonography, computed tomography, magnetic resonance imaging and scintigraphy and to emphasize the importance of performing a thyroid scan in every case of thyroid ectopia to accurately identify all sites of functioning thyroid tissue.

Ectopic thyroid tissue occurs in about 7 to 10% of the general population. Localization in the anterior mediastinum is rare: seven cases reported in the literature, most associated with thyroid dysfunction. We report the case of a 77-year-old woman who presented ectopic thyroid tissue in the anterior mediastinum and a normally-located normally-functioning gland.

Ectopic thyroid tissue in the submandibular space with the thyroid gland in its normal location is an extremely rare phenomenon. We present a case of a 75-year-old woman who had painless swelling in the left submandibular space and was referred to our hospital with the suspicion of having a malignant tumor originating from the submandibular gland. Histologic examination showed normal follicular thyroid tissue without any sign of malignancy. In general there are 3 explanations for the presence of ectopic thyroid tissue found in the submandibular region: (1) displacement during the course of embryonal development, (2) spread of tissue during surgery on a normally located thyroid gland, and (3) metastasis of a highly differentiated papillary thyroid carcinoma. We reviewed the literature with respect to the embryological background and the clinical management of such cases.

This report describes a 62-year-old woman with a history of pulmonary embolism who presented with a right ventricular cardiac mass that proved histologically to be normal thyroid tissue. The patient was clinically and biochemically euthyroid. Six months after excision, an iodine-123 whole-body uptake and scan demonstrated no residual ectopic thyroid tissue.

This report describes an unusual location of ectopic thyroid gland tissue. A growth in the left submandibular area was surgically excised, and the microscopic examination of the specimen revealed thyroid tissue with colloid goiter. Because this entity cannot be clinically distinguished from a salivary gland tumor, ectopic thyroid tissue should be considered in the differential diagnosis of swellings involving the submandibular area.

The first case of a papillary carcinoma arising in ectopic thyroid tissue within a branchial cyst in a 34 yr old woman is presented. This also adds to the existing list of unusual sites where ectopic thyroid tissue has been described. All histological types of carcinoma have been reported in ectopic thyroid tissue, papillary carcinoma being the most common histological type, accounting for 85% of these tumors. The criteria for establishing this diagnosis of carcinoma arising in ectopic thyroid tissue within branchial cyst is discussed.

Ectopic thyroid tissue in the chest is rare. We report a case of a euthyroid patient with benign ectopic thyroid tissue presenting as a thymic mass in association with a multinodular goiter. Both disorders were managed successfully by surgical intervention.

Aging changes were studied in the kidney of the male annual fish, Nothobranchius guentheri . The aging changes included tubule dilation, thickening of the Bowman's capsule, lipochrome in histiocytes, malignant tumors and ectopic thyroid tissue. Since these fish are short-lived in both nature and the laboratory, they should provide an interesting model for studies in the biology of aging.

Pilot programs for screening of newborn infants for congenital hypothyroidism began in North America in 1972. To date, the five oldest programs (Quebec, Pittsburgh, Toronto, Oregon Regional, and New England Regional) have screened 1,046,362 infants. A total of 277 infants with congenital hypothyroidism have been detected and seven have been missed, resulting in a total of 284 affected infants in the screened population and an overall incidence of one in 3,684 live births. Of the affected infants, 246 were determined to have primary hypothyroidism, an incidence of one in 4,254 births. Ten infants with secondary-tertiary hypothyroidism were detected in Quebec, Oregon, and Toronto, an incidence of one in 68,200 births. Of all the infants with primary hypothyroidism who were adequately studied, 63% were determined to have aplastic or hypoplastic glands, 14% normal or enlarged glands, and 23% ectopic thyroid tissue. The estimated minimum incidence of infants with TBG deficiency is one in 8,913 births. Only 8 of the 277 detected infants were suspected clinically to have congenital hypothyroidism prior to the time of confirmation of the diagnosis at 4 to 8 weeks of age. The cost of screening varied from $0.70 to $1.60 per infant, depending on which costs were included in the estimate. Preliminary evidence from Quebec suggests that infants treated in the program have normal developmental testing scores at 18 months of age.

Six girls, aged 5 to 15 years, presented with thyroid masses in otherwise nonpalpable thyroid glands and with normal serum thyroxine levels. Scintiscanning before and after TSH stimulation confirmed the presence of autonomous nodules in the four adolescents, of whom two had elevated T 2 levels. Surgical exploration revealed adenomatous thyroid hyperplasia in three of the girls and papillary adenocarcinoma in the fourth. Scans in the other two girls revealed absence of the left lobe. One of them proved to have agenesis of the left lobe with enlargement of the right lobe because of lymphocytic thyroiditis. The other girl had an ectopic thyroid with chronic inflammation. A thorough diagnostic evaluation of single or multiple functioning thyroid masses in children and adolescents is essential in establishing the correct diagnosis. The possibility that carcinoma can occur in autonomous nodules as well as in hemiagenesis and ectopic thyroid tissue is discussed. An approach to the management of functioning thyroid masses in the pediatric age group is proposed.

A 12-year-old neutered male Husky dog had a neoplasm at the base of the heart which did not invade surrounding tissues. Microscopically, the neoplasm was composed of nests and sheets of polyhedral cells subdivided into lobules by trabeculae of fine fibrovascular stroma. Adjacent to the neoplasm was a rim of ectopic thyroid tissue that appeared histologically normal. The possible differential diagnoses for the neoplasm were aortic body tumour, ectopic thryoid tumour and ectopic parathyroid tumour; the ultrastructural characteristics revealed it to be an aortic body tumour.

Subhyoid ectopic thyroid tissue existing in the absence of a normal thyroid gland is a rare finding. The preoperative clinical impression of this lesion is nearly always thyroglossal duct cyst and its excision results in myxedema. Radioactive scan of subhyoid midline spherical masses is the only means of preoperative assessment of ectopic thyroid tissue and the presence of normal thyroid gland as well. In the absence of a scan, suspected thyroglossal duct cysts should be bisected at the time of surgery to prove they are not thyroid tissue. No midline subhyoid ectopic thyroid should be excised unless there is a normal thyroid gland.

Struma cordis, ectopic thyroid tissue located in the heart, is extremely rare. To our knowledge, this is the first report of struma cordis obstructing the left ventricular outflow tract. The tumor was removed successfully using cardiopulmonary bypass.