Page 37 - World Journal of Laparoscopic Surgery

CASE REPORT
Endoscopic Ectopic Thyroidectomy

3
2
4
1
5
Ramakrishnapillai Padmakumar , Aravind Balakrishnan , Madhukara Pai , Kevin J Chiramel , Farish Shams , Premna Subin 6
AbstrAct
Aim and objective: To show the advantage of endoscopic approach for lateral ectopic thyroid removal.
Background: Ectopic thyroid tissue lateral to midline is very rare. Because of its unusual location, lateral ectopic thyroid gland can cause
diagnostic difficulties when diseased.
Case description: Here we are presenting a case of a male patient with submandibular ectopic thyroid tissue with multinodular goiter and
absent thyroid tissue in normal anatomic site. He underwent endoscopic-assisted total thyroidectomy. This technique for ectopic thyroid removal
has not been reported in the literature so far.
Conclusion: Endoscopic approach for removal of the diseased gland will allow for a magnified view of the adjoining structures and better
cosmesis for the patient.
Clinical significance: Lateral ectopic thyroid should be in differential diagnosis of lateral neck swelling.
Keywords: Ectopic thyroid, Endoscopic, Endoscopic thyroidectomy, Minimal access surgery, Submandibular region.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1419

bAckground 1–4 Department of General and Laparoscopic Surgery, VPS Lakeshore

Ectopic thyroid tissue usually occurs in the midline and that too Hospital and Keyhole Clinic, Kochi, Kerala, India
most commonly in cervical region (lingual 90%). 1–4 Its prevalence 5,6 Department of Laparoscopic Surgery, Verwandeln Institute, Kochi,
5
is approximately 1/100,000 to 1/300,000. The remaining ectopic Kerala, India
thyroid glands (10%) can be found in infrahyoid, submandibular, Corresponding Author: Ramakrishnapillai Padmakumar, Department
prelaryngeal, mediastinum, esophagus, heart, diaphragm, of General and Laparoscopic Surgery, VPS Lakeshore Hospital and
and parapharyngeal regions. In most of the cases, the ectopic Keyhole Clinic, Kochi, Kerala, India, Phone: +91 9447230370, e-mail:
thyroid gland will be the only functioning gland. Ectopic thyroid drrpadmakumar@gmail.com
tissue lateral to midline is very rare. These lateral ectopic thyroid How to cite this article: Padmakumar R, Balakrishnan A, Pai M, et al.
tissues when diseased may lead to difficulty in diagnosis due to Endoscopic Ectopic Thyroidectomy. World J Lap Surg 2020;13(3):
its unexpected location. Here we are going to present a case of 136–137.
a male patient with submandibular ectopic thyroid tissue with Source of support: Nil

multinodular goiter and absent normal tissue in normal anatomic Conflict of interest: None
site. He underwent endoscopic-assisted total thyroidectomy. This
technique for ectopic thyroid removal has not been reported in
literature so far. complete removal of ectopic thyroid tissues was done under
general anesthesia. Initially, the gland was approached from left
cAse description axillary breast ports. We dissected the gland from the surrounding

A 58-year-old male patient presented to our department with tissues by endoscopic method. For retrieval of specimen, we put a
complaints of a swelling in the upper neck on left submandibular
region for about 6 months.
It was associated with rapid increase in size. There were no
other associated symptoms. On examination, a 5 × 3 cm painless
swelling was noted in the left submandibular region. The lump was
soft in consistency. Thyroid tissue was not palpable in the normal
anatomical location (Fig. 1).
Ultrasonography revealed a well-circumscribed
heterogeneously hyperechoic nodule in the left submandibular
region with absent thyroid gland in the thyroid bed—possibly
ectopic thyroid nodule. Fine-needle aspiration biopsy of the
swelling was taken which revealed colloid goiter. Thyroid
scintigraphy revealed an area of increased radionuclide uptake in
the submandibular region and no radionuclide uptake was seen in
the neck in the thyroid bed.
Preoperative thyroid hormones and biochemical tests were
normal. As gland was enlarging rapidly in size, endoscopic-assisted Fig. 1: Extended neck showing submandibular ectopic thyroid gland

© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.