Page 38 - World Journal of Laparoscopic Surgery
P. 38

Endoscopic Ectopic Thyroidectomy
                                                               and then thyroid scintigraphy was performed for confirmation of
                                                               our diagnosis. All the surgeries performed for lateral ectopic thyroid
                                                               so far has been by open method. We performed an endoscopic-
                                                               assisted total thyroidectomy which has not been reported in
                                                               literature so far. Endoscopic approach for removal of the diseased
                                                               thyroid gland will give a magnified view of the adjoining structures
                                                               and better cosmesis for the patient.
                                                               conclusion
                                                               Lateral ectopic thyroid tissue is a very rare condition of which most
                                                               common site is in submandibular location. Endoscopic approach
                                                               for removal of the diseased ectopic gland has not been reported
            Fig. 2: Ectopic thyroid in relation with surrounding structures  earlier. The procedure is very safe and gives a much better cosmetic
                                                               outcome.
            small skin incision in the submandibular region and the specimen
            was removed in toto (Fig. 2). This helped in significantly minimizing  references
            the scar in cervical region.                         1.  Zieren J, Paul M, Scharfenberg M, et al. Submandibular ectopic
               Postoperative period was uneventful, and he was discharged on   thyroid gland. J Craniofac Surg 2006;17(6):1194–1198. DOI: 10.1097/01.
            third postoperative day. Thyroxine 100 μg was started, as there was   scs.0000246502.69688.60.
            no other functioning thyroid gland. Histopathology report showed     2.  Choi JY, Kim JH. A case of an ectopic thyroid gland at the lateral neck
            features consistent with multinodular colloid goiter.   masquerading as a metastatic papillary thyroid carcinoma. J Korean
                                                                    Med Sci 2008;23(3):548–550. DOI: 10.3346/jkms.2008.23.3.548.
                                                                 3.  Huang TS, Chen HY. Dual thyroid ectopia with a normally located
            discussion                                              pretracheal thyroid gland: case report and literature review. Head
            Ectopic thyroid in the submandibular region was first described   Neck 2007;29(9):885–888. DOI: 10.1002/hed.20604.
                          6
            by Helidonis et al.  They speculated that the ectopic thyroid has     4.  Aköz T, Erdogan B, Ayhan M, et al. Ectopic submandibular thyroid
                                                                    tissue. Rev Laryngol Otol Rhinol (Bord) 1998;119(5):323–325.
            a parahyoid location and because of its dimension resembled a     5.  Akanmu IN, Adewale OM. Lateral cervical ectopic thyroid masses with
            submandibular gland anomaly. Abnormalities of thyroid gland   eutopic multinodular goiter: an unusual presentation. Hormones
            during embryologic development and migration may result in   (Athens) 2009;8(2):150–153. DOI: 10.14310/horm.2002.1232.
            ectopic thyroid gland. Normally, migration of the thyroid gland is     6.  Helidonis E, Dokianakis G, Papazoglou G, et al. Ectopic thyroid gland
                                                    7
            from the foramen cecum to the pretracheal position.  In addition   in the submandibular region. J Laryngol Otol 1980;94(2):219–224.
            to normal migration pathway of the thyroid gland, ectopic thyroid   DOI: 10.1017/S0022215100088708.
            tissue can be seen even in mediastinal, intracardiac, gastrointestinal,      7.  Yılmaz MS, Aytürk S, Güven M, et al. Submandibular ectopic thyroid
            and intraperitoneal locations. 4,8,9  Ectopic thyroid tissue is mostly   with normally located thyroid gland. Kulak Burun Bogaz Ihtisas Derg
                                                                    2014;24(1):50–53. DOI: 10.5606/kbbihtisas.2014.41713.
            (90%) localized in sublingual position.              8.  Feller KU, Mavros A, Gaertner HJ. Ectopic submandibular thyroid
               Asymptomatic ectopic thyroid tissue may become symptomatic,   tissue with a coexisting active and normally located thyroid
            particularly in the adolescence and pregnancy period due to   gland: case report and review of literature. Oral Surg Oral Med
            increase in thyroid-stimulating hormone level and due to thyroid   Oral Pathol Oral Radiol Endod 2000;90(5):618–623. DOI: 10.1067/
            tissue hyperplasia. 10,11  All diseases that involve thyroid tissue in   moe.2000.108804.
            its normal location can also involve ectopic thyroid tissue. The     9.  Kanaya H, Tanigaito Y, Shyono N, et al. A rare case of ectopic, normally
            differential diagnosis should include thyroglossal duct cyst,   functioning thyroid tissue presenting as a left submandibular mass.
            hyperplastic lymphoid tissue, lymphangioma, fibroma, lipoma,   Nippon Jibiinkoka Gakkai Kaiho 2005;108(9):850–853. DOI: 10.3950/
                                                                    jibiinkoka.108.850.
            dermoid cyst, squamous cell carcinoma, minor salivary gland tumor,     10.  Kurukahveciŏglu S, Arslan H, Kocatürk S, et al. Ectopic thyroid gland
            lymphoma, and vascular tumors. 12,13                    at infrahyoid localization: case report. Kulak Burun Bogaz Ihtis Derg
               Ultrasonography (USG), scintigraphy, computerized    2007;15(2):87–90.
            tomographic scan (CT), and magnetic resonance imaging (MRI) are     11.  Bersaneti JA, Silva RDP, Ramos RRN, et al. Ectopic thyroid presenting
            the methods that can be used in the diagnosis. Thyroid scintigraphy   as a submandibular mass. Head and Neck Pathology 2011;5(1):63–66.
            is a sensitive and specific method in determining that thyroid gland   DOI: 10.1007/s12105-010-0209-z.
                                  13
            is not in its normal location.  USG and CT are beneficial in the     12.  Prado H,  Prado  A, Castillo B. Lateral ectopic thyroid: a case
            diagnosis but have low sensitivity and specificity. In MRI, ectopic   diagnosed preoperatively. Ear, Nose Throat J 2012;91(4):E14–E18.
                                                                    DOI: 10.1177/014556131209100417.
                                                            13
            tissue is observed to be iso- or hyperintense compared to muscles.      13.  Çeliker M, Çeliker FB, Turan A, et al. Submandibular lateral ectopic
            In addition to imaging of the normal thyroid tissue, thyroid   thyroid tissue: ultrasonography, computed tomography, and
            scintigraphy is also important to show the functions of the lingual   scintigraphic findings. Case Rep Otolaryngol 2015;2015:769604. DOI:
            thyroid tissue. In our case, we performed USG followed by FNAC   10.1155/2015/769604.









                                                 World Journal of Laparoscopic Surgery, Volume 13 Issue 3 (September–December 2020)  137
   33   34   35   36   37   38   39   40   41   42   43