EP132 – Dual hyperfunctioning thyroid ectopia: dual surgical approach

     

    Salazar Osorio, Alejandro1; Moreno, Andrey2; Rojas, Andres Felipe3
    1 Specialist in Training in Surgical Oncology, National Cancer Institute, Bogota, Colombia
    2 Head & Neck Surgeon, National Cancer Institute, Bogota, Colombia
    3 Specialist in Training in Head & Neck Surgery, National Cancer Institute, Bogota, Colombia

     

    Case report: A case of 36-year-old female patient is presented, who is being treated since 2012 with nilotinib for a chronic myeloid leukemia. Based on clinical symptoms and functional thyroid testing, hyperthyroidism was diagnosed, (TSH <0.0005 T4L 2.25 ng/ml T3 11.39 pg/ml AcTG 62.32) treatment was initiated with methimazole and propranolol. Subsequent studies showed an absence of the thyroid gland in its usual anatomical site.  A fusion of its lobes were identified (3 X 4.5CM) and localized at the level of the thyroid cartilage . Incidentally a 1.7 X 1.7 CM nodule was found at the base of the tongue. Due to hepatic toxicity associated with concomitant chronic use of nilotininb, methimazole and propranolol, a total thyroidectomy was considered. Due to her age and wish to avoid scars on her neck, a video assisted axillary thyroidectomy as well as a trans oral approach to her ectopic lingual thyroid, was successfully performed. Post op pathology confirmed thyroid tissue at both sites while excluding malignancy. The patient fully recovered from the operation and has minimal scars at axillary access ports.

    Conclusion: A combined minimally invasive thyroidectomy and a trans oral approach are described in successfully treating a hyperthyroid, dual thyroid ectopia patient. While these approaches are not considered the standard of care in our country, efforts are being made in order to implement technological advancements along with non-conventional access techniques in order to provide patients with the best available surgical outcomes.

     

    References:

    1. Noussios, G., Anagnostis, P., Goulis, D.G., Lappas, D., Natsis, K. Ectopic thyroid tissue: Anatomical, clinical, and surgical implications of a rare entity (2011) European Journal of Endocrinology, 165 (3), pp. 375-382.
    2. Guerra G, Cinelli M, Mesolella M, Tafuri D, Rocca A, Amato B, Rengo S, Testa D. Morphological, diagnostic and surgical features of ectopic thyroid gland: a review of literature. Int J Surg. 2014;12 Suppl 1:S3-11. doi: 10.1016/j.ijsu.2014.05.076. Epub 2014 Jun 2. Review. PubMed PMID: 24887357.
    3. Bhatia P, Mohamed HE, Kadi A, Kandil E, Walvekar RR. Remote access thyroid surgery. Gland Surg. 2015 Oct;4(5):376-87. doi: 10.3978/j.issn.2227-684X.2015.05.02. Review. PubMed PMID: 26425450; PubMed Central PMCID: PMC4561655.
    4. Mohamed HE, Kandil E. Robotic trans-axillary and retro-auricular thyroid surgery. J Surg Oncol. 2015 Sep;112(3):243-9. doi: 10.1002/jso.23955. Epub 2015Aug 14. Review. PubMed PMID: 26274340.
    5. Berber E, Bernet V, Fahey TJ 3rd, Kebebew E, Shaha A, Stack BC Jr, Stang M, Steward DL, Terris DJ; American Thyroid Association Surgical Affairs Committee. American Thyroid Association Statement on Remote-Access Thyroid Surgery. Thyroid. 2016 Mar;26(3):331-7. doi: 10.1089/thy.2015.0407. Review. PubMed PMID: 26858014; PubMed Central PMCID: PMC4994052.

 

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