Abstract
This case describes a fit and well 17-year-old male who underwent surgical resection of a longstanding, painless, right lateral neck swelling. Believed to be either a vascular malformation, ranula or enlarged sublingual gland from pre-operative MR studies, histopathological examination of the mass revealed it as normal thyroid tissue. Post-operative imaging confirmed the absence of any remaining thyroid tissue. Hypothyroidism was confirmed with subsequent thyroid function tests. Interestingly, a “thyroid storm” which presented unknowingly during the surgical removal of the lesion did not trigger suspicion that thyroid tissue was being handled at the time. Normal, ectopic thyroid tissue in the lateral neck is rare but should be considered a differential diagnosis for neck lumps, particularly if it also presents as an intraoral swelling, as in this case. The presence of the orthotopic thyroid gland should be confirmed with diagnostic imaging prior to surgical excision of unknown neck masse
Highlights
This case describes a fit and well 17-year-old male who underwent surgical resection of a longstanding, painless, right lateral neck swelling
Ectopic thyroid tissue is defined as “thyroid tissue not located anterolaterally to the second and fourth tracheal cartilages.”[3,4] Most ectopic presentations are found at the base of the tongue and in the midline whilst lateral aberrant presentations are extremely rare.[2]
1 to 3% of all ectopic thyroids are located in the lateral neck, of which 70% are submandibular.[1]
Summary
Eccentric position Lack of classic flow voids (similar foci not evident on T1 weighted images) Lack of classic “salt and pepper” appearance. Lack of enhancement Lack of enhancement No clinical suspicion No other adenopathy observations had normalised and the patient was discharged. This was retrospectively diagnosed as acute thyrotoxicosis or a “thyroid storm”. The patient failed to attend multiple follow-up appointments at the oral and maxillofacial surgery department. He was contacted in writing where it was impressed upon him the importance of continuing the medication and the need for life-long monitoring. At a further clinic review, the patient’s compliance had improved and thyroid function tests were restored to normal levels (TSH 0.5 and free T4 19.4)
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call