Abstract
Thyroid hemiagenesis (TH) is a rare congenital anomaly that is usually asymptomatic. Functional disorders of the thyroid make the patient symptomatic. TH is usually and incidentally established during evaluation of patients with symptomatic thyroid pathology. We report the case of a patient of TH who became symptomatic with hyperactivity of the gland. The patient presented with signs and symptoms of thyrotoxicosis. Physical examination revealed asymmetric nodular goiter at the right lobe. Biochemical analysis established the diagnosis of hyperthyroidism. Ultrasound of the thyroid gland revealed the absence of the left lobe and a large, solitary hypoechoic solid nodule in the right lobe. Nuclear scan showed the absence of the left lobe and revealed a large, autonomous solitary nodule in the right lobe. The diagnosis was a toxic adenoma. After medical control of hyperthyroidism, the patient was surgically treated with hemithyroidectomy. We prescribed postoperative replacement medication with L-thyroxin. Hyperthyroidism makes TH cases symptomatic. Thyroid ultrasound and scintigraphy incidentally discover agenesis of one lobe during evaluation of thyrotoxicosis. Hemithyroidectomy, including the autonomous nodule, is the procedure of choice for patients with toxic adenoma. Hemithyroidectomy in TH cases technically becomes a total thyroidectomy with a need for postoperative thyroid replacement therapy.
Highlights
Total absence of one lobe of the thyroid gland, thyroid hemiagenesis (TH), is a rare anatomical anomaly that is usually asymptomatic
Ultrasound of the thyroid gland revealed the absence of the left lobe and a 33 × 25 mm hypoechoic solid nodule with a cystic component in the right lobe
Thyroid nuclear scan with Tc-99 m pertechnetate showed that the left lobe was not visualized and further revealed a larger, hot, autonomous, hyperactive solitary nodule in the right lobe (Figure 1)
Summary
Total absence of one lobe of the thyroid gland, thyroid hemiagenesis (TH), is a rare anatomical anomaly that is usually asymptomatic. Ultrasound of the thyroid gland revealed the absence of the left lobe and a 33 × 25 mm hypoechoic solid nodule with a cystic component in the right lobe. Thyroid nuclear scan with Tc-99 m pertechnetate showed that the left lobe was not visualized (agenesis) and further revealed a larger, hot, autonomous, hyperactive solitary nodule in the right lobe (Figure 1). Cervical magnetic resonance imaging (MRI) revealed the absence of the left lobe and isthmus of the thyroid gland, and a 26 x 23 mm solid nodule with a central cystic component. Right superior and inferior parathyroid glands and the recurrent laryngeal nerve (RLN) were identified at the usual anatomical position They were fully exposed and preserved during thyroid surgery. The patient is euthyroid with LT4 (150 μg/day) replacement It reveals hot, hyperactive, large solitary nodule in the right lobe.
Sign-in/Register to view highlights & summary 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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
