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Congenital thyroid hemiagenesis with multinodular goiter.

Bhartiya S, Verma A, Basu S, Shukla V - Acta Radiol Short Rep (2014)

Bottom Line: Developmental hemi-thyroid anomalies can result from either an abnormal descent or an agenesis of one lobe of the thyroid gland.A cytological examination showed nodular goiter with cystic degeneration.Right subtotal thyroidectomy was performed and histopathological examination confirmed adenomatous goiter with degenerative changes.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.

ABSTRACT
Thyroid hemiagenesis is a rare form of thyroid dysgenesis characterized by an absence of half of the thyroid gland. Developmental hemi-thyroid anomalies can result from either an abnormal descent or an agenesis of one lobe of the thyroid gland. We report a case of a 40-year-old woman with history of a longstanding gradually progressive thyroid swelling without any complication. An ultrasonographic examination diagnosed the absence of the left thyroid lobe and enlargement of the right lobe, which was confirmed on a computed tomography (CT) angiogram and a radionuclide scan of the neck. A cytological examination showed nodular goiter with cystic degeneration. Right subtotal thyroidectomy was performed and histopathological examination confirmed adenomatous goiter with degenerative changes. We report the rarity of the condition and emphasize the role of a comprehensive radiological, cytological, and radionuclide algorithm for an accurate preoperative diagnosis and subsequent management.

No MeSH data available.


Related in: MedlinePlus

(a) Oblique coronal (35°) thick MIP reconstruction of CT angiogram, showing major neck vessels and their branches. On the right side, the thyrocervical trunk shows origin of inferior thyroid artery (straight arrow) ascending upwards. On the left side, no comparable ascending branch could be noted from the thyrocervical trunk (hollow arrow), which was dividing to end as intercostals and muscular arteries. (b) Axial oblique (20°) thick MIP reconstruction of helical non-contrast CT scan neck, showing an empty left thyroid fossa (hollow arrow). Note the normal hyper-attenuating thyroid tissue in the right thyroid fossa (straight arrow).
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fig2-2047981614530286: (a) Oblique coronal (35°) thick MIP reconstruction of CT angiogram, showing major neck vessels and their branches. On the right side, the thyrocervical trunk shows origin of inferior thyroid artery (straight arrow) ascending upwards. On the left side, no comparable ascending branch could be noted from the thyrocervical trunk (hollow arrow), which was dividing to end as intercostals and muscular arteries. (b) Axial oblique (20°) thick MIP reconstruction of helical non-contrast CT scan neck, showing an empty left thyroid fossa (hollow arrow). Note the normal hyper-attenuating thyroid tissue in the right thyroid fossa (straight arrow).

Mentions: A 40-year-old woman presented with longstanding gradually progressive thyroid swelling with euthyroid status. The right thyroid lobe was enlarged, with a firm, non-tender nodule at the lower pole but the left lobe could not be appreciated. The biochemical thyroid profile was normal and ultrasonographic examination of the neck revealed multiple circumscribed hypoechoic lesion in right lobe of the gland suggestive of multinodular goiter. However the left lobe could not be visualized (Fig. 1). A suggestion of left thyroid lobe agenesis was entertained and a CT angiography was ordered to visualize the thyroid arteries. The multi-planner reconstructions and maximum intensity projection images revealed aplasia of left inferior thyroid artery (Fig. 2a and b). A thyroid scintigram with Tc-99 m partechnetate revealed absence of left lobe and isthmus, and a nodule in right thyroid lobe, which was functional (“hot nodule”) (Fig. 3). A fine needle cytological examination of the right lobe nodule revealed nodular goiter with cystic degeneration. A right subtotal thyroidectomy was performed to prevent the postoperative hypothyroidism and the agenesis of the left lobe and isthmus and the left inferior thyroid artery was confirmed intraoperatively. Histopathological examination of the specimen confirmed adenomatous goiter with degenerative changes. The patient was discharged following an uneventful postoperative course and was normal at 6-month follow-up.Fig. 1.


Congenital thyroid hemiagenesis with multinodular goiter.

Bhartiya S, Verma A, Basu S, Shukla V - Acta Radiol Short Rep (2014)

(a) Oblique coronal (35°) thick MIP reconstruction of CT angiogram, showing major neck vessels and their branches. On the right side, the thyrocervical trunk shows origin of inferior thyroid artery (straight arrow) ascending upwards. On the left side, no comparable ascending branch could be noted from the thyrocervical trunk (hollow arrow), which was dividing to end as intercostals and muscular arteries. (b) Axial oblique (20°) thick MIP reconstruction of helical non-contrast CT scan neck, showing an empty left thyroid fossa (hollow arrow). Note the normal hyper-attenuating thyroid tissue in the right thyroid fossa (straight arrow).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4221940&req=5

fig2-2047981614530286: (a) Oblique coronal (35°) thick MIP reconstruction of CT angiogram, showing major neck vessels and their branches. On the right side, the thyrocervical trunk shows origin of inferior thyroid artery (straight arrow) ascending upwards. On the left side, no comparable ascending branch could be noted from the thyrocervical trunk (hollow arrow), which was dividing to end as intercostals and muscular arteries. (b) Axial oblique (20°) thick MIP reconstruction of helical non-contrast CT scan neck, showing an empty left thyroid fossa (hollow arrow). Note the normal hyper-attenuating thyroid tissue in the right thyroid fossa (straight arrow).
Mentions: A 40-year-old woman presented with longstanding gradually progressive thyroid swelling with euthyroid status. The right thyroid lobe was enlarged, with a firm, non-tender nodule at the lower pole but the left lobe could not be appreciated. The biochemical thyroid profile was normal and ultrasonographic examination of the neck revealed multiple circumscribed hypoechoic lesion in right lobe of the gland suggestive of multinodular goiter. However the left lobe could not be visualized (Fig. 1). A suggestion of left thyroid lobe agenesis was entertained and a CT angiography was ordered to visualize the thyroid arteries. The multi-planner reconstructions and maximum intensity projection images revealed aplasia of left inferior thyroid artery (Fig. 2a and b). A thyroid scintigram with Tc-99 m partechnetate revealed absence of left lobe and isthmus, and a nodule in right thyroid lobe, which was functional (“hot nodule”) (Fig. 3). A fine needle cytological examination of the right lobe nodule revealed nodular goiter with cystic degeneration. A right subtotal thyroidectomy was performed to prevent the postoperative hypothyroidism and the agenesis of the left lobe and isthmus and the left inferior thyroid artery was confirmed intraoperatively. Histopathological examination of the specimen confirmed adenomatous goiter with degenerative changes. The patient was discharged following an uneventful postoperative course and was normal at 6-month follow-up.Fig. 1.

Bottom Line: Developmental hemi-thyroid anomalies can result from either an abnormal descent or an agenesis of one lobe of the thyroid gland.A cytological examination showed nodular goiter with cystic degeneration.Right subtotal thyroidectomy was performed and histopathological examination confirmed adenomatous goiter with degenerative changes.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.

ABSTRACT
Thyroid hemiagenesis is a rare form of thyroid dysgenesis characterized by an absence of half of the thyroid gland. Developmental hemi-thyroid anomalies can result from either an abnormal descent or an agenesis of one lobe of the thyroid gland. We report a case of a 40-year-old woman with history of a longstanding gradually progressive thyroid swelling without any complication. An ultrasonographic examination diagnosed the absence of the left thyroid lobe and enlargement of the right lobe, which was confirmed on a computed tomography (CT) angiogram and a radionuclide scan of the neck. A cytological examination showed nodular goiter with cystic degeneration. Right subtotal thyroidectomy was performed and histopathological examination confirmed adenomatous goiter with degenerative changes. We report the rarity of the condition and emphasize the role of a comprehensive radiological, cytological, and radionuclide algorithm for an accurate preoperative diagnosis and subsequent management.

No MeSH data available.


Related in: MedlinePlus