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The ectopic thyroid gland is a rare entity which is mostly found along the line of descent of the thyroid gland. Most of the patients present with midline swelling and usually seek medical attention. Dual ectopic thyroid gland is even rarer. The clinical examination and different imaging modalities establish its diagnosis. Radionuclide studies are highly sensitive and specific in demonstrating the functional tissues in patients with ectopic thyroid, thereby guiding further management. The authors reported a case of ectopic thyroid gland in a girl with midline neck swelling initially, subsequently lost to follow-up. She again presented with enlarged swelling after a period of three years with dual ectopic thyroid in the neck region on thyroid scan. Thyroid scintigraphy demonstrated that progression in the size of ectopic glands was due to neglect in treatment.
Keywords: Dual Ectopic Thyroid, Tc-99m Pertechnetate Scan, Subclinical Hypothyroidism
Introduction
The ectopic thyroid tissue (ETT) is a rare congenital anomaly defined as the thyroid tissue not located antero-laterally from the second to the fourth tracheal cartilage. An ectopic thyroid gland may occur anywhere along the path of initial descent of the thyroid with the majority of them in the midline neck region. The most commonly found ETT is at the base of the tongue, lingual thyroid accounting for 90% of reported cases.1 Other rare sites for these tissues are from sublingual, higher cervical, intratracheal, mediastinal to below the diaphragm.2 The exact cause of such locations is not known; however, it could be either because of development defects or aberrant migration of the gland. The ETT may be the only functioning thyroid tissue or may coexist as a separate structure with a normally located thyroid gland.3 It is more unusual for two distinct foci of ETT to be present simultaneously. The web search of Pubmed in English literature revealed only 29 cases of dual ectopic thyroid so far, with the majority of them in the midline region of the anterior neck. We describe a case of a young patient of dual ectopic thyroid where the diagnosis and its subsequent management were established with the help of Tc-99m pertechnetate thyroid scan.
Case Presentation
A five-year-old girl presented with asymptomatic midline swelling in the upper neck, gradually progressing in size (1.5×1 cm) with...