abnormality detected. Although outer retinal damages are common in laser-related injury, intraretinal fluid with cystoid change is an uncommon presentation. 7
Literature searchThe PubMed, EMBASE, and Web of Science databases were searched for articles published between 1998 and May 2020 using keywords: 'laser' and 'eye injury' and 'ocular injury' or 'laser eye injury' or 'laser ocular injury' or 'laser retinal injury' or laser macular injury' or 'laser induced maculopathy or 'laser induced retinopathy' or 'laser pointer'. Of 4969 articles yielded, 4637 duplicated or irrelevant articles were excluded and 332 articles were included. References in the included articles were reviewed to identify additional relevant studies. Of the 332 articles, those written in languages other than English were excluded, as were statements, editorials, and letters to the editor. Eventually, 157 articles were reviewed. Internationally adopted guidelines and safety manuals regarding laser use were referenced.
Introduction and importance
Having two or more sites of simultaneous ectopic thyroid tissue is a rare phenomenon. Thyroid ectopia should be considered in congenital hypothyroidism where no eutopic thyroid gland is found.
Case presentation
This case describes an incidental finding of dual ectopic thyroid tissue on computer tomography scan in an adult with known congenital hypothyroidism that was previously attributed to thyroid agenesis. The decision was made to proceed with a Sistrunk procedure to excise the ectopic submental thyroid as it became more noticeable after weight loss following bariatric surgery, and to monitor the remaining lingual thyroid with a combination of clinical symptomology, imaging and thyroid function studies given its challenging location.
Clinical discussion
The literature on pathophysiology, imaging modalities, and common considerations for surgical extirpation is reviewed.
Conclusion
The utility of thyroid scintigraphy may be limited in patients with known thyroid ectopia; other investigative modalities are helpful. The Sistrunk procedure was used to excise an ectopic thyroid, based on its embryological migration from the foramen caecum to the usual pretracheal position along the thyroglossal tract, and is a suitable technique for excision of submental thyroid tissue causing an unsightly mass and where thorough histopathological examination is required to exclude malignancy.
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