A 19-year-old woman was treated with bronchodilators for new-onset dyspnea with exercise. Her symptoms progressively worsened, culminating 4 months later in acute shortness of breath at rest. Flow-volume loops suggested a fixed obstruction and a computed tomography scan of the neck revealed a large subglottic mass. The patient underwent emergent tracheostomy and laryngoscopy and a near-obstructing intratracheal mass was found. Biopsy showed ectopic thyroid tissue. Magnetic resonance imaging of the neck showed a 1.4-cm tracheal lesion and a normally located thyroid gland. The intratracheal mass was resected endoscopically. Pathology revealed hyperplastic ectopic thyroid tissue. The patient has been maintained on thyroid hormone suppression therapy for 2 years without growth of the residual intratracheal thyroid tissue. She recently underwent a surgical palate expansion. We present this case, along with a literature review of ectopic intratracheal thyroid, its epidemiology, possible etiologies, genetic underpinnings, presentation, and treatment. The co-occurrence of an ectopic thyroid, a functioning orthotopic gland, and a high arched palate is also discussed.

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