Congenital thyroid hemiagenesis with thyroid nodules—Role of TI-RADS to prevent long term thyroid replacement therapy

Abstract

BackgroundHemi-agenesis of thyroid is a rare congenital condition with the clinical significance lying only in cases where the remnant tissue is affected by a pathology mandating removal of the gland. Henceforth, the hemi-thyroidectomy technically becomes a total thyroidectomy with a need for long term thyroid replacement therapy.Case summaryWe present a series of three cases noted over a period of two years where preoperative imaging evaluation confirmed the developmental abnormality. Further presence of a thyroid nodule in each of these cases posed a specific clinical situation whereby characterization of nodule appeared mandatory for a rational management involving life-long thyroid replacement therapy due to an ‘apparent total thyroidectomy’, if the remnant gland is removed. Ultrasound TI-RADS is a new system for evidence based sub-classification of thyroid nodules enabling both the surgeon and patient to take a streamlined decision about the overall approach for management.ConclusionProspective nodule characterization based on the thyroid image reporting and data system (TI-RADS), enables the surgeon to decide the treatment strategy sparing the patient of the cost and morbidity associated with long term thyroid replacement therapy.

Slc:Wistar/ST rats develop unilateral thyroid dysgenesis: A novel animal model of thyroid hemiagenesis

“…Taken together, it is hypothesized that the extrinsic factors might affect the thyroid morphogenesis rather than thyroid primordium itself, and the embryonic large vessels are one of the candidates for the thyroid dysgenesis in Wistar/ST rats. One recent study demonstrated that thyroid arteries were absent on the ipsilateral side of the thyroid hemiagenesis in humans, indicating that inadequate blood supply also leads to aplasia of the thyroid lobe during embryogenesis [27]. In the Wistar/ST rats, both cranial and caudal thyroid arteries were found at the side of the thyroid hemiagenesis, indicating that the thyroid hemiagenesis was unrelated to a defect in blood supply.…”

Gasless transaxillary endoscopic surgery for thyroid hemiagenesis with papillary thyroid carcinoma: a case report

“…The development of the thyroid gland, including its bilobation and descent, is closely connected to the formation of blood vessels [14]. Anomalies in thyroid development and malposition of the gland in the upper region can also be caused by inadequate blood supply [15].…”

Analysis of the Seasonality of Births in a Large Cohort of Patients with Thyroid Hemiagenesis - A Preliminary Study

“…A recent report demonstrated by CT-Angiography agenesis of the thyroid artery on the agenetic side in patients with THA. Therefore, the lack of one thyroid lobe may result from inadequate blood supply at early stages of embryogenesis (10). We cannot rule out a role of other unknown factors, which may modulate expression of the final phenotype.…”