Ectopic Intratracheal Thyroid: An Illustrative Case Report and Literature Review

Abstract

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.

Benign Intratracheal Thyroid: A Systematic Review of 43 Cases With Five New Case Reports

“…The prevalence of incidental malignancy in this study was 4.6%, which was below the widely cited 11% reported in 1962 2 . Still, the 11% prevalence could be an overestimation due to the limited pathological techniques available before 1962 20,23 . Sixteen (37.2%) patients had a history of thyroid surgery before ITT was diagnosed.…”

“…1); two were excluded for not being reported in English, 71 were excluded because of lacking detailed information, two were excluded because being redundant older reports of the same patient, and one was a report of a patient with thyroid cancer with tracheal invasion. Of the remaining 38 reports, all have orthotopic thyroid glands which could be distinguished from “ectopic thyroid.” A summary of the clinical details of the 38 ITT patients are shown in Table I 1,2,4–39 …”

Ectopic Intratracheal Thyroid: A Rare Cause of Airway Obstruction

“…It can be useful in patients who refuse or are unfit for surgery. While considering all the management options, surgical removal should be counted as the best option for the long-term outcomes [ 26 – 28 ].…”

Anatomy of thyroid and parathyroid glands and neurovascular relations

“…This tissue may be functional; however, it is usually inadequate to maintain the normal function of the thyroid if the main gland is removed. Ectopic thyroid tissue has been reported in oropharynx, infrathryoid region, mediastinum, larynx, trachea, and esophagus (Strickland etal.,1969; Myers and Pantangco,1975; Kamat et al,1979; Noyek and Friedberg,1981; Arriaga and Myers,1988; Ferlito et al,1988; Rubenfeld et al,1988; Bowen‐Wright and Jonklaas,2005). Lingual thyroid, although rare, is the most common site of ectopic thyroid tissue with reported frequency of 1/3,000 to 1/10,000 individuals (Noyek and Friedberg,1981; Williams et al,1996).…”