Graves' disease in eutopic thyroid with ectopic mediastinal thyroid tissue: Role of single photon emission computed tomography-computed tomography

Abstract

Ectopic thyroid is a rare embryological aberration due to defective migration. Most patients with ectopic thyroid tissue have absent thyroid gland in normal anatomical position and present with hypothyroidism. We present a patient with Graves’ disease in the eutopic thyroid with ectopic thyroid tissue in the mediastinum and usefulness of single-photon emission computed tomography-computed tomography.

Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach

“…One third of children with ectopic thyroid tissue might experience hypothyroidism, especially the cases with aberrant patterns [31,33]. Ectopic tissue might have a lower rate of iodine uptake and thyroid hormones production than orthotopic glands; thus, cases with aberrant thyroid are associated with hypothyroidism more often (but ectopic tissue with hyper-function has been reported, too), while decreased radioiodine uptake might prove to be a source of bias in the adequate recognition of ectopic tissue amid imaging exploration [7,34]. All types of thyroid cancer have been reported in ectopic thyroid tissue as well as different areas of thyroiditis involvement [7,[34][35][36].…”

“…Ectopic tissue might have a lower rate of iodine uptake and thyroid hormones production than orthotopic glands; thus, cases with aberrant thyroid are associated with hypothyroidism more often (but ectopic tissue with hyper-function has been reported, too), while decreased radioiodine uptake might prove to be a source of bias in the adequate recognition of ectopic tissue amid imaging exploration [7,34]. All types of thyroid cancer have been reported in ectopic thyroid tissue as well as different areas of thyroiditis involvement [7,[34][35][36]. Notably, some authors consider that the rate of malignant transformation in ectopic sites is similar with eutopic thyroid (particularly, for the papillary thyroid cancer [37]), but the level of statistical Cancers 2024, 16, 1868 4 of 58 evidence in this particular matter remains low [8,38].…”

“…EMT surveillance: conservative approach, for instance, after EMT confir amid FNA results [89] is less likely preferred. Firstly, thyroid dysfunction impairs the surgical outcome; thus, medicatio anti-thyroid drugs for newly detected hyperthyroidism [34] is mandatory further decision to be taken during follow-up (for instance, propylthioura thyroid function normalization followed by total thyroidectomy and EMT re [121] or methimazol followed by EMT removal [122]). A second surgical step after EMT resection involves a total thyroidectomy fo by radioiodine ablative therapy, TSH-suppressive thyroxine treatment, and thyroglobulin monitoring in cases with a differentiated thyroid cancer i Regardless of the pathological traits, awareness of EMTs is essential, while r was decided in most of the cases (rather than conservative approach) depending location and EMT anatomical features; the risk of malignancy (the rate of con from benign to a malignant EMT is not clearly understood, especially in long s goiter-like EMT); the ectopic tissue enlargement with compressive symptoms/sig as respiratory obstruction or compression on mediastinal organs; the risk of hem [84]; the patient's co-morbidities and medical/surgical history as well as the health status [7,13].…”

“…Another interesting detection was made via assays for newly detected Graves's disease in an adult male patient of 41 years. The case published by Agrawal et al [34] in 2019 showed an accidental imaging detection of a suspected EMT (that was never biopsied or removed) at 99m-Tc (Technetium) sodium pertechnetate scintigraphy followed by the second imaging scan in terms of SPECT-CT (single-photon emission computed tomography); due to an increased level of thyroid hormones, only a non-contrast, low-dose CT scan was performed [34].…”

Single-Photon Emission Computed Tomography Image-Assisted Diagnosis of Thyroid Diseases under Convolutional Network Neural Algorithm

“…CT scanning is difficult to distinguish between hypothyroidism, thyroid cancer, and thyroid tumors. If clinicians do not have sufficient experience, they are likely to miss the diagnosis and misdiagnose [5]. e above examination methods mainly observe the anatomical changes of the lesion, while nuclear medicine combines function and anatomy to accurately locate, stage, and prognosis [6].…”