When an ectopic and hyperfunctional thyroid nodule appears 2 decades after subtotal thyroidectomy: A case report

Hasna Ouirar; Ikrame Qasdi; Caimae Zouna; Amal Riad; Kaoutar Elmoatamid; Fatima Toulali; Ghizlane Sabbar; Kaoutar Rifai; Iraqi Hinde; Gharbi Mohamed Elhassan

doi:10.1530/endoabs.99.EP1273

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Endocrine Abstracts (2024) 99 EP1273 | DOI: 10.1530/endoabs.99.EP1273

ECE2024 Eposter Presentations Late Breaking (127 abstracts)

When an ectopic and hyperfunctional thyroid nodule appears 2 decades after subtotal thyroidectomy: A case report

Hasna Ouirar , Ikrame Qasdi , Caimae Zouna , Amal Riad , Kaoutar Elmoatamid , Fatima Toulali , Ghizlane Sabbar , Kaoutar Rifai , Iraqi Hinde & Mohamed Elhassan Gharbi

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Ibn Sina University Hospital, Endocrinology and Metabolic Diseases, Rabat, Morocco

Introduction: A toxic thyroid nodule refers to a nodule that functions autonomously, causing an overabundance of thyroid hormones. It is generally considered non-malignant. Making a decision regarding surgery in hyperthyroid patients necessitates the accurate localization of the toxic region. Here we report a case of an intrathoracic toxic thyroid nodule causing hyperthyroidism with a normally functioning cervical thyroid nodule.

Case: A 63 year-old female underwent subtotal thyroidectomy in 2000 for a multinodular goiter with preservation of the upper left pole, and postoperative course was marked by permanent hypoparathyroidism requiring replacement therapy. The pathological examination revealed a benign condition. Subsequently, in 2019, a toxic nodule developed and was treated with radioiodine therapy without improvement. Confronted with ongoing clinical and biochemical hyperthyroidism, Ultrasonographic assessment of thyroid bed showed an isoechoic left nodule measuring 17×13 mm. Thyroid scintigraphy employing 99m technetium displayed intense and heterogeneous uptake projecting into the anterior and middle mediastinum. Cervico-thoracic CT imaging disclosed a mediastinal lesion, indicating a possible ectopic thyroid nodule. The patient was treated with graded doses of Carbimazole, but partial response was provided. A left lobectomy and removal of an intrathoracic goiter were performed. Results of the histopathological evaluation are currently being processed

Discussion: Radionuclide scintigraphy is valuable in confirming suspected or clinically evident thyroid tissue that is extending into mediastinum. The possibility of the existence of external thyroidal tissue should be kept in mind in such suspicious cases. Intrathoracic goiters are generally considered an indication for surgery; radioiodine therapy remains a choice for those who cannot be operable because of advanced systemic disease or other reasons.