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Ectopic thyroid gland is a rare embryological fault of thyroid development. Dual ectopic thyroid is even more rare and only 8 cases have been reported in the literature. The author presents a case of dual ectopic thyroid in a 16-year-old boy with an anterior neck mass, which is gradually growing in size particularly in the last 2 years. The initial diagnosis was thyroglossal duct cyst. Thyroid function test revealed elevated thyroid-stimulating hormone. Ultrasound of the neck did not show thyroid gland in its normal pretracheal position. Thyroid scan (Technetium 99) revealed the diagnosis of dual thyroid ectopia (lingual and subhyoid).

A rare case of an ectopic thyroid gland in the porta hepatis and in the tongue in an asymptomatic euthyroid 24-year-old woman is reported. A solitary inhomogeneous, hypoechogenic and hyperechogenic mass in the porta hepatis was accidentally discovered by ultrasonography. Subsequent computed tomography demonstrated a heterogeneous, well-defined tumor with small calcifications without signs of environmental invasion. A hemangioma and focal nodular hyperplasia were excluded by blood pool and hepatobiliary scintigraphy. Surprisingly, fine-needle aspiration cytology revealed normal thyroid tissue. (123)I-scintigraphy confirmed the presence of ectopic dual thyroid tissue in the hepatic porta and lingua. At clinical inspection the lingual thyroid gland was palpable and visible, and appeared solid and spheroidal. The subhepatic, ectopic thyroid mass was resected. Postoperatively, thyroid hormone replacement was started to prevent an enlargement of the lingual thyroid. Today, 4 years after surgery, the patient remains euthyroid.

Serum thyroglobulin (Tg) measurements were performed in 17 children with congenital hypothyroidism due to an ectopic thyroid gland before therapy and during follow-up. Data were analysed in four periods according to duration of therapy and compared to results obtained in a group of 51 normal children aged 1 month to 6 yr. At diagnosis serum Tg was higher than the mean normal value measured at a similar age. We observed a rapid and parallel decrease of both Tg and thyroid-stimulating hormone during the early weeks of therapy. However, Tg was always detectable in the serum of treated (euthyroid) patients. After 34 months of therapy serum Tg was 11.4 +/- 1 ng/ml, a value significantly different (p less than 0.001) from that obtained in normal controls of similar age (23.5 +/- 3 ng/ml). In nine treated children aged more than 2 yr, thyroid-stimulating hormone and Tg were increased after a brief period of decreased L-thyroxine dosage. These data indicate that ectopic thyroid tissue does not involute during thyroxine therapy and, in response to elevations of serum thyroid-stimulating hormone, can be stimulated to secrete Tg.

The embryogenesis, signs and symptoms, diagnosis, and clinical management of the lingual thyroid entity are discussed. A patient with a large lingual thyroid, who also required a mandibular set-back osteotomy, is presented. The preoperative, intraoperative, and postoperative considerations and management of this patient as they relate to the lingual mass and its possible effects on the airway are discussed.

The proper management of upper airway obstruction requires prompt recognition, correct diagnosis, and appropriate treatment. Of all the causes of upper airway compromise, intratracheal thyroid is one of the least common, especially in the newborn. The majority of cases reported involve adults or adolescents, mostly in European countries. The English literature has fewer cases, none involving a newborn. The authors report a case they believe to be the first example in the English language of obstructing intratracheal thyroid in a newborn. The authors' experience and literature review of this rare anomaly are presented in an effort to acquaint others with this often unthought of cause of airway compromise.