Morphological Variations of the Thyroid Gland in the North Indians: A Cadaveric Study with its Clinical Relevance

Introduction: The morphological variations of the thyroid gland are not an uncommon phenomenon and may due to embryological remnant or non-specific development of different parts of it. Prior anatomical knowledge of these variations is of immense importance to prevent catastrophies during or after thyroid surgeries. Therefore, in this study we aimed to investigate the prevalence of morphological variations of the thyroid glands in north Indian cadavers. Subjects and Methods: This study was conducted on 50 formalin embalmed adult human cadavers aging between 40–65 years, of which 40 were males and 10 were females. Thyroid glands were dissected and examined properly for the presence of pyramidal lobe, levator glandulae thyroidae, accessory thyroid tissue and complete absence of isthmus. Results: The pyramidal lobe was present in 9 (18%) and frequently arising from the right side of the isthmus. LGT was found in 7 (14%) and almost in all cases it was extending from the apex of the pyramidal lobe to the hyoid bone. Only 2 (4%) cadavers did not show an isthmus while accessory thyroid tissue was found only in one case. Morphological variations were more common in females than in males and the difference was statistically significant (p value<0.05). The means of all measured parameters were higher in female than in male but these gender differences were not significant (p>0.05). Conclusion: Morphological variation of the thyroid gland is a common phenomenon, particularly in female. Hence it requires proper detection and documentation prior to any thyroid surgery, so that iatrogenic catastrophies can be avoided

New knowledge reserve for medical graduates: Phenotypes and functions of tissue-resident regulatory T cells / 医学研究生学报

Regulatory T cells (Tregs) play important roles in immune homeostasis and tolerance.Recently, several characteristic studies on tissue-resident Tregs have been drawing wide attention.Some tissue-resident Tregs express some special molecules and are involved in the regulation of local tissue functions apart from immune regulation.This article focuses on the functions of some tissue-resident Tregs, such as fat-resident Tregs participating in the regulation of insulin resistance, muscle-resident Tregs in the regeneration and repair of damaged skeletal muscle, and thyroid-resident Tregs in the regulation of thyroid function, aiming to help medical graduates further understand the phenotypes and functions of tissue-resident Tregs.

Importance of ectopic thyroid tissue detected in the midline of the neck: single center experience

Objective Ectopic thyroid tissue (ETT) is a rare abnormality of the thyroid gland and the true prevalence and importance is not known. The aim of this study was to evaluate ultrasonography (US) guided fine needle aspiration biposy (FNAB) results, sonographic features, and frequency of ETT detected in the midline of the neck. Subjects and methods Five thousand five hundred and twenty outpatients who were referred to our thyroid clinic between September 2010 and April 2012 and underwent thyroid US, were retrospectively analyzed. Patients with ETT, detected in the midline of the neck in US were included in the study. Thyroid functions, sonographic features, and US guided FNAB results were evaluated. Results There were 81 (81.8%) female and 18 (18.2%) male patients with a mean age of 50.9 ± 11.7. The ETT in the midline was present in 1.79% (99/5,520) of the patients. In the majority of the patients, benign sonographic features (isoechoic, regular margin, type 1 vascularization) were detected. There were 92 (92.9%) patients with a previous history of thyroidectomy and all were histopathologically benign. In 7 (7.1%) patients, there was no history of thyroid operation. FNAB results of ETT were benign. Conclusion This study evaluated the importance of ETT detected incidentally in the midline of the neck. Especially in patients with a history of thyroidectomy, the thyroid masses in the midline of the neck can be found as incidental with imaging methods. Our results suggests that the incidence of malignancy in this group is much lower than orthotopic thyroid nodules and they are often benign.

Ectopic Thyroid Tissue Co-Existing with a Eutopic Thyroid.

Ectopic thyroid tissue, a developmental defect of thyroid gland, is met with rarity in day to day clinical practice. The diagnosis of ectopic thyroid demands a meticulous clinical examination and use of different imaging modalities. We are here reporting a case which presented as an anterior neck swelling, moving with deglutition, and also on and off dysphagia. After necessary investigations she underwent surgery and then the diagnosis of ectopic thyroid was made which was later confirmed with biopsy report which was suggestive of lymphocytic thyroiditis.

A thyroid mass that moves with tongue protrusion: An ectopic thyroid gland

Thyroglossal duct cyst (TDC) is a developmental anomaly that usually appears in early childhood. The common presentation is midline swelling of the neck, which moves with both tongue protrusion and deglutition. Diagnosis is usually clinical and radiological. Fine needle aspiration cytology (FNAC) can be used as a tool for the exclusion of malignancy in adult patients. In some cases thyroid scan is done to rule out the presence or absence of the normal thyroid gland. A complete work-up is mandatory before cyst removal given that it contains only thyroid tissue. We report the case of a 32-year-old woman with only thyroid tissue in thyroglossal duct cyst.

One Case of a Primary Papillary Thyroid Carcinoma in the Intrathoracic Lymph Node / 대한이비인후과학회지

A primary papillary thyroid carcinoma in the intrathoracic lymph node is very rare. There are two potential explanations of the lesion. The first possibility of the lesion is metastatic disease from an occult primary thyroid papillary microcarcinoma. Other possibility is malignant transformation of the aberrant thyroid tissue within the intrathoracic lymph node, which is the favored etiology in this case. We experienced an extremely rare case of true intrathoracic thyroid cancer in a 78-year-old woman, presenting with an intrathoracic malignancy. We confirmed it as papillary thyroid cancer, but there were no primary sites of thyroid glands. So, we report this rare case of a primary papillary thyroid carcinoma in the intrathoracic lymph node.

Mediastinal Heterotopic Thyroid Tissue : A case report / 대한흉부외과학회지

A 47-year old woman was admitted to our hospital for removal of a known mass that was located on the suprasternal notch; specifically, the mass was located on the supero-anterior mediastinuum. The mass was removed by a cervical incision and the histopathologic diagnosis of the resected specimen was hererotopic thyroid tissue with nodular hyperplasia. Mediastinal hererotopic thyroid tissue is a rare malady, so we report here on a case of mediastinal hererotopic thyroid tissue and we review the relevant medical literature.

Increased expressions of IL-6 and its receptor gp130 in the thyroid tissues of patients with Graves' disease / 中华内分泌代谢杂志

Expressions of interleukin-6 (IL-6) and its receptor (gp80、gp130) in 8 patients with Graves' disease (GD) were compared with those in 8 euthyroid patients with nodular goiter or benign thyroid adenoma. The thyroid tissues of GD expressed significantly higher IL-6 mRNA, gp130 mRNA and IL-6 protein than those of the control group, suggesting that activated IL-6/gp130 signal pathway in the thyroid tissue may contribute to the pathogenesis of GD.

Ectopic Thyroid Tissue With a Rare Vascular Variation / Tejido Tiroideo Ectópico con una Rara Variación Vascular

Awareness of the variations and anomalous existence of some structures serve as useful guide for both in studies of human anatomy and in clinical practice today. Identification of ectopic thyroid tissue and variations in origin, number and course of the branches of the superior thyroid artery are of significant practical importance for the general, vascular surgeons and radiologist. Angiographic images with such vascular patterns may lead to confusion in interpretation. The relations of these vessels with the other structures are important for accurate diagnostic and invasive techniques and to prevent further complications during surgical interventions. In our routine dissections with the purpose of preparation of the teaching and museum specimens, it was observed that in one of the elderly male cadaver showed median thyroid tissue at a site other than in its usual pretracheal region. It was situated in the median plane extending from the hyoid bone to the front of cricoid cartilage. Normal thyroid gland in the pretracheal region was absent. Added to this rare anomaly a vascular anomaly was found in the same ectopic thyroid tissue. Solely the superior thyroid arteries supplied this median thyroid tissue. The inferior thyroid arteries were found to be absent on both sides supplying this median thyroid tissue.

Conocer la existencia de variaciones y anomalías de algunas estructuras, sirve usualmente como guía para estudios de anatomía humana y práctica clínica. La identificación de tejido tiroideo ectópico y variaciones en origen, número y curso de ramas de la arteria tiroidea superior son, por lo general, de importancia práctica significativa para cirujanos vasculares y radiólogos. Imágenes angiográficas con tales patrones vasculares pueden llevar a confusión en su interpretación. La relación de estos vasos con otras estructuras son importantes en un diagnóstico acucioso, en técnicas invasivas y para prevenir complicaciones durante intervenciones quirúrgicas. En una disección de rutina, con el propósito de preparar piezas anatómicas de museo para la enseñanza, se observó en un cadáver de sexo masculino, tejido tiroideo mediano en un sitio diferente a la región pretraqueal. Estaba situado en el plano mediano extendiéndose desde el hueso hiodes a la parte anterior del cartflago cricoides. La glándula tiroides normal en la región pretraqueal estuvo ausente. Agregada a estainusual variación, una rara anomalía vascular fue encontrada en el mismo tejido tiroideo ectópico, sólo las arterias tiroideas superiores irrigaban este tejido tiroideo mediano. No se encontraron arterias tiroideas inferiores irrigando este tejido.

A Case of Malignant Struma Ovarii / 대한산부인과학회잡지

Struma ovarii consists of thyroid tissue derived from germ cells in a mature teratoma and which all or a large part is composed of thyroid tissue. Malignant transformation and clinically evident metastatic disease are very rare. The rarity of malignant struma ovarii renders evaluation of treatment modality difficult. There is evidence that these tumors behave like their thyroid counter parts, and cytoreductive surgery followed by ablation with radioactive iodine has been advocated. We have experienced a case of malignant struma ovarii. In this report, we present clinical and pathological findings of a case of malignant struma ovarii of 51-year-old patient with a review of the concerned literatures.

Two Cases of Struma Ovarii / 대한부인종양콜포스코피학회잡지

Struma ovarii is a monodermal teratoma composed totally or in overwhelming proportion of thyroid tissue. It is uncommon and accounts for 1% to 3% of benign teratomas of ovary. Grossly, they are encapsulated neoplasms, several centimeters in diameter and have a red, shiny, and meaty surface. Microscopically, the tumor is composed of mature thyroid tissue consisting of various sizes, lined by a single layer of columnar or flattened epithelium. The clinical behavior is benign, and simple excision is adequate treatment. We had experienced two cases of struma ovarii arising in the left ovaries. So we report above cases with brief review of literatures.

Ablation of Remnant Thyroid Tissue with I-131 in Well Differentiated Thyroid Cancer After Surgery / 대한핵의학회잡지

To evaluate the effectiveness of I-131 in ablation of residual thyroid tissue, we analyzed 350 patients with thyroid cancer who were treated with various doses of I-131 after surgery for thyroid cancer. Two hundred fifty five patients were treated with l.lGBq(30mCi) of I-131 for ablation of remnant thyroid and one hundred seventeen patients received more than 2.8GBq(75mCi) of I-131. We determined the effectiveness of ablation by following I-131 whole body scan. Absent visible uptake or minimal uptake in thyroid tissue were considered as successful ablation. Of 255 patients who received doses of 30mCi I-131 therapy, 131 patients(51%) showed successful ablation of residual thyroid tissue with 2.6+/-1.7 times of I-131 therapy. Of 117 patients who received doses of the more than 75mCi I-131, 84 patients(72%) had successful remnant thyroid ablation with 1.6+/-1.1 times of I-131 therapy. According to the extent of surgery, successful ablation rates were 78%, 62%, 54%, 33% in patients who underwent total thyroidectomy, subtotal thyroidectomy, lobectomy and isthmectomy, lobectomy or tumorectomy, respectively. This study showed that ablation of remnant thyroid after surgery with 30mCi I-131 was successful only in 50%. Therefore, in cases of patients with high risk for recurrence, we recommend high dose I-131 for ablation of remnant after total thyroidectomy.