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Signs and Symptoms of Chest Diseases |

Ectopic Intrathoracic Thyroid, Presenting Two Years After Total Thyroidectomy

Leslie Jette*, MD; Scott Parrish, MD; Steven Cordero, MD
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Walter Reed National Military Medical Center, Bethesda, MD


Chest. 2012;142(4_MeetingAbstracts):977A. doi:10.1378/chest.1387935
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Abstract

SESSION TYPE: Miscellaneous Case Report Posters I

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: An intrathoracic goiter is an uncommon phenomenon with presentations ranging from asymptomatic to complete respiratory failure. The incidence of true primary intrathoracic thyroid is even less common, and we present a case of asymptomatic primary intrathoracic goiter two years after total thryoidectomy.

CASE PRESENTATION: Our patient is a 68 year old woman with an initial presentation of viral syndrome with incidental notation of heterogeneous thoracic inlet mass on CT scan. Her past medical history included breast cancer and nontoxic multinodular goiter treated with total thyroidectomy two years prior to current presentation. Under endobronchial ultrasound (EBUS) guidance, we were able identify and sample several different sections of the mass. The pathology was consistent with benign thyroid epithelium. After discussion with the patient, we have elected to serially image and evaluate serologically for any evidence of mass enlargement or hyperthyroidism.

DISCUSSION: Her diagnosis of primary intrathoracic goiter after total thyroidectomy appears to be only the second case documented in the literature. Primary intrathoracic thyroid tissue is physically separated from the cervical thyroid and has a blood supply arising from mediastinal vessels. It is a rare entity, approximately 0.2-1% of all intrathoracic goiters. An endobronchial ultrasound was recently developed that employs a curvilinear array ultrasound, allowing real-time visualization of needle biopsies. It has been reported to significantly increase the diagnostic yield of transbronchial needle aspiration in a variety of intrathoracic diseases.

CONCLUSIONS: In this case, EBUS evaluation provided real-time assessment of different echotextures and allowed safe, directly-observed biopsies of different tissue consistencies. To our knowledge, this is the first case reported in which this technology was used to diagnose a primary intrathoracic goiter.

1) Hegedus L and SJ Bonnema. Approach to management of the patient with primary or secondary intrathoracic goiter. J Clin Endocrinol Metab 2010. 95(12):5155-5162.

2) Foroulis CN, KS Rammos et al. Primary intrathoracic goiter: a rare and potentially serious entity. Thyroid. 2009. 19:213-218.

3) Noussios G, P Anagnostis et al. Ectopic thyroid tissue: anatomical, clinical, and surgical implications of a rare entity. Eur J Endo 2011; 165:375-382.

DISCLOSURE: The following authors have nothing to disclose: Leslie Jette, Scott Parrish, Steven Cordero

No Product/Research Disclosure Information

Walter Reed National Military Medical Center, Bethesda, MD

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