From the Guidelines
The management of ectopic thyroid tissue should be individualized based on the patient's symptoms, thyroid function, and the location of the ectopic tissue, with asymptomatic patients requiring regular monitoring and symptomatic patients potentially needing surgical removal or radioactive iodine therapy. The approach to managing ectopic thyroid tissue depends on several factors, including the presence of symptoms, the patient's thyroid function, and the location of the ectopic tissue.
- Asymptomatic patients with normal thyroid function may only require regular monitoring with thyroid function tests (TSH, free T4) and periodic imaging, as seen in 1.
- For patients with hypothyroidism, levothyroxine replacement therapy is indicated, typically starting at 1.6 mcg/kg/day in adults, with dose adjustments based on TSH levels every 6-8 weeks until euthyroidism is achieved, as noted in 1.
- Surgical removal is recommended for symptomatic cases causing airway obstruction, dysphagia, or when malignancy is suspected, with complete excision preferred when the ectopic tissue represents the only functioning thyroid tissue, necessitating lifelong thyroid hormone replacement post-surgery, as discussed in 1.
- Radioactive iodine (I-131) therapy may be considered for hyperfunctioning ectopic thyroid tissue, typically at doses of 10-30 mCi, as mentioned in 1. The management approach is individualized because ectopic thyroid tissue, resulting from abnormal embryological migration of the thyroid gland, can occur anywhere from the base of the tongue to the mediastinum, with lingual thyroid being the most common location, as seen in 1. Regular follow-up is essential regardless of treatment approach to monitor for changes in size, function, or development of complications, with the use of thyroid function tests and imaging studies, such as ultrasound, as noted in 1. It is also important to consider the potential risks and benefits of each treatment approach, including the risk of surgical complications, the potential for radioactive iodine therapy to cause thyroid storm, and the need for lifelong thyroid hormone replacement after surgical removal, as discussed in 1. Overall, the management of ectopic thyroid tissue requires a comprehensive and individualized approach, taking into account the patient's specific needs and circumstances, as seen in 1.
From the Research
Management of Ectopic Thyroid Tissue
The management of ectopic thyroid tissue (thyroid ectopia) can be complex and depends on various factors, including the location and size of the ectopic tissue, as well as the presence of any symptoms or associated conditions.
- Treatment with levothyroxine (L-T4) may be used to reduce the size of the ectopic thyroid tissue, as seen in a case of dual ectopic thyroid associated with thyroid hemiagenesis 2.
- In cases of ectopic thyroid carcinoma, hybrid imaging techniques such as I-131 SPECT/CT and F-18 PET/CT may be used to assess the extent of the disease and guide treatment 3.
- For patients with hyperthyroidism due to ectopic thyroid tissue, treatment options may include antithyroid drugs, radioactive iodine ablation, and surgery, depending on the underlying cause and severity of the condition 4, 5, 6.
- Surgery may be considered for patients with ectopic thyroid tissue who have compressive symptoms, concurrent cancer, or other complications, and may involve total thyroidectomy or thyroid lobectomy 5, 6.
- Annual follow-up is recommended for children with ectopic thyroid tissue, especially when their thyroid hormone replacement is stopped, to monitor for any changes in their condition 2.