Fevzi BALKAN, Bekir ÇAKIR, Celil Alper USLUOĞULLARI, Nilüfer POYRAZ, Şahin DOĞANAY, Reyhan ERSOY, Elif ÖZDEMİR, Fatma SAĞLAM

TANI AMAÇLI UYGULANAN İYOT-131 İLE ABLATE OLAN EKTOPİK TİROİD DOKUSU: OLGU SUNUMU

Otopsi çalışmalarında ektopik tiroid dokusu varlığı %10 oranında bildirilmiştir. Asemptomatik kişilerdeektopik tiroid dokusunun önemi bilinmemektedir. Bununla birlikte ektopik tiroid dokusunun tiroid kanseri için artmış risk oluşturduğuna dair raporlar literatürde mevcuttur. İyot-131 ektopik tiroid dokusuaraştırılmasında kullanılmaktadır. Tarama sintigrafisi düşük doz (2-5 mCi) ile yapılır. Tiroid bezinin gramıbaşına yaklaşık 6 MBq (160 μCi) verilen İyot-131 ise ablasyon dozudur. Bu bildiride 14 yıl önce ToksikDiffüz Guatr (TDG) tanısı ile bilateral subtotal tiroidektomi uygulanan 42 yaşındaki kadın hastaya nükstoksik diffüz nodüler guatr tanısı ile tamamlayıcı tiroidektomi uygulanmıştı. Hastanın operasyon sonrasıaltıncı ay kontrolünde orta hatta, hyoid kemik hizasında, 12X24 mm boyutunda, ektopik tiroid dokusumevcuttu. İİAB sonucu önemi belirlenemeyen atipi olarak raporlandı. İİAB sırasında hazırlanan yıkamaörneklerinden bakılan tiroglobulin seviyesi >300 idi.. Bu nedenle malignite ve uzak metastaz varlığınıdeğerlendirmek amacı ile 3 mCi İyot-131 ile tüm vücut tarama yapıldı ve sadece boyunda star artefaktaneden olan aktivite birikimi izlendi.. Sitolojik bulgular nedeni ile üç ay sonra yapılan boyun USGde iseektopik tiroid dokusu izlenmiyordu. L-Tiroksin tedavisi kesildikten sonra çekilen tiroid sintigrafisinde deektopik tiroid dokusunu düşündürecek bulguya rastlanmadı. İyot-131 uygulaması sonrası dokunun ablate olduğu kararına varıldı. Olgu ektopik tiroid dokusunun nadir görülmesi ve ilginç klinik seyri nedeniile sunulmuştur.

Ablated Ectopic Thyroid Tissue with Iodine-131 Applied for Diagnostic Purpose: Case Report

The presence of ectopic thyroid tissue has been reported at a rate of 10% in autopsy studies. Thesignificance of ectopic thyroid tissue among asymptomatic individuals is unknown. However, there arereports in literature suggesting an increased risk of thyroid cancer in the presence of ectopic thyroidtissue. Iodine-131 is used for detecting ectopic thyroid tissue. Screening scintigraphy is performed usinglow doses (2-5 mCi). Iodine-131 given for ablative purposes is approximately 6 MBq (160 μCi) per gramof thyroid gland. In this report 42-year-old woman who underwent bilateral subtotal thyroidectomy14 years ago, with a diagnosis of diffuse toxic goiter was performed completion thyroidectomy witha diagnosis of recurrent nodular diffuse toxic goiter. At six months after the operation, midline, at thelevel of the hyoid bone, 12X24 mm in size, ectopic thyroid tissue was present in patient. Atypia ofundetermined significance was reported in FNA results. The thyroglobulin level was 300 in washingsamples drawn up during FNA. In order to evaluate the presence of malignancy and metastasis, whole- body scan with 3 mCi of iodine-131 was performed and only the activity accumulation leads to starartifact was observed in the neck. Ectopic thyroid tissue was not observed in the neck ultrasoundperformed after three months because of cytologic findings . There was no findings to suggest ectopicthyroid tissue in the thyroid scintigraphy after cessation treatment of L-thyroxine. It was concluded thatthyroid tissue was ablated after application of iodine-131 treatment.

PDF

___

1. Chawla M, Kumar R, Malhotra A. Dual ectopic thyroid: case series and review of the literature. Clin Nucl Med. 2007; 32(1):1-5.
2. Dutta D, Kumar M, Thukral A, Biswas D, Jain R, Ghosh S,et al. Medical management of thyroid ectopia: Report of three cases. J Clin Res Pediatr Endocrinol. 2013; 5(3):212-5.
3. Noussios G, Anagnostis P, Goulis DG, Lappas D, Natsis K. Ectopic thyroid tissue: anatomical, clinical, and surgical implications of a rare entity. Eur J Endocrinol. 2011; 165 (3): 37582.
4. Toso A, Colombani F, Averono G, Aluffi P, Pia F. Lingual thyroid causing dysphagia and dyspnoea. Case reports and review of the literature. Acta Otorhinolaryngol Ital. 2009; 29(4) ;213-7.
5. Yoon JS, Won KC, Cho IH, Lee JT, Lee HW. Clinical characteristics of ectopic thyroid in Korea. Thyroid. 2007; (17):1117-21.
6. Mussak EN, Kacker A. Surgical and medical management of midline ectopic thyroid. Otolaryngol Head Neck Surg. 2007;136(7):870-2.
7. Mulazımoğlu M, Tamam M. Lingual thyroid and radioactive iodine therapy. Anatol J Clin Investig. 2012;6(4):261-4.
8. Smooker WRK. Oral Cavity. In Som PM, Curtis HD, eds. Head and Neck Imaging. Vol. 3. St Louis:Mosby. 1996. p. 488-544.
9. Agarwal Kk, Karunanithi S, Jain S, Tripathi M. A Case Of Dual Ectopy Thyroid Along The Thyroglossal Tract Demonstrated On 99mtc-Pertechnatate Hybrid Single Photon Emission Computed Tomography/Computed Tomography. Indian J Nucl Med. 2014;29(2):105-7.
10. Maino K, Skelton H, Yeager J, Smith KJ. Benign ectopic thyroid tissue in a cutaneous location: a case report and review. J Cutan Pathol. 2004;31(2): 195-8.
11. Quarracino M, Aguas S. Lingual thyroid: a clinical case. Med Oral. 2003;8(1):57-60.
12. Pelizzo Mr, Torresan F, Grassetto G, Briani G, Marzola Mc, Rubello D. Imaging İdentifies Submandibular Ectopic Thyroid Tissue. Clin Nucl Med. 2011;36(8):728-30.
13. Bayram F, Külahli I, Yüce I, Gökçe C, Cagli S, Deniz K. Functional Lingual Thyroid As Unusual Cause Of Progressive Dysphagia. Thyroid. 2004;14(4):321-4.