Persistent hyperthyroidism in a patient after total thyroidectomy: the thyroid anatomy has implications for treatment

Authors

  • Aleksandra Młodożeniec Department of Internal Medicine, Nephrology and Endocrinology, St. Queen Jadwiga Clinical District Hospital No 2, Rzeszow, Poland https://orcid.org/0000-0001-5241-8132
  • Agnieszka Gala-Błądzińska Department of Internal Medicine, Nephrology and Endocrinology, St. Queen Jadwiga Clinical District Hospital No 2, Rzeszow, Poland; Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland https://orcid.org/0000-0001-6617-0852

DOI:

https://doi.org/10.15584/ejcem.2021.2.11

Keywords:

Grave’s disease, pyramidal lobe, scintigraphy, thyroidectomy

Abstract

Introduction. Grave’s disease (GD) can be treated using three modalities: anti-thyroid medications, radioactive iodine therapy (RAI), or surgery. If surgery is selected, total thyroidectomy is the procedure of choice. Patients with hyperthyroidism frequently have an enlarged thyroid gland, occasionally with a pyramidal lobe.

Aim. We point the usefulness of thyroid scintigraphy, which provides valuable information regarding the thyroid anatomy.

Description of the case. The manuscript presents a case report of 43-year-old woman with unstable Grave’s disease, who underwent thyroidectomy and developed persistent hyperthyroidism postoperatively. She was referred by an endocrinologist to a nuclear medicine outpatient clinic for RAI therapy. I-iodide scintigraphy revealed two foci with excessive tracer accumulation. One of the foci in the middle of the neck corresponded to the pyramidal lobe.

Conclusion. The thyroid anatomy anomalies can lead to unnecessary implications for treatment. Identifying the pyramidal lobe preoperatively and removing it from patients requiring total thyroidectomy may decrease the recurrence rate of hyperthyroidism. Thyroid scintigraphy is a useful diagnostic tool to visualize the pyramidal lobe.

Downloads

Download data is not yet available.

References

Sjölin G , Holmberg M , Törring O , et al. The long-term outcome of treatment for Graves' hyperthyroidism. Thyroid. 2019;29(11):1545-1557.

Milojevic B, Tosevski J, Milisavljevic M, et al. Pyramidal lobe of the human thyroid gland: An anatomical study with clinical implications. Rom J Morphol Embryol. 2013;54:285-289.

Braun EM, Windisch G, Wolf G, et al. The pyramidal lobe: clinical anatomy and its importance in thyroid surgery. Surg Radiol Anat. 2007;29(1):21-27.

Wahl R, Müh U, Kallee E. Hyperthyroidism with or without pyramidal lobe Graves' disease or disseminated autonomously functioning thyroid tissue? Clin Nucl Med. 1997;22(7):451-458.

Kahaly GJ, Bartalena L, Hegedüs L, et al. 2018 European Thyroid Association Guideline for the Management of Graves' Hyperthyroidism. Eur Thyroid J. 2018;7(4):167-186.

Zeuren R, Biagini A, Grewal RK, et al. RAI thyroid bed uptake after total thyroidectomy: A novel SPECT-CT anatomic classification system. Laryngoscope. 2015;125(10):2417-2424.

Cengiz A, Sakı H, Yürekli Y. Scintigraphic evaluation of thyroid pyramidal lobe. Mol Imaging Radionucl Ther. 2013;22(2):32-35.

Kim DW, Ha TK, Park HK, et al. Sonographic detection of thyroid pyramidal lobes before thyroid surgery: a prospective single-center study. J Ultrasound Med. 2014;33(2):239-244.

Almohammed HI, Mansour S, Alhulwah AH et al. Scintigraphy has the potential to replace thyroid stimulating hormone and ultrasonography in hyperthyroidism diagnosis. Saudi J Biol Sci. 2020;27(7):1722-1725.

Patel KN, Yip L, Lubitz CC et al. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg. 2020;271(3):e21-e93.

Izenstark JL, Forsaith AL, Horwitz NH. The pyramidal lobe in thyroid imaging. J Nucl Med. 1969;10(8):519-524.

Siraj QH, Aleem N, Inam-Ur-Rehman A, et al. The pyramidal lobe: a scintigraphic assessment. Nucl Med Commun. 1989;10(9):685-693.

Giovanella L, Avram AM, Iakovou I, et al. EANM practice guideline/SNMMI procedure standard for RAIU and thyroid scintigraphy. Eur J Nucl Med Mol Imaging. 2019;46(12):2514-2525.

Park JY, Kim DW, Park JS, et al. The prevalence and features of thyroid pyramidal lobes as assessed by computed tomography. Thyroid. 2012;22(2):173-177.

Downloads

Published

2021-06-30

How to Cite

Młodożeniec, A., & Gala-Błądzińska, A. (2021). Persistent hyperthyroidism in a patient after total thyroidectomy: the thyroid anatomy has implications for treatment. European Journal of Clinical and Experimental Medicine, 19(2), 186–188. https://doi.org/10.15584/ejcem.2021.2.11

Issue

Vol. 19 No. 2 (2021)

Section

CASUISTIC PAPERS

License

Copyright (c) 2021 European Journal of Clinical and Experimental Medicine

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Our open access policy is in accordance with the Budapest Open Access Initiative (BOAI) definition: this means that articles have free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from having access to the Internet itself.

All articles are published with free open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0). If you submit your paper for publication by the Eur J Clin Exp Med, you agree to have the CC-BY license applied to your work. Under this Open Access license, you, as the author, agree that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. This facilitates freedom in re-use and also ensures that Eur J Clin Exp Med content can be mined without barriers for the research needs.