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LETTER TO EDITOR
Year : 2014  |  Volume : 29  |  Issue : 2  |  Page : 124-125  

Graves' disease with thyroid hemiagenesis: A rare abnormality with rarer presentation


1 Department of Endocrinology, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
2 Department of Medicine, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
3 Department of Radiology, St. Thomas Hospital, Changancherry, Kottayam, Kerala, India

Date of Web Publication9-Apr-2014

Correspondence Address:
Rajeev Philip
Department of Endocrinology, PIMS, Thiruvalla - 689 101, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.130321

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How to cite this article:
Philip R, Ashokan A, Philip R, Keshavan C. Graves' disease with thyroid hemiagenesis: A rare abnormality with rarer presentation. Indian J Nucl Med 2014;29:124-5

How to cite this URL:
Philip R, Ashokan A, Philip R, Keshavan C. Graves' disease with thyroid hemiagenesis: A rare abnormality with rarer presentation. Indian J Nucl Med [serial online] 2014 [cited 2019 Dec 9];29:124-5. Available from: http://www.ijnm.in/text.asp?2014/29/2/124/130321

Sir,

Thyroid hemiagenesis is a rare developmental abnormality of thyroid gland. Most of the cases of thyroid hemiagenesis are euthyroid, but rarely can be associated with hyperthyroidism, hypothyroidism or malignancy. The incidence of Graves' disease in thyroid hemiagenesis is rare and we report such a case.

A 50-year-old female patient presented with a history of swelling in the left side of the front of neck of 6 months duration. There was no family history of thyroid disease or any other developmental abnormalities. On examination, goitre was present, World Health Organization grade 2, firm, which was on the left side [Figure 1]. The right lobe of thyroid was not palpable. The thyroid function tests carried out were suggestive of thyrotoxicosis, with T3 227 ng/dl (80-200), T4 of 14.9 μg/dl (4.5-12.5) and thyroid-stimulating hormone 0.02 μiu/ml (0.35-5.50). Anti-thyroid peroxidase antibody was positive (>1300 IU ml). An ultrasound thyroid was done, which showed an enlarged left lobe of thyroid, with mildly coarsened echo texture and increased vascularity, with absent right lobe and isthmus [Figure 2]. A technetium uptake study was carried out, the perfusion study showed increased vascularity to the left lobe of the thyroid gland and delayed static image showed enlarged left lobe of thyroid with increased tracer uptake with uniform distribution. The total uptake was 5.1%. The right lobe was not visualized [Figure 3]. Based on the above clinical details and investigations, a diagnosis of Graves' disease with hemiageneis of the right lobe of the thyroid was made.
Figure 1: Unilateral thyroid swelling (left side)

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Figure 2: Ultrasound thyroid showing enlarged left lobe and absent right lobe

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Figure 3: Technetium uptake study showing increased uptake in left lobe and non-visualized right lobe

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Congenital abnormalities of the thyroid gland is rare and may be related to abnormal descent of thyroid gland, presenting as single or multiple ectopic thyroid tissue or may include structural abnormalities such as hypoplasia or hemiagenesis. [1] Thyroid hemiagenesis is an uncommon condition with only about 250 cases reported in literature until date. [2] Hemiagenesis is more common on left side with a left: Right ratio of 4:1. Most cases are sporadic but a few cases of familial hemiagenesis have been reported. [3],[4]

Most of the patients with thyroid hemiagenesis are euthyroid, but hyperthyroidism, hypothyroidism and malignancy have been reported. [5] The incidence of hyperthyroidism of the remaining lobe, as with our case is, is not well-known and literature review yielded only six case reports of the above condition.

When a patient presents with unilateral thyroid swelling, the possibilities, which are usually considered are thyroid adenoma, post-hemithyroidectomy status, or a large nodule. If the uptake study shows absent uptake on one side, the pertinent differential diagnosis include a hyper functioning nodule of the same side which is suppressing the rest of the gland, or a cold nodule on the same side. Thyroid hemiagenisis is a rare, but important differential diagnosis in this scenario and unless the thyroid uptake study is interpreted along with an ultrasound of thyroid, which picks up hemiagenesis, this rare diagnosis will be missed. Radio iodine ablation is the safe and convenient modality of treatment for Graves' disease in the presence of structural abnormalities of thyroid gland. [1]

 
   References Top

1.Harisankar CN, Preethi GR. Recurrent thyrotoxicosis due to hyperfunction of multiple ectopic thyroid tissue and residual thyroid lobes 15 years after thyroidectomy: Evaluation using technetium scanning and hybrid single-photon emission computed tomography/CT. Thyroid Res Pract 2013;10:78-9.  Back to cited text no. 1
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2.Büyükdereli G, Guney IB, Kibar M, Kinaci C. Thyroid hemiagenesis: A report of three cases and review of the literature. Ann Nucl Med 2005;19:147-50.  Back to cited text no. 2
    
3.Polak M, Sura-Trueba S, Chauty A, Szinnai G, Carré A, Castanet M. Molecular mechanisms of thyroid dysgenesis. Horm Res 2004;62 Suppl 3:14-21.  Back to cited text no. 3
    
4.Castanet M, Leenhardt L, Léger J, Simon-Carré A, Lyonnet S, Pelet A, et al. Thyroid hemiagenesis is a rare variant of thyroid dysgenesis with a familial component but without Pax8 mutations in a cohort of 22 cases. Pediatr Res 2005;57:908-13.  Back to cited text no. 4
    
5.Letonturier P, Hazard J, Tourneur R, Perlemuter L, Angel R. Thyroid hemiagenesis (single thyroid lobe). 8 cases (author's transl). Nouv Presse Med 1979;8:1227-9.  Back to cited text no. 5
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