ECTOPIC THYROID-TISSUE PRESENTING AS A MIDLINE NECK MASS

Ectopic thyroid tissue can be found anywhere between the foramen cecum and the normal position of the thyroid gland. Although very uncommon, it is most often found in the region of the foramen cecum, in patient s in whom the gland fails to descend. Extralingual thyroid tissue is m ost commonly located in the anterior cervical area, the region of the thyroglossal duct. It must be differentiated from thyroglossal duct cy st, in that it frequently represents the only source of thyroid tissue . In the majority of patients with lingual thyroid tissue, this is the only functioning thyroid. We present the case of a thirteen year old male child with a midline cervical mass first noted at one year of age . Since its early presentation, this midline mass had increased and de creased in size, and over the last three months had been associated wi th odynophagia and anterior neck swelling. A presumptive diagnosis of thyroglossal duct cyst was made. A preoperative thyroid scan revealed that this midline mass was in fact the only functioning thyroid tissue ; therefore no surgery was performed. This case demonstrates the essen tial role of a thyroid scan in the preoperative evaluation of a midlin e neck mass. Recognizing that ectopic thyroid tissue may present as a thyroglossal duct cyst and may be the only functioning thyroid avoids subjecting the child to inappropriate surgery and a life of replacemen t therapy.