A 35-year-old male patient presented to our hospital with easy fatigability and weakness in the legs, which had persisted for two weeks. He had not noticed of any breathing difficulties. He and his parents did not live in the Fukushima area, and they did not have any history of radiation exposure. In addition, he had no family history of thyroid diseases. His blood pressure was 161/80 mmHg, pulse rate was regular at 82 beats/min, and body temperature was 36.2°C. An elastic soft mass was found high in the middle of the neck in addition to a soft right lobe of the thyroid gland. The eyes were normal. Neck ultrasonography revealed thyroid tissue extending from the right lobe of the thyroid gland to the upper part of the neck, with the left lobe of the thyroid gland absent. The thyroid function was as follows: free T3 5.20 pg/ml (normal, 2.3–4.0 pg/ml); free T4 2.02 ng/dl (normal, 0.9–1.7 ng/dl); TSH (IFCC) < 0.005 μU/ml (normal, 0.43–4.23 μU/ml); TgAb (anti-thyroglobulin antibodies) 12.0 IU/ml (normal, < 28 IU/ml), TPOAb (anti-thyroid peroxidase antibodies) 12.7 IU/ml (normal, < 16 IU/ml), TRAb (TSH receptor antibodies) 4.06 IU/l (normal, < 2 IU/l); TSAb (thyroid-stimulating antibodies) 159% (normal, < 110%). The Tc thyroidal uptake was 4.82% (normal, 0.4–3.0%) and scintigraphy showed an upper and lower dumpling-shaped thyroid gland (Fig. 1). The findings of both ultrasonography and Tc scintigraphy confirmed that the elastic mass was the pyramidal lobe. Accordingly, the patient was diagnosed with Graves’ disease with thyroid hemiagenesis and a markedly enlarged pyramidal lobe. His thyroid function normalized with thiamazole treatment. In the future, it may be necessary to perform either thyroidectomy or radioactive iodine therapy when the control of the thyroid function becomes poor.
Figure 1.
Tc-99 m pertechnetate thyroid scintigraphy shows the uptake in an upper and lower dumpling-shaped thyroid gland.
Thyroid hemiagenesis is caused by abnormalities in thyroid differentiation during fetal life. Suzuki et al. detected thyroid hemiagenesis in 67(26 males) out of 299 908 children and young adults (151 374 males) in Fukushima Prefecture in Japan using ultrasonography (approximately 1 per 4500) [1]. It is generally detected when patients have abnormalities in the remaining thyroid lobe (Graves’ disease, chronic thyroiditis, thyroid cancer, etc.) or coexisting parathyroid diseases [2]. The detection of the thyroid pyramidal lobe is rare in cases of Graves’ disease with thyroid hemiagenesis [3]. We herein report a patient suffering from Graves’ disease with thyroid hemiagenesis who showed a markedly enlarged pyramidal lobe, while focusing on images of the thyroid gland.
Ethical approval
No ethical approval was needed for this clinical image.
Consent
Written informed consent was obtained from the patient for publication of his clinical course and accompanying images.
Guarantor
Shigenori Nakamura, MD.
Acknowledgements
None.
Contributor Information
Shigenori Nakamura, Thyroid and Diabetic Division, Department of Internal Medicine, Japanese Red Cross Gifu Hospital, Gifu 502-8511, Japan.
Masatoshi Ishimori, Thyroid and Diabetic Division, Department of Internal Medicine, Japanese Red Cross Gifu Hospital, Gifu 502-8511, Japan.
Shun Ito, KEYAKI Clinic, Heijima, Hashimagun Ginancho, Gifu 501-6003, Japan.
Conflict of interest
The authors declare no conflict of interest for this article.
Funding
None declared.
References
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