Recurrence of Graves' disease in ectopic thyroid tissue.

Area of Science:

• Endocrinology
• Surgical Pathology

Background:

• Graves' disease is an autoimmune disorder causing hyperthyroidism, often treated with thyroidectomy.
• Ectopic thyroid tissue, thyroid tissue found outside its normal location, can occur but is rarely a cause of Graves' disease recurrence post-thyroidectomy.

Observation:

• A 40-year-old woman with a history of Graves' disease and prior orbital decompression presented with a recurrent neck mass eight months after a total thyroidectomy.
• The mass showed minimal growth, but thyroid stimulating immunoglobulin and thyroid-stimulating hormone receptor antibody levels were elevated and increasing.

Findings:

• Surgical removal of the neck mass revealed benign thyroid tissue with diffuse hyperplasia and lymphoid follicles, consistent with Graves' disease.
• Pathology confirmed the recurrence was due to ectopic thyroid tissue located deep to the strap muscles in the right upper anterior neck.

Implications:

• This case demonstrates an unusual recurrence of Graves' disease following total thyroidectomy, attributed to ectopic thyroid tissue.
• It underscores the need to consider ectopic thyroid tissue as a potential cause of recurrent disease in the neck, even after complete thyroid removal.