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Related Concept Videos

The Thyroid Gland01:23

The Thyroid Gland

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The thyroid gland is a small, butterfly-shaped gland located in the neck and covers the anterior surface of the trachea. The gland has two lateral lobes connected by a thin tissue mass called the isthmus. Internally, each lobe comprises many small spherical structures known as thyroid follicles, surrounded by a network of blood vessels.
The follicles have a central cavity lined by simple cuboidal to squamous epithelial cells called follicular cells. These cells produce the glycoprotein...
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Functions of Thyroid Hormones01:18

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The thyroid hormone (TH) plays a pivotal role in the intricate orchestration of physiological processes, exerting profound effects on development, metabolism, and homeostasis throughout different life stages.
TH is indispensable for the normal development and maturation of the skeletal, muscular, and nervous systems during fetal and childhood growth. It facilitates bone mineral turnover and regulates protein synthesis in developing tissues, contributing significantly to overall growth and...
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Exocrine Glands: Unicellular and Multicellular Glands01:29

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Exocrine glands are classified as unicellular and multicellular. The unicellular glands are scattered single cells, such as goblet cells, found in the mucous membranes of the small and large intestines. On the other hand, multicellular exocrine glands develop as secretory sheets, like the internal lining of the abdomen or chest. Such secretory sheets release their secretions directly into the lumen of these organs. In addition, some multicellular glands have deep-seated secretory units to...
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Synthesis and Regulation of Thyroid Hormones01:20

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Low blood levels of the thyroid hormones — triiodothyronine (T3) and thyroxine (T4) — signal the hypothalamus to release the thyrotropin-releasing hormone (TRH). TRH then reaches the pituitary gland and stimulates the release of thyroid-stimulating hormone(TSH) into the bloodstream.
Upon reaching the thyroid gland, TSH stimulates the follicular cells' active uptake of iodide ions from the blood. The ions diffuse to the apical surface of the cells and are oxidized to iodine. The...
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The Pituitary Gland01:17

The Pituitary Gland

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The pituitary is a small endocrine organ in the sphenoid bone under the hypothalamus. Primarily, the pituitary in adults has two distinct anatomical and functional regions— the anterior and posterior lobes. During human fetal development, a third pituitary gland region called the pars intermedia atrophies and disappears. However, some of its cells migrate and exist adjacent to the anterior pituitary in adults.
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The Parathyroid Glands00:59

The Parathyroid Glands

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The two pairs of parathyroid glands embedded within the posterior surface of the thyroid gland are restricted by a dense capsule around them. These glands comprise two distinct cell populations—parathyroid oxyphil and parathyroid principal cells- pivotal in calcium homeostasis.
Oxyphil cells, whose functions remain elusive, emerge during late puberty, adding a layer of complexity to the parathyroid gland's intricacies. In contrast, principal parathyroid cells undertake a vital role by...
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Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
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Missed thyroid gland after total thyroidectomy.

Sangar M Faroq Abdulrahman1, Serkan Teksöz1, Sina Ferahman1

  • 1Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.

Turkish Journal of Surgery
|July 20, 2018
PubMed
Summary

A missed thyroid gland, a rare mediastinal mass after total thyroidectomy, can be diagnosed by unchanged TSH levels and imaging. Redo surgery without sternotomy offers a safe treatment option for this condition.

Keywords:
Missed thyroid glandretrosternal goitersubsternal goitertotal thyroidectomy

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Radiology

Background:

  • Missed thyroid gland is an extremely rare complication following total thyroidectomy.
  • It presents as a mediastinal thyroid mass, often due to incomplete removal of plunging goiters or unrecognized ectopic mediastinal goiters.

Purpose of the Study:

  • To report a case of missed thyroid gland diagnosed after total thyroidectomy.
  • To highlight diagnostic clues and management of this rare condition.

Main Methods:

  • Case report of a patient with multinodular goiter who underwent total thyroidectomy.
  • Postoperative evaluation included thyroid stimulating hormone (TSH) level monitoring, thyroid ultrasonography, and scintigraphy.
  • Diagnosis of missed mediastinal thyroid mass was confirmed, followed by redo surgery.

Main Results:

  • The patient presented with unchanged postoperative TSH levels, indicating a missed thyroid gland.
  • Pathological examination revealed micropapillary carcinoma.
  • Thyroid ultrasonography and scintigraphy confirmed a mediastinal thyroid mass.
  • Redo surgery was performed without sternotomy, resulting in no postoperative morbidity.

Conclusions:

  • Persistent normal postoperative TSH levels after total thyroidectomy should raise suspicion for a missed thyroid gland.
  • Imaging modalities like ultrasonography and scintigraphy are crucial for diagnosing substernal or mediastinal goiters.
  • Surgical re-exploration without sternotomy can be a safe and effective treatment for missed thyroid glands.