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Case Reports
. 2025 Apr 10;12(1):46-49.
doi: 10.1016/j.aed.2025.02.002. eCollection 2025 May-Jun.

Triple Ectopic Thyroid Gland in a 4-Year-Old Child

Manahil Mustafa  1 , Boaz Karmazyn  2 , Diane W Chen  3 , Erica A Eugster  1
Affiliations
Case Reports

Triple Ectopic Thyroid Gland in a 4-Year-Old Child

Manahil Mustafa et al. AACE Endocrinol Diabetes. .

Abstract

Background/objective: Triple ectopic thyroid is exceedingly rare. The objective of this report is to present a case of triple ectopic thyroid that presented as a right submandibular mass in a euthyroid child.

Case report: A 4-year-old boy presented with a right-sided neck mass for 2 months. Neck ultrasound revealed a soft tissue mass adjacent to the submandibular salivary gland. Post intravenous contrast computed tomography scan, an additional 2 enhancing nodules were identified in the sublingual and hyoid areas. No thyroid tissue was identified in its normal pretracheal region. A fine-needle aspiration biopsy under ultrasound guidance of the right neck mass revealed numerous follicular epithelial cells in a background of homogenous colloid, characteristic of normal thyroid tissue. A Tc-99m pertechnetate thyroid scan demonstrated that the other 2 nodules were also ectopic thyroid tissue. Further workup revealed a thyroid stimulating hormone of 6.19 mIU/L (0.7-6.4) and a free thyroxine level of 1.0 ng/dL (0.8-2.0).

Discussion: Delayed presentation of ectopic thyroid tissue as a mass presents diagnostic challenges, particularly when it is not found around the course of the thyroglossal duct and is associated with 2 additional ectopic thyroid nodules. Very few cases of triple thyroid ectopy have been reported particularly in pediatric patients.

Conclusion: Although most cases of ectopic thyroid in children are identified shortly after birth, a late presentation can occur. In a euthyroid patient presenting with a mass and absence of a thyroid gland in the normal position, thyroid ectopy should be included in the differential diagnosis.

Keywords: congenital hypothyroidism; ectopic thyroid gland; newborn screening; thyroid stimulating hormone.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Ectopic thyroid gland in submandibular area (arrow).
Fig. 2
Fig. 2
Transverse ultrasound of the right submandibular area. A, Solid hypoechoic mildly heterogeneous mass (white arrow) lateral to the salivary submandibular gland (SM). B, Color Doppler shows marked increased vascularity of the mass.
Fig. 3
Fig. 3
Post intravenous contrast computed tomography scan of the neck. A, Coronal reformat demonstrates marked homogeneous enhancement of right ectopic submandibular thyroid (white arrow) inferior to the salivary gland and midline lingual ectopic thyroid (black arrow). B, Sagittal reformat demonstrates midline marked homogeneous enhancement of the lingual (arrow) and at the level of the hyoid at the floor of the mouth (arrowhead).
Fig. 4
Fig. 4
Demonstration of the triple ectopic thyroid on nuclear medicine Technetium-99m scintigraphy. Anterior (A) and left lateral (B) pinhole images show 3 distinct locations of uptake in the right submandibular (thick arrow), midline lingual (arrowhead), and floor of the mouth (thin arrow) ectopic thyroid tissue.
See this image and copyright information in PMC

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