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|Year : 1981 | Volume
| Issue : 1 | Page : 48-50
Hemi-agenesis of thyroid.
Retnam VJ, Nayak UN, Vernekar KS, Bhandarkar SD
|How to cite this article:|
Retnam V J, Nayak U N, Vernekar K S, Bhandarkar S D. Hemi-agenesis of thyroid. J Postgrad Med 1981;27:48-50
A 26 year old woman presented herself with a swelling in the neck for 3 months. She also complained of insomnia left lobe of the thyroid (in a 26 year old woman) detected on 1131 scanning is, increased appetite, nausea and palpitation. There was no history of heat intolerance, weight loss, tremulousness or menstrual disturbances. She has three living children.
On examination, she was of medium build and was well nourished; her pulse rate was 80 per minute and blood pressure 120/80 mm of [Fig.] There were no eye signs of Graves' disease. The hands were neither moist nor warm. The right lobe of the thyroid was visible and palpable whereas no thyroid tissue was felt on the left side. The systemic examination was normal.
Radio-iodine tracer test showed normal results: 4 hour uptake 28%, 48 hour uptake 47%, liver counts 118 per 50 seconds. A thyroid scan at 48 hours showed a normal right lobe and isthmus but absent left lobe [Fig. 1]. Triiodothyronine suppression test showed normal suppression: 4 hour uptake 8%, 48 hour uptake 10%.
These results indicated (a) that the pituitary thyroid axis was functioning normally, (b) that the right lobe visible on the scan was not an autonomous nodule and (c) by inference, the left lobe was absent. As there was no history of thyroidectomy, this patient had agenesis of the left lobe of the thyroid. It was not possible to do a TSH stimulation test as the final proof of thyroid hemiagenesis, because of nonavailability of TSH.
Thyroid hemiagenesis is a rare anomaly. It was first reported in 1895 by Marshall who found the right lobe to be absent in one of the 60 childhood thyroid glands examined specifically to determine the type and frequency of anomalies of this gland. Hemiagenesis of the left lobe detected at surgery was reported from India by Das in 1962. In 1970 Hamburger and Hamburger found thyroid hemiagenesis in 4 out of 7000 patients who had a thyroid scan done for various thyroid disorders. In 1972, Harada et al from Japan reported 7 cases in patients who had exploration of the neck for thyroid disorders such as cancer and thyrotoxicosis. In 1973, Goolinger reported a case detected' at surgery in a euthyroid patient with a thyroid scan showing uptakes only on one side. Tashima et a1 in 1973 reported a case detected on thyroid scanning. Avramides et all in 1977 collected a total of 33 cases from the world literature and added three of their own.
In the present case, radio-iodine tracer test was done to rule out thyrotoxicosis. Absent left lobe on the scan was an unexpected finding.
When a thyroid scan shows the absence of thyroid tissue on one side. the possibilities to consider are: hemithyroidectomy, hemiagenesis, a cold nodule, and a large autonomous hyperfunctioning nodule in the opposite lobe [Fig. 2]. Hemiagenesis of the thyroid is the rarest of the possibilities but must be kept in mind. Most of the reported cases so far were in women and affected the left lobe of the thyroid. The present case conforms to this prototype. The cause of this anomaly would appear to be developmental in origin.
We wish to thank the Dean, K.E.M. Hospital and Seth G.S. Medical College, Bombay, for permission to publish this paper.
|1.||Avramides, A., Vichayanrat, A., Solomon, N. and Carter, A. C. (1977): Quoted in "'Year Book of Nuclear Medicine", Edited by Quinn J. L. and Spies, S. M.; Year Book Medical Publishers, 1979, p. 61. |
|2.||Das, P.: Congenital absence of one thyroid lobe. J. Ind. Med. Assoc., 39302-304, 1962. |
|3.||Goolinger, R. C.: Thyroid hemiagenesis with goitre (Letter). J. Amer. Med. Assoc., 224: 128, 1973. |
|4.||Hamburger, J. I. and Hamburger, S. W.: Thyroidal hemiagenesis. Arch. Surg. 100: 319-320, 1970. |
|5.||Harada, T., Nishikawa, Y. and Ito, K.: Aplasia of one thyroid lobe. Amer. J. Surg. 124: 617-619, 1972. |
|6.||Marshall, C. F.: Variations in the form of the thyroid gland in man. J. Ana:. Physiol., 29: 234-239, 1895. |
|7.||Tashima, C. K., Lee, W. Y. and Leong, A.: Agenesis of the thyroid. J. Amer. Med. Assoc., 224: 1761-1762, 1973. |