Heterotopie štítné žlázy- naše 15leté zkušenosti

Heterotopia of the Thyroid Gland - our Fifteen Years’Experience

Developmental disorders of the thyroid gland are very rarely described in theliterature. So far publications in the Czechoslovak and Czech otolaryngological literature summa-rize these less common findings of therotopic tissue in nine patients (9, 11, 13, 15, 16, 19, 20, 23, 27).Therapeutic procedures in heterotopic tissues are described only very rarely (4, 5). In the worldliterature more than 650 cases of impaired descensus of the thyroid are described. The classificationand nomenclature of these heterotopic tissues are done without clinical classification.When thyroid tissue is found beyond the normal physiological site it is always necessary to rule outa secondary of a malignant thyroid tumour. To rule out secondaries of a differentiated carcinomait is necessary to consult a pathologist, in particular when thyroid tissue laterally from the medianline is involved. In the differential diagnosis of tissue it is important to differentiate tumourousdisease of another origin (cysts, carcinoms, myoma, fibroma, lymphosarcoma, lymphangioma,angioma, amyloidosis, hyperplasia of lymphatic tissue, gumma, lymphoma).In case of aberrant thyroid tissue it is essential to rule out unequivocally differentiated thyroidcarcinoma. The finding of aberrant thyroid tissue is extremely rare and it can therefore be easilymistaken for a secondary of well differentiated thyroid carcinoma.The authors describe eight cases of heterotopic thyroid tissue. They discuss different approachesto treatment of this anomaly and describe the systematic classification of developmental experiencewith treatment and follow-up of patients with heterotopia of thyroid tissue.Based on the described experience they suggest a modified approach to the treatment of heterotopicthyroid tissue:A) Medicamentous therapyThis approach is recommended in particular in child patients. Treatment is supervised by anendocrinologist who indicates suppressive substitution treatment by synthetic hormonal preparations. The patients must be checked after short intervals in an endocrinological department. In childpatients the team must comprise a paediatrician. After completed development the patients aretreated as in group B.B) Surgical treatmentThis treatment involves complete removal of the thyroid gland. This must be followed by endocrinological treatment and full substitution treatment. These patients must be followed up in anendocrinological and ENT department.

Key words:
heterotopia of the thyroid gland, classification of heterotopia, treatment ofheterotopic tissue.