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Clinical Challenges
May 1998

Radioisotope Scanning of the Thyroid Gland Prior to TGD Cyst Excision: Commentary

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Arch Otolaryngol Head Neck Surg. 1998;124(5):600-601. doi:10.1001/archotol.124.5.600

THE PROBLEM posed is whether all young children requiring TGD cyst excision should undergo preoperative radioisotope scanning of the thyroid gland. The rationale for excision of TGD remnants is to prevent the complications of enlargement and infection. The question is whether preoperative diagnostic studies are cost-effective and will alter treatment in these patients. Patients with a normal thyroid gland and a TGD cyst will clearly not benefit from preoperative diagnostic studies since treatment is not altered. The problem is related to excision of ectopic thyroid tissue as the only functioning thyroid tissue and to a very small subset of patients with ectopic thyroid tissue in and associated with a TGD cyst as the only functioning thyroid tissue. I believe that the incidence of these particular problems is very rare since the vast majority of ectopic thyroid tissue is located at the base of tongue. It is probably very rare for the only functioning thyroid tissue to be ectopic thyroid tissue in a TGD cyst. I have never seen this particular circumstance. The exact incidence of ectopic thyroid tissue as the only functioning tissue is difficult to ascertain from the studies cited by Tunkel and Domenech. These studies are somewhat contradictory due to the low incidence in the population. The incidence is probably less than 1% to 2% but perhaps more than 1 in 3 million.1

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