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Clinical Problem Solving: Pathology
March 15, 2010

Pathology Quiz Case 2: Diagnosis

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2010;136(3):313-314. doi:10.1001/archoto.2010.9-b

During the third week of life, development of the thyroid begins as endoderm invaginates in the floor of the primitive pharynx. From weeks 3 to 7, the gland descends anterior to the hyoid bone enroute to its final midline, pretracheal position.1As it descends, it remains tethered to the tongue by the thyroglossal duct. This tract normally atrophies, leaving the pitlike foramen cecum cranially as a remnant. Thyroid tissue may be trapped in the caudal portion of the duct, creating the pyramidal lobe of the thyroid, which is present in one-third of the population.1While many sites of ectopic thyroid tissue have been reported, partial or total ectopy of the thyroid gland is most likely to occur along its path of descent, anywhere from the foramen cecum to the superior mediastinum. The most common site of total ectopy of the thyroid is the BOT, known as a lingual thyroid.2

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