Evaluation of the prevalence of thyroid pyramidal lobe and its relationship with thyroglossal duct cyst by ultrasonography
Öz
Aim: To evaluate the prevalence of the pyramidal lobe, associated thyroid pathologies, and its relationship with the thyroglossal duct cyst using ultrasonography (US).
Materials and Methods: Between December 2022 and July 2024, 1132 patients who underwent thyroid or neck US examinations were retrospectively reviewed. Additionally, 128 total thyroidectomy patients who were not included in the analysis of the pyramidal lobe were also evaluated for the presence and location of residual thyroid tissue.
Results: The pyramidal lobe was detected in 526 (46.5%) patients and was observed less frequently in patients with reduced thyroid gland size (23.2%; p=0.002). The pyramidal lobe predominantly arose from the left half of the isthmus (51.5%). In 8 (1.5%) patients, a nodule was observed in the pyramidal lobe.
A pyramidal lobe was detected in 12 (80%) cases with thyroglossal duct cyst. A significant relationship was found between the presence of a pyramidal lobe and the presence of a thyroglossal duct cyst (p=0.009).
No relationship was found between the presence of a pyramidal lobe and chronic thyroiditis, subacute thyroiditis, Graves’ disease, and a nodule in the thyroid gland (p>0.05). Pyramidal lobe residue was detected in 18% of patients who underwent total thyroidectomy.
Conclusion: The pyramidal lobe is a commonly observed accessory lobe of the thyroid gland. This study has demonstrated its relationship with the thyroglossal duct cyst, another remnant of the thyroglossal duct. It is important to evaluate both embryological remnants with preoperative ultrasound to prevent possible recurrences after total thyroidectomy.
Anahtar Kelimeler
Pyramidal lobe Ultrasonography Thyroglossal duct cyst Thyroid Thyroidectomy
Kaynakça
- Policeni BA, Smoker WRK, Reede DL. Anatomy and embryology of the thyroid and parathyroid glands. Semin Ultrasound CT MR. 2012;33(2):104–14.
- Sturniolo G, Bonanno L, Gagliano E, Tonante A, Taranto F, Mamo M, et al. [The thyroid pyramidal lobe: frequency, morphological features and related diseases]. Chir Ital. 2008;60(1):41–6.
- Dağdeviren M, Sapaz G, Deveci S, Öztürk C, Ramadan SU, Beyan E. Tiroid Piramidal Lob İnsidansı ve Tiroid Fonksiyonları İle İlişkisi. AATD. 2019;3(1):6–10.
- Thompson LDR, Herrera HB, Lau SK. A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts. Head Neck Pathol. 2016;10(4):465–74.
- Park JS, Kim DW, Shin GW, Park JY, Lee YJ, Choo HJ, et al. Prevalence and Features of Thyroglossal Duct Cyst on Ultrasonography, According to Radioactive Iodine Therapy: A Single-Center Study. Front Endocrinol (Lausanne). 2020;11:188.
- Park JY, Kim DW, Park JS, Kang T, Kim YW. The prevalence and features of thyroid pyramidal lobes as assessed by computed tomography. Thyroid. 2012;22(2):173–7.
- Mortensen C, Lockyer H, Loveday E. The incidence and morphological features of pyramidal lobe on thyroid ultrasound. Ultrasound. 2014;22(4):192–8.
- Freilinger A, Kaserer K, Zettinig G, Pruidze P, Reissig LF, Rossmann T, et al. Ultrasound for the detection of the pyramidal lobe of the thyroid gland. J Endocrinol Invest. 2022;45(6):1201–8.
- Kim DW, Jung SL, Kim J, Ryu JH, Sung JY, Lim HK. Comparison between ultrasonography and computed tomography for detecting the pyramidal lobe of the thyroid gland: a prospective multicenter study. Korean J Radiol. 2015;16(2):402–9.
- Sencar ME, Calapkulu M, Sakiz D, Unsal IO, Cayir D, Hepsen S, et al. Residual Pyramidal Lobe Increases Stimulated Thyroglobulin and Decreases Endogenous Thyroid Stimulating Hormone Stimulation in Differentiated Thyroid Cancer Patients. Endocr Pract. 2021;27(3):212–5.
- Kim DW, Ha TK, Park HK, Kang T. Sonographic detection of thyroid pyramidal lobes before thyroid surgery: a prospective single-center study. J Ultrasound Med. 2014;33(2):239–44.
- Santrac N, Besic N, Buta M, Oruci M, Djurisic I, Pupic G, et al. Lymphatic drainage, regional metastases and surgical management of papillary thyroid carcinoma arising in pyramidal lobe--a single institution experience. Endocr J. 2014;61(1):55–9.
- Yoon SG, Yi JW, Seong CY, Kim JK, Kim SJ, Chai YJ, et al. Clinical characteristics of papillary thyroid carcinoma arising from the pyramidal lobe. Ann Surg Treat Res. 2017;92(3):123–8.
- Ogawa C, Kammori M, Onose H, Yamada E, Shimizu K, Yamada T. Follicular carcinoma arising from the pyramidal lobe of the thyroid. J Nippon Med Sch. 2009;76(3):169–72.
- Wood CB, Bigcas JL, Alava I, Bischoff L, Langerman A, Kim Y. Papillary-Type Carcinoma of the Thyroglossal Duct Cyst: The Case for Conservative Management. Ann Otol Rhinol Laryngol. 2018;127(10):710–6.
- Geraci G, Pisello F, Li Volsi F, Modica G, Sciumè C. The importance of pyramidal lobe in thyroid surgery. G Chir. 2008;29(11–12):479–82.
- Kim DW, Jung SL, Baek JH, Kim J, Ryu JH, Na DG, et al. The prevalence and features of thyroid pyramidal lobe, accessory thyroid, and ectopic thyroid as assessed by computed tomography: a multicenter study. Thyroid. 2013;23(1):84–91.
- Milojevic B, Tosevski J, Milisavljevic M, Babic D, Malikovic A. Pyramidal lobe of the human thyroid gland: an anatomical study with clinical implications. Rom J Morphol Embryol. 2013;54(2):285–9.
- Dessie MA. Anatomical variations and developmental anomalies of the thyroid gland in Ethiopian population: a cadaveric study. Anat Cell Biol. 2018;51(4):243–50.
- Prakash null, Rajini T, Ramachandran A, Savalgi GB, Venkata SP, Mokhasi V. Variations in the anatomy of the thyroid gland: clinical implications of a cadaver study. Anat Sci Int. 2012;87(1):45–9.
- Cengiz A, Sakı H, Yürekli Y. Scintigraphic evaluation of thyroid pyramidal lobe. Mol Imaging Radionucl Ther. 2013;22(2):32–5.
- Levy HA, Sziklas JJ, Rosenberg RJ, Spencer RP. Incidence of a pyramidal lobe on thyroid scans. Clin Nucl Med. 1982;7(12):560–1.
- Singh S, Rosenthal DI, Ginsberg LE. Enlargement and transformation of thyroglossal duct cysts in response to radiotherapy: imaging findings. AJNR Am J Neuroradiol. 2009;30(4):800–2.
- Thompson LD. Thyroglossal duct cyst. Ear Nose Throat J. 2017;96(2):54–5.
- Vaz-Pereira R, Santos C, Monteiro A, Pinto de Sousa J. Recurrence of Graves’ disease in the thyroglossal duct after total thyroidectomy. BMJ Case Rep. 2022;15(2):e248166.
- Sawicka-Gutaj N, Klimowicz A, Sowinski J, Oleksa R, Gryczynska M, Wyszomirska A, et al. Pyramidal lobe decreases endogenous TSH stimulation without impact on radio-iodine therapy outcome in patients with differentiated thyroid cancer. Ann Endocrinol (Paris). 2014;75(3):141–7.
Tiroid piramidal lob sıklığının ve tiroglossal duktus kisti ile ilişkisinin ultrasonografi ile değerlendirilmesi
Öz
Amaç: Piramidal lob sıklığının, eşlik edebilecek tiroid patolojilerinin ve piramidal lobun tiroglossal duktus kisti ile ilişkisinin ultrasonografi (US) ile değerlendirilmesi amaçlanmıştır
Gereç ve Yöntem: Aralık 2022 ile Temmuz 2024 tarihleri arasında tiroid veya boyun US tetkiki yapılan 1132 hasta retrospektif olarak incelendi. Ayrıca piramidal lob analizine dahil edilmeyen 128 total tiroidektomili hasta da operasyon sonrasında rezidü tiroid dokusu varlığı ve yerleşimi yönünden değerlendirildi.
Bulgular: Hastaların 526 (%46,5)’sında piramidal lob saptandı ve tiroid bezi boyutu azalmış olgularda piramidal lob daha az sıklıkla izlendi (%23,2; p=0,002). Piramidal lobun ağırlıklı olarak istmus sol yarımından (%51,5) köken aldığı görüntülendi. Hastaların 8 (%1,5)’inde piramidal lobda nodül izlendi. Tiroglossal duktus kisti mevcut olan olguların 12 (%80)’sinde piramidal lob saptandı. Piramidal lob ile tiroglossal duktus kisti varlığı arasında anlamlı ilişki bulundu (p=0,009). Kronik tiroidit, subakut tiroidit, Graves hastalığı ve tiroid bezinde nodül varlığının piramidal lob mevcudiyeti ile ilişkisi saptanmadı (p>0,05). Total tiroidektomili hastaların %18’inde piramidal lob rezidüsü tespit edildi.
Sonuç: Piramidal lob, tiroid bezinin sık görülen aksesuar lobu olup, bir diğer tiroglossal duktus kalıntısı olan tiroglossal duktus kisti ile ilişkisi bu çalışmada gösterilmiştir. Total tiroidektomi planlanan hastalarda olası nükslerin önlenmesi için her iki embriyolojik kalıntının da cerrahi öncesi US ile değerlendirilmesi önem taşımaktadır.
Anahtar Kelimeler
Piramidal lob Ultrasonografi Tiroglossal duktus kisti Tiroid Tiroidektomi
Kaynakça
- Policeni BA, Smoker WRK, Reede DL. Anatomy and embryology of the thyroid and parathyroid glands. Semin Ultrasound CT MR. 2012;33(2):104–14.
- Sturniolo G, Bonanno L, Gagliano E, Tonante A, Taranto F, Mamo M, et al. [The thyroid pyramidal lobe: frequency, morphological features and related diseases]. Chir Ital. 2008;60(1):41–6.
- Dağdeviren M, Sapaz G, Deveci S, Öztürk C, Ramadan SU, Beyan E. Tiroid Piramidal Lob İnsidansı ve Tiroid Fonksiyonları İle İlişkisi. AATD. 2019;3(1):6–10.
- Thompson LDR, Herrera HB, Lau SK. A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts. Head Neck Pathol. 2016;10(4):465–74.
- Park JS, Kim DW, Shin GW, Park JY, Lee YJ, Choo HJ, et al. Prevalence and Features of Thyroglossal Duct Cyst on Ultrasonography, According to Radioactive Iodine Therapy: A Single-Center Study. Front Endocrinol (Lausanne). 2020;11:188.
- Park JY, Kim DW, Park JS, Kang T, Kim YW. The prevalence and features of thyroid pyramidal lobes as assessed by computed tomography. Thyroid. 2012;22(2):173–7.
- Mortensen C, Lockyer H, Loveday E. The incidence and morphological features of pyramidal lobe on thyroid ultrasound. Ultrasound. 2014;22(4):192–8.
- Freilinger A, Kaserer K, Zettinig G, Pruidze P, Reissig LF, Rossmann T, et al. Ultrasound for the detection of the pyramidal lobe of the thyroid gland. J Endocrinol Invest. 2022;45(6):1201–8.
- Kim DW, Jung SL, Kim J, Ryu JH, Sung JY, Lim HK. Comparison between ultrasonography and computed tomography for detecting the pyramidal lobe of the thyroid gland: a prospective multicenter study. Korean J Radiol. 2015;16(2):402–9.
- Sencar ME, Calapkulu M, Sakiz D, Unsal IO, Cayir D, Hepsen S, et al. Residual Pyramidal Lobe Increases Stimulated Thyroglobulin and Decreases Endogenous Thyroid Stimulating Hormone Stimulation in Differentiated Thyroid Cancer Patients. Endocr Pract. 2021;27(3):212–5.
- Kim DW, Ha TK, Park HK, Kang T. Sonographic detection of thyroid pyramidal lobes before thyroid surgery: a prospective single-center study. J Ultrasound Med. 2014;33(2):239–44.
- Santrac N, Besic N, Buta M, Oruci M, Djurisic I, Pupic G, et al. Lymphatic drainage, regional metastases and surgical management of papillary thyroid carcinoma arising in pyramidal lobe--a single institution experience. Endocr J. 2014;61(1):55–9.
- Yoon SG, Yi JW, Seong CY, Kim JK, Kim SJ, Chai YJ, et al. Clinical characteristics of papillary thyroid carcinoma arising from the pyramidal lobe. Ann Surg Treat Res. 2017;92(3):123–8.
- Ogawa C, Kammori M, Onose H, Yamada E, Shimizu K, Yamada T. Follicular carcinoma arising from the pyramidal lobe of the thyroid. J Nippon Med Sch. 2009;76(3):169–72.
- Wood CB, Bigcas JL, Alava I, Bischoff L, Langerman A, Kim Y. Papillary-Type Carcinoma of the Thyroglossal Duct Cyst: The Case for Conservative Management. Ann Otol Rhinol Laryngol. 2018;127(10):710–6.
- Geraci G, Pisello F, Li Volsi F, Modica G, Sciumè C. The importance of pyramidal lobe in thyroid surgery. G Chir. 2008;29(11–12):479–82.
- Kim DW, Jung SL, Baek JH, Kim J, Ryu JH, Na DG, et al. The prevalence and features of thyroid pyramidal lobe, accessory thyroid, and ectopic thyroid as assessed by computed tomography: a multicenter study. Thyroid. 2013;23(1):84–91.
- Milojevic B, Tosevski J, Milisavljevic M, Babic D, Malikovic A. Pyramidal lobe of the human thyroid gland: an anatomical study with clinical implications. Rom J Morphol Embryol. 2013;54(2):285–9.
- Dessie MA. Anatomical variations and developmental anomalies of the thyroid gland in Ethiopian population: a cadaveric study. Anat Cell Biol. 2018;51(4):243–50.
- Prakash null, Rajini T, Ramachandran A, Savalgi GB, Venkata SP, Mokhasi V. Variations in the anatomy of the thyroid gland: clinical implications of a cadaver study. Anat Sci Int. 2012;87(1):45–9.
- Cengiz A, Sakı H, Yürekli Y. Scintigraphic evaluation of thyroid pyramidal lobe. Mol Imaging Radionucl Ther. 2013;22(2):32–5.
- Levy HA, Sziklas JJ, Rosenberg RJ, Spencer RP. Incidence of a pyramidal lobe on thyroid scans. Clin Nucl Med. 1982;7(12):560–1.
- Singh S, Rosenthal DI, Ginsberg LE. Enlargement and transformation of thyroglossal duct cysts in response to radiotherapy: imaging findings. AJNR Am J Neuroradiol. 2009;30(4):800–2.
- Thompson LD. Thyroglossal duct cyst. Ear Nose Throat J. 2017;96(2):54–5.
- Vaz-Pereira R, Santos C, Monteiro A, Pinto de Sousa J. Recurrence of Graves’ disease in the thyroglossal duct after total thyroidectomy. BMJ Case Rep. 2022;15(2):e248166.
- Sawicka-Gutaj N, Klimowicz A, Sowinski J, Oleksa R, Gryczynska M, Wyszomirska A, et al. Pyramidal lobe decreases endogenous TSH stimulation without impact on radio-iodine therapy outcome in patients with differentiated thyroid cancer. Ann Endocrinol (Paris). 2014;75(3):141–7.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Tıp Eğitimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 8 Eylül 2025 |
| Gönderilme Tarihi | 11 Ocak 2025 |
| Kabul Tarihi | 5 Haziran 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 64 Sayı: 3 |
