Don’t Forget the Pyramidal Lobe Remnant During Total Thyroidectomy for Thyroid Cancer.
J.A.Benmoussa et al
Endo.Practice 24(4)april 208
Patient has a midline mass seen on CT extending from the hyoid bone to the thyroid bed. S/p Total Thyroidectomy for papillary thyroid cancer.
- The pyramidal lobe can extend from the hyoid bone to the thyroid bed in as many as 50% ( more oftern in men.)
- 10% have thyroid cancer in the TGD cyst.
- Surgeons leaving the pyramidal lobe and its extensions can cause unnecessary radioiodine therapyto remove a mass that is not cancer in the follow up.
- 46% of radioiodine uptake foci in thyroid cancer ablation is due to remnants of the pyramidal lobe. Laterally there is the tubercule of Zukerlandi taht also will take up the radioiodine.
- Surgeons need to find and remove the pyramidal lobe at the surgery to prevent an actual recurrence or it is seen on CT and lights up during radioiodine therapy and is not a recurrence causing unnecessary overuse of radiation treatment..
- If it is left after the surgery and if it has a 10% chance of harboring thyroid cancer it will cause a recurrence that is really a persistence, as it was missed at the original surgery.
CT of pyramidal lobe extending from the hyoid bone to the
thyroid bed after the total thyroidectomy.
Thyrogen stimulated I/131 3.6% uptake is the remnant pyramidal lobe left behind after the surgery..