title: Non-elevation of TSH after total thyroidectomy: a surgical surprise.
abstract: A 31-year-old woman with papillary carcinoma of the thyroid with right cervical lymph nodal metastasis underwent total thyroidectomy with modified radical neck dissection. At follow-up 6 weeks after surgery, she had not developed clinical features of hypothyroidism and her thyroid-stimulating hormone (TSH) was within normal limits. Further evaluation including technetium scintigraphy of the thyroid and MRI of the chest confirmed thyroid tissue, thyrothymic thyroid rest (TTR), in the superior mediastinum. The patient's TSH elevated well after reoperation of TTR. She underwent radioiodine ablative therapy and suppressive thyroxine therapy as per the protocol for well-differentiated thyroid cancer follow-up. The clinical importance of these embryological rests of thyroid tissue, especially in the management of thyroid malignancies, is discussed in this report.
authors.affiliation: Department of Endocrine Surgery, Madras Medical College, Chennai, Tamil Nadu, India Department of Endocrinology and Endocrine Surgery, Endocrine and Speciality clinic, Chennai, Tamil Nadu, India.
authors.forename: Dhalapathy
authors.initials: D
authors.lastname: Sadacharan
authors.affiliation: Department of Endocrinology and Endocrine Surgery, Endocrine and Speciality clinic, Chennai, Tamil Nadu, India Department of Endocrinology, Sri Ramachandra Medical College, Chennai, Tamilnadu, India.
authors.forename: Shriraam
authors.initials: S
authors.lastname: Mahadevan
authors.affiliation: Department of Endocrine Surgery, Madras Medical College, Chennai, Tamil Nadu, India.
authors.forename: Sankaran
authors.initials: S
authors.lastname: Muthukumar
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Madras Medical College, Chennai, Tamilnadu, India.
authors.forename: Shanmugasundaram
authors.initials: S
authors.lastname: Dinesh
mesh_terms: D000328:Adult; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D002828:Choristoma / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008482:Mediastinum / Q000000981:diagnostic imaging* / Q000601:surgery; D037981:Neck Dissection; D011877:Radionuclide Imaging; D013959:Thyroid Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D013972:Thyrotropin / Q000097:blood*
chemical_list: D013972:Thyrotropin