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A Case of Aberrant Thyroid Tissue in the Trachea

1950; BMJ; Volume: 3; Issue: 1 Linguagem: Inglês

10.1136/jcp.3.1.48

1472-4146

Tamara Cooper,

Restraint-Related Deaths

Abberant thyroid nodules in the larynx are mentioned in standard textbooks (Price, 1941), but a study of the literature reveals that they are rare, and Joll (1932) in his book on diseases of the thyroid gland does not describe a British case.Aberrant thyroid tissue may be formed in three ways: (1) during the process of differentiation in the foetus small fragments of primitive thyroid may be enclosed in the respiratory tract (von Bruns, 1914); (2) the developing thyroid may penetrate the wall of the larynx or trachea at some weak spot and subsequently develop in the new site (Paltauf, 1891); and (3) it is claimed that aberrant tissues may be formed as the result of neoplastic invasion of low grade malignancy.Willis (1948) considers that " lateral aberrant thyroids " should be regarded as metastatic deposits, but does not comment on central or intratracheal thyroids.He does, however, make the significant point that in the lateral examples the corresponding thyroid lobe is enlarged.Although enlargement was present in the case to be described no proof of malignancy was found and a developmental anomaly was the probable cause.This theory of origin is supported by Meyer's (1910) case in an infant at an age when thyroid neoplasm is improbable.The first case recorded seems to be that of von Ziemssen, 1875 (quoted by Joll), in a woman 18 years old.(The majority of examples have been in women.)Dom's (1919) case in a man, which was associated with vocal cord paralysis and occurred after local removal, would seem to illustrate Willis's (1948) contention that at least some aberrant thyroids are in fact neoplastic.Godel (1921) published details of the case of a woman aged 39 in whom there was thyroid tissue inside the trachea joined to a hypertrophied thyroid outside the trachea.Maier (1922) collected 28 cases, and estimated that one out of every 15 intra- tracheal tumours are of thyroid origin.His patient had obstructive symptoms related to pregnancy.Bundschuh (1925) met with two instances, both in women; operation for removal undertaken on account of acute occlusion of the airway in pregnancy was successful.Vacher and Denis (1927) describe a woman who gave a six years' history of respiratory distress, worse in each of four successive pregnancies.In the fourth month of the last of these she sought advice.Laryngoscopy showed a submucous tumour below the larynx and, although the Wassermann test was negative, anti-syphilitic treatment was begun but was unsuccessful.It was followed by 20 exposures to deep x-ray therapy, but the on July 27, 2023 by guest.