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BENIGN / MALIGNANT THYROID DISEASES AND THE PYRAMIDAL LOBE – USEFUL CLINICAL TIPS

Pyramidal lobe (PL) is an embryological remnant of thyroglossal duct and is considered a normal part of the thyroid gland. The incidence of PL ranges from 15 % to 75 % in anatomical studies and the shape, position and size vary greatly.

1.Thyroid tissue in pyramidal lobe may not be active and hence may be invisible on scintigraphy

2.Complete excision of PL should be performed in patients with PTC because

-PTC is often multifocal. Interestingly, in one study including 1107 patients with PTC, occult malignancy in surgically resected PL was 3.6 %.

                -PL resection facilitates postoperative radioiodine therapy (if and when indicated)

                -PL preservation is insufficient to maintain adequate thyroid function

                -PL resection facilitates patient’s follow-up (based on Tg-levels)

3.The PL may be activated following bilateral lobectomy, potentially exposing the patient to the risk of recurrent non-malignant disease (such as in Graves’ disease)

4.Sporadic cases of primary PTC located in the PL have been reported

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