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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Ectopic thyroid – a case series
Correspondence Address :
Bertha A, Department of Anatomy,
Christian Medical College, Vellore 632 002, India
Phone number: (Res): 0416- 2284026; (Off): 2284245
Telefax No. 0091-0416-2262268
Email: bertha@cmcvellore.ac.in; bertharathinam@gmail.com
Introduction and aim: Thyroid dysgenesis refers to conditions which are related to defects in the thyroid organogenesis, which present as absent, ectopically located or reduced glandular tissue. We report our experience on ectopic thyroid and its diagnosis and management in our institution over the past five years.
Materials and methods: A retrospective analysis of all the patients who were evaluated for pathologies in the thyroid, who underwent thyroid scintigraphy by using 99mTechnetium from January 2005 to December 2010, was done. 2 mCi of pertechnetate was given intravenously and the images were acquired after 20 minutes. The patients were imaged by using a gamma camera.
Observations: A total of 134 patients underwent the study, of which 12 patients (8.95%) were found to have ectopic thyroid. Ectopic thyroid tissue was observed not only in the midline cervical region – in the lingual, suprahyoid and the subhyoid locations, but also in the submandibular region in one individual.
Conclusion: In our series of observations, 8.95% of all the cases which were screened for thyroid diseases, showed ectopic thyroid tissue. Lingual thyroid was seen in 41.6% of the cases. Most of our patients responded well to hormonal therapy and did not need any surgical intervention. Long term follow up is absolutely necessary, as the prevalence of malignancies is higher in these individuals.
Thyroid embryogenesis, ectopic thyroid tissue, thyroid scintigraphy.
Embryogenesis of the thyroid gland
The thyroid gland is the first endocrine organ to develop on the 24th day of the embryonic period (20 somites stage)(1). It develops as a midline endodermal derivative of the pharynx of the developing foregut. It is first identified as a median thickening of the endoderm, lying in the floor of the pharynx between the first and the second pharyngeal pouches, immediately dorsal to the aortic sac. This area later invaginates to form a median diverticulum in the fourth week of development, caudal to the median tongue bud. The median thyroid diverticulum is connected to the pharynx by the thyroglossal duct. The initial site of connection in the floor of the mouth is marked by the foramen caecum, from which it extends inferiorly in the midline which is anterior to the primordium of the hyoid bone, often forming a recurrent loop around the hyoid bone1.
It is not uncommon to find ectopic thyroid tissue between the foramen caecum and the normal position of the thyroid gland, often in the region of the foramen caecum, as a lingual thyroid at the base of the tongue, in patients whose glands fail to descend. Extra lingual thyroid tissue is commonly located in the midline in the anterior cervical area, corresponding to the path of the thyroglossal duct (1). Interestingly, ectopic thyroid tissue has been described in the lateral cervical area also. It is rare, but there have been reports of ectopic tissue in the submandibular region(2), the trachea(3), the mediastinum(4), the heart(5), the lung(6), the duodenum(7), the adrenal gland(8), the parotid gland(9) and the gall bladder(10). Ectopic thyroid tissue is known to undergo malignant changes(3), (4),(11),(12). This retrospective study was undertaken to calculate the prevalence of ectopic thyroid among the patients who came with any thyroid abnormality to our institution.
A retrospective analysis of all the patients who were evaluated for pathologies in the thyroid, who underwent thyroid scintigraphy by using 99mTechnetium from January 2005 to December 2010, was done. A total of 134 patients underwent thyroid scintigraphic studies. 2 mCi of pertechnetate was administered intravenously after all the precautions were taken and the images were acquired after 20 minutes. All the patients were imaged by using a gamma camera. (G E Infinia Hawkeye and Seimens Symbia)
Observations
The prevalence of ectopic thyroid among the 134 patients who were investigated for thyroid abnormalities was 12 (8.95 %). The youngest patient was three years of age and the oldest patient presented at 21 years of age. The average age at presentation in our institution was 10.6 years. 58% of our study patients were females. The most common presenting complaint was a swelling in the neck, in seven individuals (54%). Three patients (23%) presented with a swelling in the posterior third of the tongue and difficulty in swallowing. One patient came to the hospital for the evaluation of short stature and two others presented with hypothyroidism. Lingual thyroid was the commonest site of the ectopic thyroid at 41.6%, followed by hyoid which was seen in 25% and 8.3% each of thyroglossal cyst, subhyoid, suprahyoid and submandibular ectopic thyroid tissue (Table 1). Surgical excision was done for two cases (16.6%) and the rest of the cases were administered hormone replacement therapy.
The prevalence of ectopic thyroid is less than 10% in the reviewed literature and our study recorded a prevalence of 8.95%, confirming the same11. The remnant of the thyroglossal duct which does not atrophy, presents mostly as a midline thyroglossal cyst, but can track anywhere from the thyroid cartilage up to the base of the tongue.
Only one of our patients presented with a midline hyoid thyroglossal cyst, which was the only functional thyroid tissue (Table/Fig 1). An aberrant or ectopic thyroid gland may occur anywhere along the path of the initial descent of the thyroid, although it is most common at the base of the tongue, just posterior to the foramen caecum (1), (11). In our series, 41.6% of the cases had lingual thyroid, which represented a complete failure of the thyroid in descending (Table/Fig 2). The incomplete descent of the thyroid gland leads to the final resting point of the thyroid gland in the hyoid, the suprahyoid or the subhyoid areas. Three individuals presented with ectopic thyroid tissue in the hyoid region, one presented with ectopic thyroid in the suprahyoid region (Table/Fig 3), and one presented with ectopic thyroid in the subhyoid region (Table/Fig 4). There was one case of ectopic thyroid in the lateral cervical area, in the submandibular region (Table/Fig 5).
The patients can be clinically asymptomatic or the ectopic thyroid may often cause discomfort and / or local compression that may necessitate a surgical approach. In our series, most of the patients presented with features of hypothyroidism. Biochemically, they were all found to have elevated thyroid stimulating hormone (TSH) levels. A few of them presented with dysphagia which was secondary to obstruction which was caused due to the lingual thyroid. The youngest patient presented with swelling and purulent discharge in the submental region for 6 months. On examination, he was found to have a 2x3 cms cystic swelling in the submandibular region, which moved on deglutition and protrusion of the tongue. Incidentally, he was found to have phimosis.
A five year old female presented with a swelling in the midline of the neck of three years duration. On examination, the 2x2 oval swelling was found to move, with the deglutition and the protrusion of the tongue and it was transilluminant. A patient came to the hospital at 15 years of age for the evaluation of short stature, with a history of pain in the right and left hips, of three months duration. There was no weight loss, polyuria, polydipsia or proximal muscle weakness. The oldest patient presented with a swelling at the base of the tongue of 13 years duration and excessive sleep. A majority of these patients were treated with hormonal replacement therapy and only two patients (16.6%) required surgical excision. Excisions were done for the suprahyoid and the subhyoid ectopic thyroid tissue. The biopsy confirmed the presence of ectopic thyroid tissue in both the cases. The patient with the submandibular ectopic thyroid was treated with hormone replacement therapy. All our patients on hormonal treatment are on regular follow-up since 2005 and are clinically asymptomatic. Iodine ablation was not resorted to in our series, as most of those who were affected were below the age of 18 years and had presented with significant hypothyroidism. None of our cases presented with thyrotoxicosis. Hormonal treatment was therefore preferred over surgery which has a high rate of complications. The estimated incidence for carcinoma arising in a lingual thyroid was only 1%11, (12). In our series, as the follow up of the patients was for too short an interval, the malignant potential cannot be commented at this stage.
In these series of observations, of the 12 cases which were studied, 41.6% were lingual thyroids and there was a slightly higher preponderance of the ectopic thyroid in females. It was noted that the patients responded well to hormonal therapy and that they did not require any surgical intervention. Long term follow up is absolutely necessary. as the prevalence of malignancies is higher in these individuals.
Ectopic thyroid due to the defective organogenesis of the thyroid gland is not very uncommon in our population. They should be borne in mind, detected early and treated adequately to prevent complications like dysphagia and malignancies.
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