Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
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On Sep 2018




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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




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Lucknow
On Sep 2018




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On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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.
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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

Important Notice

Case report
Year : 2011 | Month : December | Volume : 5 | Issue : 8 | Page : 1634 - 1636

Multiple Anomalies in the Morphology and the Blood Supply of the Thyroid Gland: A Case Report

Rimpi Gupta, Rajan Kumar Singla

1. MBBS, M.S. Anatomy, Senior Lecturer, Department of Anatomy, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, INDIA. 2. MS Anatomy Additional Professor Department of Anatomy, Government Medical College Amritsar-143001, Punjab, India. PLACE OF STUDY: 1. Department of Anatomy, Govt.Medical college, Amritsar, India. 2. Department of Anatomy, Govt.Medical college, Amritsar, India.

Correspondence Address :
Rimpi Gupta
H. No. 73/1, Azad chowk,
Ferozepur cantt. Punjab, India.
Phone: 09463872734.
E-mail: dr.rimpigupta15@gmail.com

Abstract

During the routine undergraduate dissection of the thyroid gland of a 50 year old male cadaver, multiple anomalies in the morphology and the blood supply of the thyroid gland were encountered. These were in the form of the absence of the thyroid isthmus, the presence of the pyramidal lobe and levator glandulae thyroidae on the right side and the bilateral absence of the superior thyroid artery, the gland being supplied solely by the inferior thyroid arteries which came out as the branches of the thyrocervical trunk. Agenesis of the isthmus can be associated with other types of dysorganogenesis, such as the absence of a lobe or the presence of ectopic thyroid tissue and hence, in clinical practice, when such a condition is diagnosed, it is necessary to perform a differential diagnosis against other pathologies such as autonomous thyroid nodule, thyroiditis, etc. The knowledge of various developmental anomalies of the gland and the variations in the neurovascular relations helps the surgeon in the better planning of a safe and effective surgery.

Keywords

Anatomy, Isthmus, Pyramidal lobe, Levator glandulae thyroidae, Superior thyroid artery

How to cite this article :

Rimpi Gupta, Rajan Kumar Singla. MULTIPLE ANOMALIES IN THE MORPHOLOGY AND THE BLOOD SUPPLY OF THE THYROID GLAND: A CASE REPORT. Journal of Clinical and Diagnostic Research [serial online] 2011 December [cited: 2019 Apr 21 ]; 5:1634-1636. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=December&volume=5&issue=8&page=1634-1636&id=1806

Introduction
The thyroid gland is the first endocrine gland to start developing in the embryo. It is well known for its developmental anomalies which include persistence of the pyramidal lobe, thyroglossal cysts, agenesis of the thyroid gland, agenesis of the isthmus alone or of the aberrant thyroid gland, etc (1),(2). It is a highly vascular endocrine gland which is placed anteriorly in the neck, extending from the fifth cervical to the first thoracic vertebrae. The gland is composed of two lateral lobes which are connected by a narrow median isthmus. The isthmus measures about 1.25 cm transversely as well as vertically and it is usually placed anterior to the second and the third Tracheal rings (3). The anomalies of the development of the thyroid gland distort the morphology of the gland and they may cause clinical functional disorders and various thyroid illnesses (4). The knowledge of the various developmental anomalies of the gland and the variations in the neurovascular relations will help the surgeons in the better planning of a safe and effective surgery (5).

Case Report

During the routine undergraduate dissection of the thyroid gland of a 50 year old male cadaver in the Department of Anatomy, Govt. Medical college, Amritsar, India, the following anomalies were found:

• Absence of the thyroid isthmus • Presence of the right pyramidal lobe • Presence of levator glandulae thyroidae on the right side. • Bilateral absence of the superior thyroid artery, the gland being supplied solely by the inferior thyroid artery.

The right and the left lobes were lying independently on either side of the trachea. The right lobe measured 3.5cms along its anterior border and 2.2cms transversely, its apex being at the level of the lower border of the thyroid cartilage and its base being at the level of the third tracheal ring. The left lobe measured 3.0cms along its anterior border and 2.0cms transversely, its apex being at the level of the middle of the cricoid cartilage and its base being at the level of the fourth tracheal ring. The pyramidal lobe was 2.3cms long and 1.5cms wide. The length and breadth of the levator glandulae thyroidae were 3.5cms and 0.3-0.4cms respectively. It extended from the pyramidal lobe to the hyoid bone. The superior thyroid arteries were absent on both the sides. Instead, the two lobes were supplied by the inferior thyroid arteries which came out as the branches of the thyrocervical trunk on both the sides. There was no anastomosis between the two inferior thyroid arteries (See (Table/Fig 1)). There was no scar on the neck which suggested that the subject had not undergone any surgery. There was no ectopic thyroid tissue between the root of the tongue and the gland’s position.

Discussion

Pastor et al (2006) (6) defined the agenesis of the thyroid isthmus as the complete and congenital absence of the thyroid isthmus. Its incidence varies between 3%–33%, as has been reported by various authors (See (Table/Fig 2).

The levator glandulae thyroidae was encountered in 49.5% of the dissections which were performed by Ranade et al, 2008 (11). According to Gregory and Guse (2007) (13), Soemmerring’s levator glandulae thyroidae is an accessory muscle which runs from the hyoid bone to insert partly on the thyroid cartilage and partly on the isthmus of the thyroid gland. Merkel (1913) (14) thought that the levator glandulae was constant and glandular, though it was usually surrounded by muscle fibres. Huschke (1845) (15) spoke of the structure only as glandular, while he mentioned nothing about the muscle (7),(8),(9),(10). Bourgery (1831) (16) described and illustrated a muscle which he called as “hyo-thyroïdien”, which occupied theplace of the pyramidal lobe. Finally, Godart (1847) (17) (12),(13) reported a case in which the structure was indeed muscular, on the basis of the nitric acid test for the muscle. Soemmerring’s muscle is the same as the hyo-thyro-glandulaire of Pointe, the levator glandulae thyroideae superficialis medius et longus of Krause (1879) (18) and the musculus thyroideus of Merkel (1913) (14); its usual full name in the literature being ‘levator glandulae thyroideae of Soemmerring’ (Table/Fig 3)(16),(17),(18),(19),(20),(21),(22).

Morrigyl and Sturm (1996) (19) reported a rare case in which both the inferior thyroid arteries and the left superior thyroid artery were absent.

All the previous researchers mentioned the individual incidence of these anomalies, but all were silent about all the variations which occurred in the same cadaver. Probably none had encountered a case with so many anomalies as was found in the present cadaver.

Ontogeny
The agenesis of the isthmus can be explained as an anomaly of the embryological development. The adult thyroid gland has two types of endocrine cells, the follicular and the parafollicular cells, which are derived from two different embryological cell families. The follicular cells come from the endodermic cells of the primitive pharynx and the parafollicular cells come from the neural crest (20). The thyroid gland begins to develop as a median thickening of the endoderm on the floor of the pharynx, between the first and the second pharyngeal pouches. This area later invaginates to form the median diverticulum, which appears in the latter half of the fourth week. This thyroid diverticulum grows in allometric proliferation, becoming a solid cellular cord which is called the thyroglossal duct. The duct grows caudally and bifurcates to give rise to the thyroid lobes and the isthmus . At the same time when its caudal growth is taking place, the cephalic end of the thyroglossal duct degenerates (21). A high division of the thyroglossal duct can generate two independent thyroid lobes with the absence of the isthmus. The absence of the isthmus can be associated with other types of dysorganogenesis, such as the absence of either lobe or the presence of ectopic thyroid tissue (22).

Phylogeny
When we trace the phylogeny, it is seen that the isthmus may be missing in amphibians, birds and among mammals- monotremes, certain marsupials, cetaceans, carnivores and rodents. In rhesus monkeys (Macacus rhesus) also, there is no isthmus (6).

Clinical significance
Clinically, the diagnosis of the agenesis of the isthmus can be made with scintigraphy, which can also be performed with an overload of TSH. The diagnosis can also be made with the aid of ultrasonography, computerized tomography (C.T.) and magnetic resonance imaging (M.R.I.) or during a surgical procedure. In asymptomatic patients with nodular goitres, fine-needle aspiration biopsies and eventually, immunohistochemistry tests are useful in supporting the medical decision, but when agenesis is present, the importance of the pre-operative differentiation between the benign and the malignant lesions is critical, considering the surgical procedure and the possibility of the impairment of the thyroid function (23). When an image of the absence of the isthmus is observed, a differential diagnosis against autonomous thyroid nodule, thyroiditis, primary carcinoma, neoplastic metastasis and infiltrative diseases such as amyloidosis should be considered (6).

Conclusion

The agenesis of the isthmus can be associated with other types of dysorganogenesis, such as the absence of a lobe or the presence of ectopic thyroid tissue and hence, in clinical practice, when such a condition is diagnosed, it is necessary to perform a differential diagnosis against other pathologies such as autonomous thyroid nodule, thyroiditis, etc. The surgeon who plans a thyroidectomy must be prepared to find variations like ectopic thyroid nodules around the normally-located thyroid gland. Proper identification of the vessels is very important in order to avoid major complications. Hence, a thorough knowledge of the thyroid anatomy and its associated anatomical variations is very much essential, so that these anomalies may not be overlooked in the differential diagnosis.

Key Message

The thyroid gland is a highly vascular gland which is composed of two lateral lobes which are connected by a narrow median isthmus. The anomalies of the development of the thyroid gland distort the morphology of the gland and they may cause clinical functional disorders and various thyroid illnesses.

References

1.
Marshall CF. Variations in the form of the thyroid gland in man. J Anat Physiol 1895;29:234–39.
2.
Testut L, Latarjet A. Anatomia Human. Tomo IV. 9th ed. Barcelona: Salvat editors; 1978; 402-4. Spanish. Cited by Sankar KD, Bhanu SP, Susan PJ, Gajendra K. Agenesis of the isthmus of thyroid gland, with bilateral levator glandulae thyroidae. Inter J Anat Vari 2009; 2:29-30.
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Standring S, Herold E, Healy JC, Johnson D, Williams A. In: Endocrine system. Gray’s Anatomy. 38th ed. Elsevier, Churchill Livingstone; 2005; 1891-92.
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Dixit D, Shilpa MB, Harsh MP, Ravishankar MV. Agenesis of the isthmus of the thyroid gland in adult human cadavers: a case series. Cases J 2009; 2:6640.
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Pastor VJF, Gil VJA, De Paz Fernández FJ, Cachorro MB. Agenesis of the thyroid isthmus. Eur J Anat 2006;10:83-84.
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Kulkarni MN, Kadam JY. Absence of the thyroid isthmus. J Anat Soc Ind 2001; 50(1):97.
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Braun E, Windisch G, Wolf G, Hausleitner L, Anderhuber F. The pyramidal lobe: clinical anatomy and its importance in thyroid surgery. Surg Radiol Anat 2007;29:21-27.
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Ranade AV, Rai R, Pai MM, Nayak SR, Prakash, Krishnamurthy A, Narayana S. Anatomical variation of the thyroid gland: possible surgical implications. Singapore Med J 2008;49:831-34.
12.
Sankar KD, Bhanu SP, Susan PJ, Gajendra K. Agenesis of the isthmus of the thyroid gland, with bilateral levator glandulae thyroidae. Inter J Anat Vari 2009; 2:29-30.
13.
Gregory JK, Guse DM. Unique variant of levator glandulae thyroideae muscle. Clin Anat 2007; 20:966-7. Cited by Ranade AV, Rai R, Pai MM, Nayak SR, Prakash, Krishnamurthy A, Narayana S. Anatomical variation of the thyroid gland: possible surgical implications. Singapore Med J 2008;49:831–4.
14.
Merkel FS. Die Anatomie des Menschem mit Hinweisen auf die arztliche Praxis, Abt. 3. Wiesbaden: JF Bergman, 1913: 50. German. Cited by Ranade AV, Rai R, Pai MM, Nayak SR, Prakash, Krishnamurthy A, Narayana S. Anatomical variation of the thyroid gland: possible surgical implications. Singapore Med J 2008;49:831-34.
15.
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