Autonomously functioning thyroid rests following total thyroidectomy for Graves' disease

Graves' disease may be managed medically, surgically, or with radioiodine. One of the least discussed surgical complications is incomplete resection and subsequent growth of residual thyroid tissue along the embryologic pathway of descent from the base of the tongue to the lower neck. Illustrated here is a woman who, 1 year following total thyroidectomy for Graves' disease, developed two palpable neck masses. Tc-99m pertechnetate imaging demonstrated two corresponding foci. The findings were most consistent with enlarging, autonomously functioning thyroid tissue rests. If the patient had received radioiodine, one can speculate that these foci might also have been ablated.