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PubMed This is a summary of 18 peer-reviewed journal articles Updated
Endocrinology

Imaging and Diagnosis: Making Sure Nothing is Missed

At a Glance

Thyroid scintigraphy is the gold standard for diagnosing thyroid ectopia because it confirms if a neck mass is functioning thyroid tissue. Doctors must perform this scan before removing any midline neck lump to ensure they do not accidentally remove a patient's only working thyroid gland.

When a child or adult has a lump in the middle of their neck or at the back of their tongue, the most important medical rule is this: Never surgically remove a midline neck mass until you know for certain if it is the patient’s only functioning thyroid tissue [1][2].

In many people with thyroid ectopia, that “lump” is not an extra growth—it is their entire thyroid gland [3]. Removing it by mistake (thinking it is a simple cyst) leads to permanent iatrogenic hypothyroidism, meaning the patient will have no natural way to produce thyroid hormone and must take lifelong medication [4][5].

The “Gold Standard”: Thyroid Scintigraphy

While many doctors start with an ultrasound, the definitive “gold standard” test for thyroid ectopia is thyroid scintigraphy [6][1].

  • How it works: The patient receives a tiny amount of a radioactive tracer (usually Technetium-99m or Iodine-123) [7][8]. Because thyroid cells are the only ones in the body that “eat” these tracers, they glow brightly on a special camera [9].
  • Why it’s unique: Unlike a standard X-ray or ultrasound, scintigraphy shows function, not just shape [9]. It tells the doctor: “Yes, this mass is made of thyroid cells” and “No, there is no other thyroid tissue anywhere else in the neck” [10][11].

A Note on Radiation Safety and Pregnancy

The radioactive tracer used in scintigraphy involves a very small amount of radiation that clears the body quickly. However, scintigraphy is strictly contraindicated during pregnancy and breastfeeding. If you are pregnant, your doctor will rely entirely on ultrasound and blood tests to monitor the mass, avoiding any radiation risk to the baby.

Comparing the Tools

Doctors often use a combination of scans to get the full picture.

Tool What it Sees Role in Thyroid Ectopia
Ultrasound Anatomy and shape. Best first step to see if a thyroid is in the “normal” spot [1]. Safe during pregnancy.
Scintigraphy Function and identity. Crucial. Confirms the mass is thyroid tissue and checks for other tissue [6].
CT / MRI Detailed 3D maps. Excellent for planning surgery if the mass is causing breathing or swallowing problems [12].
SPECT/CT Function + 3D Map. The most advanced version; it overlays the “glow” of the thyroid onto a detailed 3D map of the neck [13][14].

Why Ultrasound Isn’t Enough

Ultrasound is a wonderful, non-invasive tool, but it has limits. In about 15% of cases, an ultrasound might miss small pieces of thyroid tissue that a scintigraphy scan would catch [15]. More importantly, an ultrasound cannot prove that a mass is functional thyroid tissue—it can only show that a “solid mass” exists [12]. Relying only on ultrasound before surgery is risky because it cannot definitively distinguish between ectopic thyroid and other types of neck cysts [16].

The Role of FNA Biopsies

Fine-Needle Aspiration (FNA) Biopsy: You may hear about an FNA biopsy for neck masses. While useful for checking for cancer, an FNA should be used with caution in suspected ectopic thyroid cases [17]. It is generally not performed until scintigraphy proves it is not the patient’s only thyroid tissue, or it is done purely to rule out malignancy in a rapidly growing or suspicious mass.

Completeness Checklist for Your Imaging Report

When you receive your radiology report, look for these specific details. If they aren’t there, ask your doctor for clarification.

  • [ ] Presence/Absence of Orthotopic Gland: Does the report explicitly state if there is a thyroid gland in the normal location (below the Adam’s apple)? [10]
  • [ ] Tracer Uptake: If scintigraphy was done, did the mass “take up” the tracer? [14]
  • [ ] Anatomical Boundaries: Does the report describe if the mass is touching the airway or esophagus? [13]
  • [ ] Blood Supply: Is the mass hypervascular (having a high blood supply)? Ectopic thyroid tissue often has many blood vessels [18].

Note: Your doctor will also order separate blood tests for TSH and Free T4 [7]. These will not appear on your imaging report, but they are essential for understanding how the mass is functioning.

Common questions in this guide

Why do I need a thyroid scintigraphy scan for a neck mass?
A scintigraphy scan is the only test that can prove whether a neck lump is actually functioning thyroid tissue. It helps surgeons ensure they don't accidentally remove your only working thyroid gland, which would cause permanent hypothyroidism.
Can an ultrasound alone diagnose an ectopic thyroid?
While ultrasound is a great first step to check the neck's anatomy, it cannot definitively prove if a mass is functional thyroid tissue. Scintigraphy or SPECT/CT scans are usually needed to confirm the diagnosis.
Is thyroid scintigraphy safe during pregnancy?
No, thyroid scintigraphy uses a small amount of radioactive tracer and is strictly contraindicated during pregnancy and breastfeeding. If you are pregnant, your doctor will rely on ultrasounds and blood tests to monitor the mass safely.
What does an 'orthotopic' thyroid gland mean on my imaging report?
An orthotopic thyroid gland means your body has thyroid tissue in its normal, expected location below the Adam's apple. Confirming this is crucial before considering surgery on any ectopic thyroid mass.
Will removing an ectopic thyroid cause hypothyroidism?
If the ectopic lump is your only functioning thyroid tissue, removing it will result in permanent iatrogenic hypothyroidism. This means your body will no longer produce natural thyroid hormone, and you will require lifelong medication.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Does the imaging confirm that there is a normally located (orthotopic) thyroid gland in my child's neck?
  2. 2.If we remove this lump, will my child become permanently hypothyroid?
  3. 3.Can we perform a Tc-99m or I-123 scintigraphy scan to verify if this mass is functioning thyroid tissue?
  4. 4.Was the ultrasound sensitive enough to see all potential thyroid tissue, or should we also do a SPECT/CT?
  5. 5.Are there any pregnancy contraindications for the scans you are suggesting?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (18)
  1. 1

    Dual thyroid ectopia-role of thyroid scintigraphy and neck ultrasonography.

    Jain TK, Meena RS, Bhatia A, et al.

    Indian journal of nuclear medicine : IJNM : the official journal of the Society of Nuclear Medicine, India 2015; (30(4)):338-40 doi:10.4103/0972-3919.164023.

    PMID: 26430320
  2. 2

    [Ectopic thyroid tissue after total thyroidectomy].

    Seitz D, Todt I, Boga E, et al.

    HNO 2020; (68(6)):447-450 doi:10.1007/s00106-019-00754-7.

    PMID: 31578600
  3. 3

    [Ectopic thyroid gland: clinical features and diagnostics in children].

    Shreder EV, Vadina TA, Konyukhova MB, et al.

    Problemy endokrinologii 2022; (68(3)):76-85 doi:10.14341/probl12876.

    PMID: 35841171
  4. 4

    Lingual Thyroid Unmasked by Acute Stroke: A Hidden Airway Emergency.

    Yoneoka Y, Tange A, Honda K, Ohara N

    Cureus 2025; (17(12)):e99162 doi:10.7759/cureus.99162.

    PMID: 41536379
  5. 5

    Missed retrosternal ectopic thyroid tissue in a patient operated for multinodular goiter.

    Kesici U, Koral Ö, Karyağar S, et al.

    Ulusal cerrahi dergisi 2016; (32(1)):67-70 doi:10.5152/UCD.2015.2916.

    PMID: 26985161
  6. 6

    [A rare renal tumour : Ectopic thyroid tissue in the kidney].

    Mata Mera C, Kreutzer N, Lorenzen J, Truß M

    Der Urologe. Ausg. A 2018; (57(8)):944-946 doi:10.1007/s00120-018-0724-1.

    PMID: 30019081
  7. 7

    Incidental Finding of Triple Ectopic Thyroid: Case Report and Review of the Literature.

    Zeineddine F, El-Hajj G, Hajj MA, Chahinian R

    Asia Oceania journal of nuclear medicine & biology 2024; (12(2)):179-184 doi:10.22038/AOJNMB.2024.75895.1532.

    PMID: 39050238
  8. 8

    99mTc Sodium Pertechnetate Uptake in Ectopic Mediastinal Thyroid Tissue on Hybrid Thyroid Scintigraphy.

    Siddique M, Bashir H

    Clinical nuclear medicine 2018; (43(11)):820-822 doi:10.1097/RLU.0000000000002201.

    PMID: 30015662
  9. 9

    Functional and molecular thyroid imaging.

    Giovanella L, Petranović Ovčariček P

    The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of... 2022; (66(2)):86-92 doi:10.23736/S1824-4785.22.03428-8.

    PMID: 35166094
  10. 10

    Bilateral Breast Uptake of 99mTc-Pertechnetate in a Neonate With Congenital Hypothyroidism.

    Rakshpaul S, Malhotra G, Rao SC, et al.

    Clinical nuclear medicine 2020; (45(5)):412-413 doi:10.1097/RLU.0000000000002970.

    PMID: 32149805
  11. 11

    Synchronous Ectopic Thyroid Gland and Ectopic Parathyroid Adenoma on 99mTc-Sestamibi Scintigraphy and Correlative Imaging.

    Palot Manzil FF, Eichhorn J, Vattoth S

    Journal of nuclear medicine technology 2023; (51(3)):263-264 doi:10.2967/jnmt.122.265249.

    PMID: 37316305
  12. 12

    The value of scintigraphy, computed tomography, magnetic resonance imaging, and single-photon emission computed tomography/computed tomography for the diagnosis of ectopic thyroid in the head and neck: A STROBE-compliant retrospective study.

    Xu F, Shao Z, Yang G, et al.

    Medicine 2018; (97(13)):e0239 doi:10.1097/MD.0000000000010239.

    PMID: 29595677
  13. 13

    Thyroid scintigraphy and hybrid SPECT/CT in a rare case of dual ectopic thyroid.

    Jain S, Jain S, Singh D

    Journal of nuclear medicine technology 2022; doi:10.2967/jnmt.122.264508.

    PMID: 36041877
  14. 14

    Usefulness of Hybrid Single-Photon Emission Computed Tomography/ Computed Tomography in a Case of Ectopic Thyroid Tissue in the Thyroglossal Duct Remnant.

    Calandri E, Filippi L, Alessandro F, et al.

    Indian journal of nuclear medicine : IJNM : the official journal of the Society of Nuclear Medicine, India 2021; (36(1)):97-99 doi:10.4103/ijnm.IJNM_43_20.

    PMID: 34040314
  15. 15

    Thyroid Imaging in Infants.

    Goldis M, Waldman L, Marginean O, et al.

    Endocrinology and metabolism clinics of North America 2016; (45(2)):255-66.

    PMID: 27241963
  16. 16

    An unusual mediastinal mass.

    Hardy J, Jeyabalan AR, Bhatt N, Medford AR

    The journal of the Royal College of Physicians of Edinburgh 2016; (46(2)):93-95 doi:10.4997/JRCPE.2016.205.

    PMID: 27929571
  17. 17

    Ectopic thyroid in EBUS: experience from a quality assurance programme.

    Vuorisalo A, Tommola E, Eloranta P, et al.

    APMIS : acta pathologica, microbiologica, et immunologica Scandinavica 2023; (131(5)):217-225 doi:10.1111/apm.13303.

    PMID: 36809572
  18. 18

    Cine clips increase the detection of thyroid pyramidal lobe in routine thyroid sonogram.

    Yan Y, He X, Hu K, et al.

    Ultrasound (Leeds, England) 2024; (32(3)):157-163 doi:10.1177/1742271X231225047.

    PMID: 39100789

This page explains imaging and diagnostic tools for thyroid ectopia for educational purposes only. Always consult your endocrinologist or surgeon to interpret your specific scans and pathology reports.

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