Congenital thyroid hemiagenesis with thyroid nodules—Role of TI-RADS to prevent long term thyroid replacement therapy

BACKGROUND: Hemi-agenesis of thyroid is a rare congenital condition with the clinical significance lying only in cases where the remnant tissue is affected by a pathology mandating removal of the gland. Henceforth, the hemi-thyroidectomy technically becomes a total thyroidectomy with a need for long term thyroid replacement therapy. CASE SUMMARY: We present a series of three cases noted over a period of two years where preoperative imaging evaluation confirmed the developmental abnormality. Further presence of a thyroid nodule in each of these cases posed a specific clinical situation whereby characterization of nodule appeared mandatory for a rational management involving life-long thyroid replacement therapy due to an ‘apparent total thyroidectomy’, if the remnant gland is removed. Ultrasound TI-RADS is a new system for evidence based sub-classification of thyroid nodules enabling both the surgeon and patient to take a streamlined decision about the overall approach for management. CONCLUSION: Prospective nodule characterization based on the thyroid image reporting and data system (TI-RADS), enables the surgeon to decide the treatment strategy sparing the patient of the cost and morbidity associated with long term thyroid replacement therapy.