Case Report Thyrotoxicosis Associated with a Hypopharyngeal Toxic Nodular Thyroid S. Ali Imran, 1 Adam Hinchey, 2 Rob Hart, 3 Martin Bullock, 4 Andrew Ross, 5 and Steven Burrell 5 1 Division of Endocrinology and Metabolism, Department of Medicine, Dalhousie University, Halifax, NS, Canada 2 Dalhousie Medical School, Halifax, NS, Canada 3 Division of Otolaryngology, Department of Surgery, Dalhousie University, Halifax, NS, Canada 4 Department of Pathology, Dalhousie University, Halifax, NS, Canada 5 Division of Nuclear Medicine, Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada Correspondence should be addressed to S. Ali Imran; ali.imran@nshealth.ca Received 24 August 2017; Accepted 15 October 2017; Published 2 November 2017 Academic Editor: Toshihiro Kita Copyright © 2017 S. Ali Imran et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Ectopic thyroid is a rare developmental anomaly which may be either asymptomatic or present with thyroid dysfunction as well as pressure symptoms. Here we present a novel case of thyrotoxicosis associated with a hypopharyngeal multinodular thyroid in a female. Removal of the ectopic thyroid led to normalization of the thyroid status. 1. Case Description A 32-year-old female was referred to the endocrine clinic for assessment of hyperthyroidism. She was previously known to have mild depression that was controlled on Cipralex 10 mg daily. She had originally gone to her family physician for frequent palpitations and excessive sweating for the past 3 months. Preliminary work-up showed thyroid stimulating hormone (TSH) of <0.01 mIU/L (normal: 0.35–5.50) and serum free thyroxine (fT4) of 20 pmol/L (9.5–19.0). Te family physician prescribed methimazole, 5mg twice a day, and 8 weeks later her TSH became 6.01 mIU/L and serum fT4 dropped to 9.0 pmol/L. Methimazole was discontinued and she remained biochemically euthyroid until a follow- up blood test around 9 months later showed TSH of <0.01 mIU/L, fT4 of 17.4, and free triiodothyronine (fT3) of 7.2pmol/L (normal: 3.5–6.5) at which point she was referred to endocrinology. She denied any family history of thyroid disorders and, on initial assessment, her pulse was 82/minute (regular), blood pressure was 110/84, she had mild tremor and moist skin, and her refexes were brisk (grade 3). Tere was no evidence of thyroid associated ophthalmopathy. Methimazole 5 mg twice a day was again initiated and the preliminary investigations revealed that thyroid receptor antibody was <1 IU/L (normal < 1) and antithyroid peroxidase antibody was < 10 IU/mL (normal ≤ 40). A 99m Tc-pertechnetate thyroid scan was performed (Figure 1(a)) afer discontinuing methimazole for 4 days, which revealed heterogeneous uptake in a large lob- ulated mass superior to the right lobe of the thyroid. Uptake throughout the thyroid itself was relatively homogenous. Te 6-hour radioiodine ( 131 Iodine) uptake was measured at 27.1% (normal < 20%) but may have been underestimated as counts from the mass above the thyroid may not have been fully detected by the probe. Her thyroid indices normalized with methimazole 5mg daily, which was continued for one year and then stopped. However, within few weeks of stopping methimazole she experienced recurrence of thyrotoxic symp- toms including palpitations, excessive sweating, and anxiety and repeat testing showed suppression of serum TSH to <0.01 mIU/L with fT4 being 16.1 pmol/. 99m Tc-pertechnetate was repeated which was similar in appearance (not shown). Tis time SPECT-CT (Single Photon Emission Computed Tomography-Computed Tomography) imaging was also per- formed to better localize the mass, revealing it to be in the Hindawi Case Reports in Endocrinology Volume 2017, Article ID 5128563, 4 pages https://doi.org/10.1155/2017/5128563