Lateral Cervical Ectopic Thyroid: A Seven-Step Diagnostic Algorithm and Dual-Axis Treatment Strategy Derived From Case Analysis and Literature Review.

Abstract

Lateral cervical ectopic thyroid gland (LETG) is rare and often difficult to distinguish from metastatic lymphadenopathy; furthermore, no standardized surgical strategy is available. This study aims to clarify the clinical features of and establish an optimized management framework for this anomaly. We present one benign LETG case and one malignant LETG case and performed a systematic literature review (2000-2025), yielding a pooled analysis of 69 cases. The analysis revealed that a definitive pre- or intra-operative diagnosis was pivotal. Malignant pathology in both the lateral neck lesion and the orthotopic thyroid gland predicted multiple surgeries (41.7%, p = 0.007; 39%, p = 0.038). Crucially, the utilization of intraoperative frozen sections was decisive, as all patients who underwent this approach avoided a second operation. LETG management necessitates a systematic approach. Our proposed "Seven-Step Diagnostic Algorithm" and "Dual-Axis Treatment Strategy" facilitate precise differentiation, enable a definitive single-stage surgery, minimize reoperations, and guide selective preservation of the orthotopic thyroid.