Case Report: A pyramidal lobe coexisting with a left-sided thyroid goiter displacing trachea and esophagus: A cadaveric finding with clinical implications

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Methods Routine dissection of the neck of an 86-year-old female donated a Greek cadaver. Results A thyroid gland variant was identified coexisting with a TGo originating from the left thyroid lobe. The variant is a pyramidal lobe located on the left side of the isthmus. Owing to the presence of the TGo, the left CCA, along with the left IJV, deviated 50.6 mm ipsilaterally from the midline of the neck. The right CCA had a minor deviation of 30.8 mm, from the midline to the right side due to the proximity of the shifted trachea and esophagus with the CCA origin. The trachea and esophagus deviated contralaterally to the TGo, 24.4 mm from the midline. Conclusions CCA compression, stenosis, and angulation may cause dizziness, weakness, and hypomnesia. The potential outcomes were worse with IJV compression. Atherosclerosis tends to occur more often in arteries with inclined (angulated) parts. 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F1000Research 2024, 13 :212 ( https://doi.org/10.12688/f1000research.146026.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Revised Case Report: A pyramidal lobe coexisting with a left-sided thyroid goiter displacing trachea and esophagus: A cadaveric finding with clinical implications [version 2; peer review: 1 approved, 1 approved with reservations] Triantafyllou George https://orcid.org/0009-0001-0122-2436 1 , Tsakotos George 1 , Łukasz Olewnik 2 , [...] Aliki Fiska 3 , Christos Koutserimpas 1,4 , Nicol Zielinska 2 , Piagkou Maria https://orcid.org/0000-0002-4831-8005 1 Triantafyllou George https://orcid.org/0009-0001-0122-2436 1 , Tsakotos George 1 , [...] Łukasz Olewnik 2 , Aliki Fiska 3 , Christos Koutserimpas 1,4 , Nicol Zielinska 2 , Piagkou Maria https://orcid.org/0000-0002-4831-8005 1 PUBLISHED 13 Sep 2024 Author details Author details 1 Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Goudi, Athens, 11527, Greece 2 Department of Anatomical Dissection and Donation, Chair of Anatomy and Histology,, Medical University of Lodz, Lodz, Poland 3 Department of Anatomy, , School of Medicine, Democritus University of Thrace, Alexandroupoli, Greece 4 Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Athens, Greece Triantafyllou George Roles: Conceptualization, Data Curation, Investigation, Methodology, Validation, Writing – Original Draft Preparation Tsakotos George Roles: Formal Analysis, Funding Acquisition, Methodology, Resources, Visualization, Writing – Original Draft Preparation Łukasz Olewnik Roles: Methodology, Writing – Review & Editing Aliki Fiska Roles: Formal Analysis, Writing – Review & Editing Christos Koutserimpas Roles: Data Curation, Writing – Review & Editing Nicol Zielinska Roles: Data Curation, Writing – Review & Editing Piagkou Maria Roles: Conceptualization, Investigation, Resources, Supervision, Writing – Original Draft Preparation OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the HEAL1000 gateway. Abstract Background The current report describes a unimodular thyroid goiter (TGo), identified unilaterally in a female cadaver, causing displacement or compression effects in the adjacent neck structures (common carotid artery (CCA) and internal jugular vein (IJV),). Methods Routine dissection of the neck of an 86-year-old female donated a Greek cadaver. Results A thyroid gland variant was identified coexisting with a TGo originating from the left thyroid lobe. The variant is a pyramidal lobe located on the left side of the isthmus. Owing to the presence of the TGo, the left CCA, along with the left IJV, deviated 50.6 mm ipsilaterally from the midline of the neck. The right CCA had a minor deviation of 30.8 mm, from the midline to the right side due to the proximity of the shifted trachea and esophagus with the CCA origin. The trachea and esophagus deviated contralaterally to the TGo, 24.4 mm from the midline. Conclusions CCA compression, stenosis, and angulation may cause dizziness, weakness, and hypomnesia. The potential outcomes were worse with IJV compression. Atherosclerosis tends to occur more often in arteries with inclined (angulated) parts. READ ALL READ LESS Keywords thyroid gland, nodular goiter, effect, compression, displacement Corresponding Author(s) Piagkou Maria ( [email protected] ) Close Corresponding author: Piagkou Maria Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 George T et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: George T, George T, Olewnik Ł et al. Case Report: A pyramidal lobe coexisting with a left-sided thyroid goiter displacing trachea and esophagus: A cadaveric finding with clinical implications [version 2; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :212 ( https://doi.org/10.12688/f1000research.146026.2 ) First published: 21 Mar 2024, 13 :212 ( https://doi.org/10.12688/f1000research.146026.1 ) Latest published: 13 Sep 2024, 13 :212 ( https://doi.org/10.12688/f1000research.146026.2 ) Revised Amendments from Version 1 According to reviewers' comments, a brief explanation of the pyramidal lobe anatomy and its surgical significance was added to this new version. According to reviewers' comments, a brief explanation of the pyramidal lobe anatomy and its surgical significance was added to this new version. See the authors' detailed response to the review by Gkionoul Chatzioglou See the authors' detailed response to the review by Ismail Hakki Nur READ REVIEWER RESPONSES Introduction The thyroid gland (TG), which is located in the middle area of the neck, produces hormones that are vital for development, growth, and metabolism. It is estimated that 15.8% of the general population has benign chronic enlargement of the TG, the so-called “thyroid goiter” (TGo). 1 This anterolateral mass of the neck has a prevalence ranging between 4.7% and 28.3% among populations. 1 Although the incidence of TGo in developed countries is approximately 4%, it is approximately 10 % in countries with iodine deficiency. 2 TGo may be a simple or a diffuse enlargement without nodules or may have a uninodular (with a 5% prevalence of malignancy) or multinodular (with a significantly lower prevalence of malignancy) pattern. 3 , 4 TGo may also extend inferiorly to the anterior mediastinum, with most substernal masses being benign multinodular lesions. However, TGo extension may be malignant or may rarely have an anteroposterior direction to the neck, into the retropharyngeal area (in depth extension). 5 TGo development has various etiologic factors, such as genetic mutations, smoking, natural goitrogens, autoimmune thyroid disease (Graves’ or Hashimoto’s disease), iodine deficiency, malignancy, dyshormonogenesis, infiltrative disease, and radiation. 2 , 6 Thyrotropin-secreting pituitary tumors and thyroid hormone resistance. 7 The syndromic background may include Pendred syndrome (an autosomal recessive disorder caused by a biallelic mutation in the PDS gene, leading to a pendrin protein defect) 8 and Cowden syndrome identified in Lhermitte-Duclos disease. 9 In the current case, a uninodular TGo was unilaterally identified in a female cadaver, causing displacement effects in adjacent neck structures. The detailed findings and clinical implications of this study are discussed. Case report During routine dissection of the neck of an 86-year-old female donated Greek cadaver, a TG variant was identified coexisting with a TGo originating from the left thyroid lobe. The variant is a pyramidal lobe located on the left side of the isthmus. The maximum anteroposterior diameter of the left TG lobe (thickness, with the TGo) was 3.8 mm and the maximum cephalocaudal diameter (height) was 4.4 mm. The contralateral lobe dimensions were 1.9 mm and 3.3 mm, respectively. A pyramidal lobe (2.5 mm height) was identified to the left of the midline of the TG isthmus ( Figure 1 ). TGo volume measurements were performed using ImageJ Software. 10 The surface area was calculated at 31.2 cm 3 . Owing to the presence of the TGo, the left common carotid artery (LCCA), along with the left internal jugular vein (LIJV), deviated 50.6 mm ipsilaterally from the midline of the neck (in an anterolateral direction). The right common carotid artery (RCCA) had a minor deviation of 30.8 mm, from the midline to the right side due to the proximity of the shifted trachea and esophagus with the RCCA origin. The trachea and esophagus deviated contralaterally to the TGo, 24.4 mm from the midline ( Figure 2 ). The TGo type, benign or malignant, cause of death, and cadaver’s medical history were unknown. The cadavers were donated to the Anatomy Department of the Medical School of the National and Kapodistrian University of Athens after written informed consent was obtained from the “Anatomical Gift Program”. Figure 1. A. The left-sided thyroid goiter (TGo) compressed and displaced ipsilaterally the left common carotid artery (LCCA) and the left internal jugular vein (LIJV), asterisk depicting the possible site of compression on the arterial wall. B. The pyramidal lobe (asterisk) left to the midline of the isthmus, R-right side, L-left side. C. The right-sided trachea and esophagus displacement. A–C. The angulated part of the LCCA. Figure 2. A, B. The neck area after the removal of the thyroid gland. The black line coursing the midline area of the neck. Right black line depicting the displacement of the trachea (T) and esophagus and indirectly the right common carotid artery (RCCA) and the left black line depicting the displacement of the left common carotid artery (LCCA). Discussion In the current case, the TG volume was 31.2 cm 3 , a high volume for a female subject according to Ovchinnikov et al., 11 who considered the TG volume enlarged when its values were higher than the normal range (4.55-18.0 cm 3 in females, and 7.7-22.6 cm 3 in males). Patients with TGo may have neck compression symptoms due to mass compression of the trachea, great vessels, or the esophagus. The substernal extension of the mass may also extend into the chest or posterior mediastinum. 12 In-depth extension of the mass may be located retropharyngeally. Neck vessels displacement In the current case, the development of an enlarged left-sided TGo in the anterolateral direction displaced the LCCA and the LIJV, probably resulting in vessel compression. The trachea had a lateral right-side displacement from the midline, and consequently further displaced the RCCA and RIJV. Ovchinnikov et al. 11 pointed out that vessel dysfunction can be detected when the TG volume is increased by 1.4 times, however in the current case, it is unknown if the TG lobe was increased, resulting in a compression effect. Common carotid artery (CCA) compression and/or stenosis may cause dizziness, weakness, and hypomnesia. Meanwhile, the potential outcomes are worse for the IJV 11 (with phlebectasia, decreased blood flow at the compression point, and increased velocity beneath that point). Both CCA and IJV compression outcomes were released with TGo resection, and the anatomy was reorganized. 11 Atherosclerosis tends to occur more often in arteries with inclined (angled) parts. Hence, in the current case, TGo and the resulting CCA deviation may potentially favor the development of atherosclerosis; however, larger angiographic studies should confirm this hypothesis. Stula et al. 13 highlighted that the repeated mechanical force exerted by sternocleidomastoid muscle contraction on the arterial wall has a slight impact on atherosclerotic plaque development. 14 In the current case, the existence of TGo further guided the CCA in proximity to or on the sternocleidomastoid muscle. Trachea and esophagus displacement In the current case, both tracheal and esophageal displacements were compressed on the RCCA. Tracheal inclination may lead to airway distress. 14 In Shaha’s study, 14 18% of patients with TG had acute airway problems requiring emergency care (and some of them intubation). Shaha 14 more often recorded tracheal (25%) than esophageal (18%) compression. In cases of esophageal compression, the most common clinical sign is dysphagia. 14 The symptoms of tracheal and esophageal displacement could lead to an earlier surgical intervention to relieve pulmonary and gastrointestinal symptoms. 15 It is of paramount importance to identify the tracheal location with clinical examination (palpation), as an indication of pulmonary pathology (e.g., pneumonia and atelectasia) or any other anomaly (TG). Surgical outcomes Airway problems due to an enlarged TGo may be an indication for mass resection. 15 Difficult airway management is a challenge for anesthesiologists, requiring proper assessment, planning, and sometimes a multidisciplinary approach to establish a secure airway. 16 Fiberoptic intubation is challenging in extreme cases of enlarged TGo coexisting with tracheal narrowing. In such cases, awake fiberoptic intubation and intraoperative anesthetic management of the patient are proposed to obtain a definitive airway through venovenous extracorporeal membrane oxygenation. 16 However, the type of TGo resection remains controversial. 15 Bann et al., 17 after investigating the effect of age on the distance of the TG from the sternal notch, observed that the TG was 15 mm closer to the sternal notch in patients aged 80 years and over than in patients age group–18-39 years. Thus, surgeons should direct their incision at a mean distance of 20 mm cephalad to the sternal notch. In the current case, the TG was identified 31.9 mm cephalad to the sternal notch, as supported by Bann et al. 17 This close incision to the TG may lead to iatrogenic injury of the adjacent neurovascular structures or even the TG. In cases of enlarged TGos, surgeons usually intraoperatively identify the mass development anteriorly and displacement of the adjacent structures (CCA) posteriorly, such as the posterior cervical triangle area. 18 Thus, in the current case, the CCA and IJV were displaced laterally rather than posteriorly. Linhares et al. 19 recorded the prevalence of substernal extension of the TGo in 10% of patients (109/1080 patients who underwent surgical resection for multinodular TGo). Patients with substernal TGo and progressive enlargement and/or compressive symptoms should undergo surgical excision. As in the current case, TGos may also coexist with TG variants, such as accessory lobes or tissues found superiorly, inferiorly, externally, and posteriorly to the TG. Such variants may be a source of pitfalls during preoperative diagnosis using scintigraphic imaging for thyroidectomies. 20 Rarely, thyroid tissue within the tracheal lumen could be a cause of upper respiratory obstruction and must be investigated to determine whether it is an ectopic tissue or malignant invasion of the trachea. 20 The pyramidal lobe overall pooled prevalence has been calculated at 42.82%, according to Ostrowski et al. 21 meta-analysis. The most common type of pyramidal lobe is its origin from the left lobe, similar to the current case, with a pooled prevalence of 40.10%. The second most common type is its origin from the right lobe (25.39%). The presence of this variant lobe can implicate thyroidectomy. If the variant lobe is affected by carcinoma along with the rest of the gland, its incomplete dissection could lead to metastasis to the adjacent lymph nodes. 21 Therefore, it is very important for head and neck surgeons to preoperatively identify this variation before thyroidectomy. 21 Conclusion The TG variant (pyramidal lobe) coexisted with a unilateral (left-side) unimodular enlarged TGo. The unimodular development of the mass caused an ipsilateral inclination of both the CCA and IJV and a contralateral deviation of the trachea and esophagus, which indirectly compressed the RCCA. CCA compression, stenosis, and angulation may cause dizziness, weakness, and hypomnesia. The potential outcomes were worse with IJV compression. Atherosclerosis tends to occur more often in arteries with inclined (angulated) parts. Author contributions Conceptualization: GTr, MP; methodology: GTs, LO; data collection: GTr, CK, MP; analysis and interpretation of results: AF, NZ; writing—original draft: GTr, GTs, MP; writing—review and editing: LO, AF, CK, NZ; critical revision of the manuscript: all authors; approval of the final version of the manuscript: all authors. Ethical approval As this is a single case report that is completely on a cadaver, and no ethical clearance was required, as a cadaver is used for teaching and research purposes. Consent The cadavers were donated to the Anatomy Department of the Medical School of the National and Kapodistrian University of Athens after written informed consent was obtained from the “Anatomical Gift Program”, for educational and research purposes. Data availability No data are associated with this article. Acknowledgements The authors would like to express their gratitude to body donors and their families for their contribution to medical education and anatomy research. References 1. Andersson M, Takkouche B, Egli I, et al. : Current global iodine status and progress over the last decade towards the elimination of iodine deficiency. PubMed. 2005. Reference Source 2. Medeiros-Neto G, Camargo RY, Tomimori EK: Approach to and Treatment of Goiters. Med. Clin. North Am. 2012 Mar; 96 (2): 351–368. Publisher Full Text 3. Brito JP, Yarur AJ, Prokop LJ, et al. : Prevalence of Thyroid Cancer in Multinodular Goiter Versus Single Nodule: A Systematic Review and Meta-Analysis. Thyroid. 2013 Apr; 23 (4): 449–455. PubMed Abstract | Publisher Full Text 4. Chen AY, Bernet VJ, Carty SE, et al. : American Thyroid Association Statement on Optimal Surgical Management of Goiter. Thyroid. 2014 Feb; 24 (2): 181–189. PubMed Abstract | Publisher Full Text 5. 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Bethesda, Maryland, USA: US. National Institutes of Health. Reference Source 11. Ovchinnikov EA, Maksimova IY, Agarkova DI, et al. : Compression of great cervical vessels in nodular goiter as indicated for thyroidectomy. Clin. Med. 2023; 3 : 97–102. Reference Source 12. Tsilivigkos C, Bishop MA: Substernal Thyroidectomy. PubMed. 2023. Reference Source 13. Stula I, Kojundzic SL, Guic MM, et al. : Carotid artery stenosis in correlation with neck and carotid artery anatomy. Vascular. 2021 May 30; 30 (3): 524–531. PubMed Abstract | Publisher Full Text 14. Shaha MDAR: Surgery for Benign Thyroid Disease Causing Tracheoesophageal Compression. Otolaryngol. Clin. N. Am. 1990 Jun; 23 (3): 391–401. PubMed Abstract | Publisher Full Text 15. Stang MT, Armstrong MJ, Ogilvie JB, et al. : Positional Dyspnea and Tracheal Compression as Indications for Goiter Resection. Arch. Surg. 2012 Jul 1; 147 (7): 621–626. PubMed Abstract | Publisher Full Text 16. Tan D, Zhang X: Awake Fiberoptic Nasotracheal Intubation and Anesthetic Management of a Patient With a Compressed and Deviated Airway From a Massive Thyroid Goiter: A Case Report. Cureus. 2023 Feb 21; 15 : e35278. PubMed Abstract | Publisher Full Text | Free Full Text 17. Bann DV, Kim Y, Zacharia T, et al. : The effect of aging on the anatomic position of the thyroid gland. Clin. Anat. 2016 Nov 27; 30 (2): 205–212. PubMed Abstract | Publisher Full Text 18. McBain LJ, Iwanaga J, Oskouian RJ, et al. : Bilateral Displacement of the Common Carotid Arteries by a Large Goiter. Cureus. 2018 Sep 13; 10 : e3298. PubMed Abstract | Publisher Full Text | Free Full Text 19. Linhares SM, Scola WH, Remer LF, et al. : Depth of mediastinal extension can predict sternotomy need for substernal thyroid goiters. Surgery. 2022 Nov; 172 (5): 1373–1378. PubMed Abstract | Publisher Full Text 20. Kowalczyk KA, Majewski A: Analysis of surgical errors associated with anatomical variations clinically relevant in general surgery. Review of the literature. Transl. Res. Anat. 2021 Jun; 23 : 100107. Publisher Full Text 21. Ostrowski P, Bonczar M, Iwanaga J, et al. : The prevalence and anatomy of the pyramidal lobe of the thyroid gland: A meta-analysis with implications for thyroid surgery. Clin. Anat. 2023 Sep; 36 (6): 937–945. PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 21 Mar 2024 ADD YOUR COMMENT Comment Author details Author details 1 Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Goudi, Athens, 11527, Greece 2 Department of Anatomical Dissection and Donation, Chair of Anatomy and Histology,, Medical University of Lodz, Lodz, Poland 3 Department of Anatomy, , School of Medicine, Democritus University of Thrace, Alexandroupoli, Greece 4 Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Athens, Greece Triantafyllou George Roles: Conceptualization, Data Curation, Investigation, Methodology, Validation, Writing – Original Draft Preparation Tsakotos George Roles: Formal Analysis, Funding Acquisition, Methodology, Resources, Visualization, Writing – Original Draft Preparation Łukasz Olewnik Roles: Methodology, Writing – Review & Editing Aliki Fiska Roles: Formal Analysis, Writing – Review & Editing Christos Koutserimpas Roles: Data Curation, Writing – Review & Editing Nicol Zielinska Roles: Data Curation, Writing – Review & Editing Piagkou Maria Roles: Conceptualization, Investigation, Resources, Supervision, Writing – Original Draft Preparation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 13 Sep 2024, 13:212 https://doi.org/10.12688/f1000research.146026.2 version 1 Published: 21 Mar 2024, 13:212 https://doi.org/10.12688/f1000research.146026.1 Copyright © 2024 George T et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article George T, George T, Olewnik Ł et al. Case Report: A pyramidal lobe coexisting with a left-sided thyroid goiter displacing trachea and esophagus: A cadaveric finding with clinical implications [version 2; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :212 ( https://doi.org/10.12688/f1000research.146026.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 21 Mar 2024 Views 0 Cite How to cite this report: Nur IH. Reviewer Report For: Case Report: A pyramidal lobe coexisting with a left-sided thyroid goiter displacing trachea and esophagus: A cadaveric finding with clinical implications [version 2; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :212 ( https://doi.org/10.5256/f1000research.160057.r271283 ) The direct URL for this report is: https://f1000research.com/articles/13-212/v1#referee-response-271283 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 10 Sep 2024 Ismail Hakki Nur , Erciyes University, Kayseri, Turkey Approved VIEWS 0 https://doi.org/10.5256/f1000research.160057.r271283 Since this research is a Case study, diagnosis and treatment are not possible. For this reason, I say no to the third evaluation question. The authors have evaluated the subject properly with a short and concise explanation. The rate ... Continue reading READ ALL Since this research is a Case study, diagnosis and treatment are not possible. For this reason, I say no to the third evaluation question. The authors have evaluated the subject properly with a short and concise explanation. The rate of encountering such cases in clinics is not low. 1- In order for the manuscript to be more fluid, I recommend that you pay attention to the corrections I have included in the manuscript. 2- Primary lobe should be added to the description section of Figure 1. 3- It is clinically important for the authors to indicate the diameter of the left CCA in their studies, if they have measurements. 4- The work done is acceptable. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? No Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Research is important to the clinic. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Nur IH. Reviewer Report For: Case Report: A pyramidal lobe coexisting with a left-sided thyroid goiter displacing trachea and esophagus: A cadaveric finding with clinical implications [version 2; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :212 ( https://doi.org/10.5256/f1000research.160057.r271283 ) The direct URL for this report is: https://f1000research.com/articles/13-212/v1#referee-response-271283 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 13 Sep 2024 George Triantafyllou , Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Goudi, Athens, 11527, Greece 13 Sep 2024 Author Response Thank you very much for your time and kind comments! Competing Interests: No competing interests were disclosed. Thank you very much for your time and kind comments! Thank you very much for your time and kind comments! Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 13 Sep 2024 George Triantafyllou , Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Goudi, Athens, 11527, Greece 13 Sep 2024 Author Response Thank you very much for your time and kind comments! Competing Interests: No competing interests were disclosed. Thank you very much for your time and kind comments! Thank you very much for your time and kind comments! Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Chatzioglou G. Reviewer Report For: Case Report: A pyramidal lobe coexisting with a left-sided thyroid goiter displacing trachea and esophagus: A cadaveric finding with clinical implications [version 2; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :212 ( https://doi.org/10.5256/f1000research.160057.r259614 ) The direct URL for this report is: https://f1000research.com/articles/13-212/v1#referee-response-259614 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 16 May 2024 Gkionoul Chatzioglou , Istanbul Health and Technology University, İstanbul, Turkey Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.160057.r259614 The case report describes a unilateral thyroid goiter (TGo) coexisting with a thyroid gland variation (pyramidal lobe) in an aged female cadaver. The authors meticulously explain the thyroid gland's dimensions and the displacement implications on surrounding neck tissues. While the ... Continue reading READ ALL The case report describes a unilateral thyroid goiter (TGo) coexisting with a thyroid gland variation (pyramidal lobe) in an aged female cadaver. The authors meticulously explain the thyroid gland's dimensions and the displacement implications on surrounding neck tissues. While the paper provides useful information about the anatomical changes and therapeutic implications of TGo, several issues require more discussion and clarification. The authors successfully demonstrate the importance of anatomical variations in thyroid morphology and their clinical implications. However, a more thorough examination of the occurrence and clinical significance of pyramidal lobes in thyroid surgery would improve the paper's usefulness. Additionally, evaluating the potential impact of thyroid variations on preoperative imaging accuracy and surgical outcomes may provide clinicians with significant information. Overall, the case report is well-written and organized, with detailed explanations of anatomical findings and displacement effects. Minor adjustments, such as improving the clarity of certain technical terms and abbreviations and including a brief summary of major findings and consequences, will improve the manuscript's readability and accessibility. In conclusion, the case report provides important anatomical insights into the coexistence of a thyroid gland variation and unilateral thyroid goiter, which has consequences for surgical planning and patient treatment. More research on the clinical significance of thyroid variations and their impact on surgical outcomes is needed to expand our understanding of thyroid pathophysiology and improve patient treatment. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Human anatomy and variations I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Chatzioglou G. Reviewer Report For: Case Report: A pyramidal lobe coexisting with a left-sided thyroid goiter displacing trachea and esophagus: A cadaveric finding with clinical implications [version 2; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :212 ( https://doi.org/10.5256/f1000research.160057.r259614 ) The direct URL for this report is: https://f1000research.com/articles/13-212/v1#referee-response-259614 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 13 Sep 2024 George Triantafyllou , Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Goudi, Athens, 11527, Greece 13 Sep 2024 Author Response Thank you very much for your time and kind comments. A brief paragraph was added explaining the pyramidal lobe anatomy and surgical significance. With best regards! Competing Interests: No competing interests were disclosed. Thank you very much for your time and kind comments. A brief paragraph was added explaining the pyramidal lobe anatomy and surgical significance. With best regards! Thank you very much for your time and kind comments. A brief paragraph was added explaining the pyramidal lobe anatomy and surgical significance. With best regards! Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 13 Sep 2024 George Triantafyllou , Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Goudi, Athens, 11527, Greece 13 Sep 2024 Author Response Thank you very much for your time and kind comments. A brief paragraph was added explaining the pyramidal lobe anatomy and surgical significance. With best regards! Competing Interests: No competing interests were disclosed. Thank you very much for your time and kind comments. A brief paragraph was added explaining the pyramidal lobe anatomy and surgical significance. With best regards! Thank you very much for your time and kind comments. A brief paragraph was added explaining the pyramidal lobe anatomy and surgical significance. With best regards! Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 21 Mar 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 13 Sep 24 Version 1 21 Mar 24 read read Gkionoul Chatzioglou , Istanbul Health and Technology University, İstanbul, Turkey Ismail Hakki Nur , Erciyes University, Kayseri, Turkey Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Nur I. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 10 Sep 2024 | for Version 1 Ismail Hakki Nur , Erciyes University, Kayseri, Turkey 0 Views copyright © 2024 Nur I. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Since this research is a Case study, diagnosis and treatment are not possible. For this reason, I say no to the third evaluation question. The authors have evaluated the subject properly with a short and concise explanation. The rate of encountering such cases in clinics is not low. 1- In order for the manuscript to be more fluid, I recommend that you pay attention to the corrections I have included in the manuscript. 2- Primary lobe should be added to the description section of Figure 1. 3- It is clinically important for the authors to indicate the diameter of the left CCA in their studies, if they have measurements. 4- The work done is acceptable. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? No Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Research is important to the clinic. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 13 Sep 2024 George Triantafyllou, Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Goudi, Athens, 11527, Greece Thank you very much for your time and kind comments! View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Nur IH. Peer Review Report For: Case Report: A pyramidal lobe coexisting with a left-sided thyroid goiter displacing trachea and esophagus: A cadaveric finding with clinical implications [version 2; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :212 ( https://doi.org/10.5256/f1000research.160057.r271283) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-212/v1#referee-response-271283 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Chatzioglou G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 16 May 2024 | for Version 1 Gkionoul Chatzioglou , Istanbul Health and Technology University, İstanbul, Turkey 0 Views copyright © 2024 Chatzioglou G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The case report describes a unilateral thyroid goiter (TGo) coexisting with a thyroid gland variation (pyramidal lobe) in an aged female cadaver. The authors meticulously explain the thyroid gland's dimensions and the displacement implications on surrounding neck tissues. While the paper provides useful information about the anatomical changes and therapeutic implications of TGo, several issues require more discussion and clarification. The authors successfully demonstrate the importance of anatomical variations in thyroid morphology and their clinical implications. However, a more thorough examination of the occurrence and clinical significance of pyramidal lobes in thyroid surgery would improve the paper's usefulness. Additionally, evaluating the potential impact of thyroid variations on preoperative imaging accuracy and surgical outcomes may provide clinicians with significant information. Overall, the case report is well-written and organized, with detailed explanations of anatomical findings and displacement effects. Minor adjustments, such as improving the clarity of certain technical terms and abbreviations and including a brief summary of major findings and consequences, will improve the manuscript's readability and accessibility. In conclusion, the case report provides important anatomical insights into the coexistence of a thyroid gland variation and unilateral thyroid goiter, which has consequences for surgical planning and patient treatment. More research on the clinical significance of thyroid variations and their impact on surgical outcomes is needed to expand our understanding of thyroid pathophysiology and improve patient treatment. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Human anatomy and variations I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 13 Sep 2024 George Triantafyllou, Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Goudi, Athens, 11527, Greece Thank you very much for your time and kind comments. A brief paragraph was added explaining the pyramidal lobe anatomy and surgical significance. With best regards! View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Chatzioglou G. Peer Review Report For: Case Report: A pyramidal lobe coexisting with a left-sided thyroid goiter displacing trachea and esophagus: A cadaveric finding with clinical implications [version 2; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :212 ( https://doi.org/10.5256/f1000research.160057.r259614) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-212/v1#referee-response-259614 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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