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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.