RESUMEN
OBJECTIVES: Lingual thyroid is a rare condition that affects approximately 1 in 100,000 individuals. Although it is usually detected in the pediatric population through newborn screening tests or evaluation of congenital hypothyroidism, there are cases in which it remains undetected until adulthood or until symptoms arise because of glandular enlargement. The possible symptoms of lingual thyroid include foreign body sensation in the throat, dysphagia, dyspnea, and hemorrhage. Several cases of lingual thyroid are asymptomatic and accompanied by subclinical hypothyroidism. Herein, we present three cases of lingual thyroid treated with thyroid hormone suppressive therapy. CASE PRESENTATION: The three patients sought medical attention because of a sore throat or foreign body sensation in the throat. Their newborn screening tests and developmental histories were normal. These patients exhibited subclinical hypothyroidism and were treated with hormone suppression therapy. CONCLUSIONS: Patients with lingual thyroid frequently exhibit subclinical hypothyroidism. Hormone treatment may help to reduce the size of the ectopic thyroid and improve symptoms. If an increase in size is noted during follow-up or symptoms do not improve, surgical treatments may be considered.
Asunto(s)
Hipotiroidismo , Tiroides Lingual , Humanos , Tiroides Lingual/complicaciones , Tiroides Lingual/diagnóstico , Tiroides Lingual/patología , Hipotiroidismo/complicaciones , Hipotiroidismo/tratamiento farmacológico , Hipotiroidismo/patología , Femenino , Masculino , Niño , Preescolar , Pronóstico , Tiroxina/uso terapéuticoRESUMEN
The lingual ectopic thyroid is a sporadic case. Based on the medical records of Dr. Soetomo General Academic Hospital, Surabaya, they only found one case of ectopic thyroid at least in the last ten years. There is no consensus in the literature about the best therapeutic strategy in managing ectopic thyroid. A 20-year-old female patient with a diagnosis of ectopic lingual thyroid. She has complained of lumps at the base of her tongue since she was ten years old. She performed a partial excision of the tumor with a transoral approach. Partial excision of the lingual ectopic thyroid results in an airway free from obstruction, leaving the rest of the thyroid tissue functioning so that the patient does not require lifelong hormone treatment but has the potential for hypertrophy to recur. The transoral approach provides post-operative results that maintain aesthetic function and reduce morbidity and hospitalization. Partial excision of lingual ectopic thyroid gives good results.
Asunto(s)
Tiroides Lingual , Disgenesias Tiroideas , Humanos , Femenino , Adulto Joven , Adulto , Niño , Tiroides Lingual/diagnóstico , Tiroides Lingual/cirugía , Lengua/cirugía , Disgenesias Tiroideas/diagnóstico , Disgenesias Tiroideas/cirugía , Tiroidectomía/métodosRESUMEN
PURPOSE: To review the management of patients with lingual thyroid (LT) causing upper airway obstruction and to suggest a diagnostic and therapeutic workflow. METHODS: A PubMed review of published cases from January 1980 up to December 2020 of LT causing upper airway obstruction. We selected cases of confirmed LTs that presented with non-state-dependent airway obstruction. An illustrative case report is presented. RESULTS: Twenty-one articles fulfilling the inclusion criteria were found, reporting 24 cases (7 neonatal, 2 pediatric and 15 adults). The main presenting symptoms was dyspnea with increased work of breathing, followed by dysphagia and stridor most commonly in neonates. At least one imaging modality was performed in all patients. Thyroid function was altered in half the patients and normal in the other half. The LT was the only thyroid tissue in all cases except 2. Altogether, 5/24 patients required tracheostomies and two-thirds of the patients underwent surgical resection of the LT (mostly transoral). Also 2/3 of the patients received thyroid replacement therapy. After a median follow-up of 17 months, airway symptoms had fully resolved for all patients but one. CONCLUSION: While rare, ectopic LTs should be considered in the differential diagnosis of stridor, dyspnea and airway obstruction. In neonates, concomitant presence of hypothyroidism on neonatal screening and airway obstruction should prompt the search for a LT. Early identification and thyroid replacement therapy seem to significantly relieve symptoms of upper airway obstruction, but severe obstruction and concomitant airway lesions may require more definitive management approaches.
Asunto(s)
Obstrucción de las Vías Aéreas , Tiroides Lingual , Adulto , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/cirugía , Niño , Disnea/diagnóstico , Disnea/etiología , Humanos , Recién Nacido , Tiroides Lingual/complicaciones , Tiroides Lingual/diagnóstico , Tiroides Lingual/terapia , Ruidos Respiratorios/etiología , Traqueostomía/efectos adversosRESUMEN
INTRODUCTION: Ectopic thyroid tissue presenting at the base of the tongue, called lingual thyroid, is a clinical rarity. Clinical presentation varies depending upon either the severity of regional symptoms associated with the enlargement of gland size, or the features related to thyroid dysfunction. PATIENT CONCERNS: We reported a case of a 29-year-old female who presented with symptoms of easy fatigue and depression for 3 months. DIAGNOSIS: After a series of diagnostic workup, the lingual thyroid with severe hypothyroidism was diagnosed. INTERVENTION AND OUTCOME: She received conservative treatment with thyroid hormone replacement and the symptoms improved significantly. LESSONS: Lingual thyroid is a rare entity that needs careful diagnostic workup including clinical examination, biochemical tests, imaging methods such as ultrasonography, scintigraphy, computed tomography, magnetic resonance imaging, and fine-needle aspiration cytology to plan the management. Lingual thyroid with hypothyroidism and no neck regional symptoms can be conservatively treated and requires regular follow-up for the prevention of potential risk of malignant transformation.
Asunto(s)
Hipotiroidismo/clasificación , Tiroides Lingual/complicaciones , Tiroides Lingual/diagnóstico , Adulto , Femenino , Humanos , Hipotiroidismo/complicaciones , Hipotiroidismo/tratamiento farmacológico , Tiroides Lingual/diagnóstico por imagen , Tiroides Lingual/patología , Hormonas Tiroideas/uso terapéuticoRESUMEN
A 34-year-old woman with a history of congenital hypothyroidism and 15 years of obstructive sleep apnoea was admitted with a left submandibular swelling secondary to a dental infection. A CT scan of the neck identified an incidental 27 mm tongue base mass and the absence of any cervical thyroid tissue. This mass was not observable on examination of the oropharynx but was seen on fine nasendoscopy while thyroid function tests showed good thyroid stimulating hormone suppression. Her acute dental infection was treated and, following multidisciplinary team discussion, she was diagnosed with an ectopic lingual thyroid. She was offered different management options including no intervention and radio-iodide treatment but opted for transoral robotic resection. The lesion was resected en bloc with clear margins and histology confirmed lingual thyroid tissue. Since the procedure, she has remained free of sleep apnoea with a significantly improved quality of life.
Asunto(s)
Tiroides Lingual , Procedimientos Quirúrgicos Robotizados , Robótica , Apnea Obstructiva del Sueño , Adulto , Femenino , Humanos , Tiroides Lingual/diagnóstico , Tiroides Lingual/diagnóstico por imagen , Calidad de Vida , Apnea Obstructiva del Sueño/etiología , Apnea Obstructiva del Sueño/cirugíaRESUMEN
Lingual thyroid is secondary to the absence of migration of the thyroid diverticulum. The latter develops locally, that is, at the level of the foramen caecum. It may be the only thyroid tissue present, or it may be associated with a normal thyroid. The occurrence of a lingual thyroid carcinoma is rare accounting for about thirty cases described in the literature. This study reports a case of vesicular carcinoma in lingual thyroid.
Asunto(s)
Tiroides Lingual/patología , Neoplasias de la Tiroides/patología , Femenino , Humanos , Tiroides Lingual/diagnóstico , Persona de Mediana Edad , Neoplasias de la Tiroides/diagnósticoRESUMEN
A 22-year-old man presented to our department with a mass on the base of his tongue. He had a cavernous voice causing a moderate speech disorder, and he had some difficulty in swallowing. He had severe problems with sleep, associated with apnoea. In a fibreoptic laryngoscopic examination, a large 4×5 cm vascular mass was detected extending from the base of the patient's tongue to his epiglottis. It covered the epiglottis. Thyroid scintigraphy showed only thyroid tissue on the base of the tongue. Surgery was initiated transorally under the guidance of a rigid endoscope, but as the mass continued extended to the epiglottis, a transhyoid approach was taken. At a 3-month follow-up, the patient was symptom free. Electrocautery-assisted resection under the guidance of a rigid endoscope can reliably be used in surgery of a lingual thyroid. However, a transhyoid approach provides a better view and also helps in achieving haemostasis.
Asunto(s)
Epiglotis/patología , Laringoscopía , Tiroides Lingual/diagnóstico , Procedimientos Quirúrgicos Orales/métodos , Apnea Obstructiva del Sueño/etiología , Trastornos del Habla/etiología , Lengua/cirugía , Adulto , Epiglotis/cirugía , Estudios de Seguimiento , Humanos , Tiroides Lingual/complicaciones , Tiroides Lingual/cirugía , Masculino , Apnea Obstructiva del Sueño/patología , Apnea Obstructiva del Sueño/cirugía , Trastornos del Habla/patología , Lengua/anomalías , Lengua/patologíaAsunto(s)
Enfermedades de la Lengua/patología , Lengua/anatomía & histología , Anquiloglosia , Diagnóstico Diferencial , Glositis Migratoria Benigna/diagnóstico , Glositis Migratoria Benigna/tratamiento farmacológico , Glositis Migratoria Benigna/etiología , Glositis Migratoria Benigna/patología , Humanos , Inmunosupresores/uso terapéutico , Tiroides Lingual/diagnóstico , Tiroides Lingual/patología , Melanoma/diagnóstico , Melanosis/diagnóstico , Melanosis/etiología , Melanosis/patología , Anomalías de la Boca/diagnóstico , Anomalías de la Boca/patología , Anomalías de la Boca/cirugía , Síndrome de Peutz-Jeghers/diagnóstico , Síndrome de Peutz-Jeghers/patología , Psoriasis/complicaciones , Fumar/efectos adversos , Lengua/irrigación sanguínea , Lengua/patología , Enfermedades de la Lengua/diagnóstico , Enfermedades de la Lengua/etiología , Neoplasias de la Lengua/diagnóstico , Lengua Fisurada/diagnóstico , Lengua Fisurada/etiología , Lengua Fisurada/patología , Lengua Vellosa/diagnóstico , Lengua Vellosa/etiología , Lengua Vellosa/patología , Várices/diagnóstico , Várices/patologíaRESUMEN
This case study presents an incidental noting of a lingual thyroid on thyroid scintigraphy that had implications in later breast surgery. This information changed patient management and mitigated risk during intubation for breast cancer surgery.
Asunto(s)
Hallazgos Incidentales , Tiroides Lingual/diagnóstico , Tiroides Lingual/cirugía , Anciano , Femenino , Humanos , Tiroides Lingual/diagnóstico por imagen , Pertecnetato de Sodio Tc 99m , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos XAsunto(s)
Quistes/congénito , Enfermedades de la Laringe/congénito , Quistes/diagnóstico por imagen , Quistes/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Enfermedades de la Laringe/diagnóstico por imagen , Enfermedades de la Laringe/cirugía , Laringoscopía , Terapia por Láser , Tiroides Lingual/diagnósticoRESUMEN
BACKGROUND: Surgical excision of an ectopic lingual thyroid has traditionally been associated with significant morbidity and has therefore been reserved for patients with severe obstructive symptoms or suspected malignancy. Transoral robotic surgery (TORS) has provided a minimally invasive approach to completely and safely excise ectopic lingual thyroid. METHODS: Three index cases were identified from the detailed clinical database of TORS patients. A systematic review of the management of ectopic lingual thyroid in the English literature was performed. RESULTS: TORS-assisted excision of a lingual thyroid gland was successfully performed in 3 patients with excellent functional outcomes CONCLUSION: TORS-assisted excision of an ectopic lingual thyroid is a safe and feasible treatment modality with minimal morbidity, and, in experienced hands, should be offered as a valid treatment for this pathology.
Asunto(s)
Tiroides Lingual/cirugía , Cirugía Endoscópica por Orificios Naturales , Robótica , Tiroidectomía/instrumentación , Adulto , Medicina Basada en la Evidencia , Estudios de Factibilidad , Femenino , Humanos , Hipotiroidismo/etiología , Tiroides Lingual/complicaciones , Tiroides Lingual/diagnóstico , Persona de Mediana Edad , Boca , Cirugía Endoscópica por Orificios Naturales/métodos , Tiroidectomía/métodos , Resultado del TratamientoRESUMEN
Examination of the oral cavity can provide significant diagnostic information regarding the general health of the patient. The oral cavity is affected by a multitude of pathologic conditions of variable cause and significance; however, there are numerous normal variations of oral soft tissue structures that may resemble a pathologic state. Understanding these variations assists practitioners to discriminate between normal versus abnormal findings and determine the appropriate course of management, if necessary.
Asunto(s)
Enfermedades de la Boca/diagnóstico , Enfermedades de la Boca/terapia , Atención Primaria de Salud , Traumatismos de los Tejidos Blandos/diagnóstico , Traumatismos de los Tejidos Blandos/terapia , Anquiloglosia , Diagnóstico Bucal , Humanos , Leucoedema Bucal/diagnóstico , Leucoedema Bucal/terapia , Tiroides Lingual/diagnóstico , Tiroides Lingual/terapia , Anomalías de la Boca/diagnóstico , Anomalías de la Boca/terapiaRESUMEN
Lingual thyroid is the most common presentation of ectopic thyroid tissue. In contrast, to that laryngeal location is extremely rare. We report a case of 59 years old woman with a history of progressive dyspnea and nodular thyroid goiter. Endoscopic examination revealed subglottic smooth tumor of the right side of the larynx. CT scans revealed mass localized in infraglottic part of the larynx, causing infraglottic stenosis. The biopsy of the tumor revealed: Struma nodosa. Reviewing the literature we found only seven cases described. We present development of the thyroid gland and origins causing ectopy.
Asunto(s)
Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/cirugía , Tiroides Lingual/diagnóstico , Tiroides Lingual/cirugía , Disgenesias Tiroideas/diagnóstico , Disgenesias Tiroideas/cirugía , Femenino , Humanos , Laringe/diagnóstico por imagen , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , UltrasonografíaRESUMEN
After total thyroidectomy for papillary thyroid carcinoma, a 37-year-old woman underwent a 2-mCi (131)I whole-body scan which demonstrated focal uptake in the anterior neck and in the oropharynx. Preoperative contrast-enhanced neck computed tomography demonstrated a small enhancing nodule typical for ectopic thyroid at the tongue base. She was then treated with 150 mCi (131)I. Small asymptomatic lingual thyroid remnants typically do not affect high-dose (131)I therapy.
Asunto(s)
Tiroides Lingual/diagnóstico , Tiroides Lingual/cirugía , Orofaringe/metabolismo , Tiroidectomía , Imagen de Cuerpo Entero , Adulto , Transporte Biológico , Femenino , Humanos , Radioisótopos de Yodo/metabolismo , Tiroides Lingual/metabolismoRESUMEN
OBJECTIVE: We report an extremely rare case of the simultaneous occurrence of a thyroglossal duct cyst and a lingual thyroid in the absence of an orthotopic thyroid gland, in a seven-year-old girl from South India. METHOD: Case report and a review of the English language literature on the subject. RESULTS: The patient presented with a mass on the tongue that had been present for three years, and an anterior neck swelling that had been present for two years. Examination revealed a midline, pinkish, firm mass present on the posterior one-third of the tongue. The neck showed a midline cystic swelling in the infrahyoid position. Radiological imaging confirmed the clinical findings, revealing the absence of her thyroid gland in the normal location. Sistrunk's procedure was performed leaving behind a lingual thyroid. At 13-month follow up, the patient was euthyroid with no recurrence. CONCLUSION: To our knowledge the association of a lingual thyroid and a thyroglossal cyst has only been reported once in the literature. The presence of a lingual thyroid in the absence of a normally located thyroid gland or functioning thyroid tissue along the thyroglossal tract, confirmed by radionuclide and computed tomography imaging, may indicate the failure of the normal descent of the thyroid gland during embryonic development. This probable absence of the descent of the thyroid raises questions regarding the origin of thyroglossal duct cysts.