Lingual thyroid with severe hypothyroidism: A case report.

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.

Transoral robotic resection of a lingual thyroid: a novel treatment for obstructive sleep apnoea.

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.

Obstructive lingual thyroid; suprahyoid intracervical surgical procedure - A case report. / Tiroides lingual obstructivo, intervención quirúrgica vía transcervical suprahioidea: reporte de un caso.

INTRODUCTION: The treatment of lingual thyroid is controversial and should be individualized. Options include hormonal replacement, surgery in the presence of bleeding and obstruction of the airway and the digestive tract, and radioisotope therapy. CLINICAL CASE: 8-year-old girl presenting with discomfort when swallowing. A pink, well-vascularized mass, not painful or ulcerated, protruding from the base of the tongue and virtually closing the whole oropharynx, was observed. Absence of thyroid tissue in its normal position was reported by the ultrasound department. Cervical computed axial tomography confirmed the diagnosis and the presence of pharyngeal obstruction. Thyroid hormone replacement was established. As a result of dysphagia symptom progression, surgery was indicated. Thyroid removal was performed by means of a cervicotomy, with re-implantation of thyroid tissue laminas. The postoperative course was uneventful and replacement treatment was maintained, with an excellent clinical status four years later.

INTRODUCCION: El tratamiento de la tiroides lingual es controvertido y debe individualizarse. Las opciones incluyen el reemplazo hormonal, cirugía en presencia de hemorragia y obstrucción de la vía aérea o digestiva, y la terapia con radioisótopos. CASO CLINICO: Niña de 8 años de edad, con molestias a la deglución. Se observa masa rosada, muy vascularizada, no dolorosa ni ulcerada, que protruye desde la base de la lengua y cierra prácticamente toda la orofaringe. Ecografía informa ausencia de tejido tiroideo en su posición normal. Tomografía axial computarizada cervical comprueba el diagnóstico y la obstrucción faríngea. Se indicó tratamiento sustitutivo de las hormonas tiroideas. Ante la progresión de los síntomas de disfagia, se indicó cirugía. Se describe la exéresis tiroidea por vía cervical, suprahioidea, con reimplante de láminas de tejido tiroideo. Evolucionó sin complicaciones y se mantiene tratamiento sustitutivo, con excelente estado clínico después de cuatro años.

A case report of coexistence of ectopic lingual thyroid with hypoplastic normal thyroid gland.

Ectopic lingual thyroid along with a normally located thyroid gland is an uncommon condition caused by an aberrant descent of thyroid during embryogenesis. It is more common among females and expresses during puberty, pregnancy and menopause. It is mostly associated with hypothyroidism. Patient usually presents with complaints of dysphagia, dysphonia and suffocation. Treatment of choice depends upon the primary complaint of the patient. We present the case of a young female who underwent tracheostomy to relieve respiratory tract obstruction during puberty and was later diagnosed as a case of ectopic lingual thyroid by radioactive iodine uptake and CT scan imaging. She had an associated hypothyroidism; patient was then put on thyroxine and after making her euthyroid she was operated by transoral route and her ectopic lingual thyroid was removed. She was discharged on a maintenance dose of thyroxin.

Tiroides lingual obstructivo, intervención quirúrgica vía transcervical suprahioidea: reporte de un caso / Obstructive lingual thyroid; suprahyoid intracervical surgical procedure - A case report

Introducción: El tratamiento de la tiroides lingual es controvertido y debe individualizarse. Las opciones incluyen el reemplazo hormonal, cirugía en presencia de hemorragia y obstrucción de la vía aérea o digestiva, y la terapia con radioisótopos. Caso clínico: Niña de 8 años de edad, con molestias a la deglución. Se observa masa rosada, muy vascularizada, no dolorosa ni ulcerada, que protruye desde la base de la lengua y cierra prácticamente toda la orofaringe. Ecografía informa ausencia de tejido tiroideo en su posición normal. Tomografía axial computarizada cervical comprueba el diagnóstico y la obstrucción faríngea. Se indicó tratamiento sustitutivo de las hormonas tiroideas. Ante la progresión de los síntomas de disfagia, se indicó cirugía. Se describe la exéresis tiroidea por vía cervical, suprahioidea, con reimplante de láminas de tejido tiroideo. Evolucionó sin complicaciones y se mantiene tratamiento sustitutivo, con excelente estado clínico después de cuatro años

Introduction: The treatment of lingual thyroid is controversial and should be individualized. Options include hormonal replacement, surgery in the presence of bleeding and obstruction of the airway and the digestive tract, and radioisotope therapy. Clinical case: 8-year-old girl presenting with discomfort when swallowing. A pink, well-vascularized mass, not painful or ulcerated, protruding from the base of the tongue and virtually closing the whole oropharynx, was observed. Absence of thyroid tissue in its normal posi-tion was reported by the ultrasound department. Cervical computed axial tomography confirmed the diagnosis and the presence of pharyngeal ob-struction. Thyroid hormone replacement was established. As a result of dysphagia symptom progression, surgery was indicated. Thyroid removal was performed by means of a cervicotomy, with re-implantation of thyroid tissue laminas. The postoperative course was uneventful and replacement treatment was maintained, with an excellent clinical status four years later

Resección transoral endoscópica de tiroides lingual / Endoscopic transoral resection of lingual thyroid

La presencia de tejido tiroideo ectópico en la base de la lengua es muy infrecuente, y la mayoría de los pacientes tienen hipotiroidismo. La indicación de tratamiento depende de la presencia o no de síntomas; la cirugía es la primera elección. Diversas técnicas quirúrgicas han sido descriptas, pero para nosotros el abordaje transoral con endoscopios constituye la mejor opción, por la buena exposición y la mínima morbilidad que produce. Se describe el caso clínico de una mujer que consultó por odinofagia, con diagnóstico de tiroides lingual y que fue tratada con éxito mediante un abordaje transoral con asistencia de endoscopios. (AU)

The presence of ectopic thyroid tissue at the base of the tongue is very rare, and most patients have hypothyroidism. The indication of treatment depends on the presence or not of symptoms, surgery being the first choice. Various surgical techniques have been described, being for us the transoral approach with endoscopes the best option, due to the good exposure, and minimum morbidity that it produces. The clinical case of a woman who consulted for odynophagia, with a diagnosis of lingual thyroid and who was successfully treated by a transoral approach with endoscopic assistance is described. (AU)

Congenital Oral Masses: An Anatomic Approach to Diagnosis.

Although congenital oral masses are rare, they are readily detectable during fetal US screening. Most congenital oral masses are benign, but some may cause mechanical airway obstruction, resulting in poor outcomes at delivery. The radiologist's ability to describe these abnormalities and their physiologic sequelae accurately can have a substantial effect on perinatal treatment. Furthermore, despite being rare, congenital oral lesions encountered at screening and at follow up fetal MRI provide the opportunity to make a specific diagnosis by following a simple anatomic approach. This article describes an anatomic algorithm as the framework for accurate diagnosis of congenital oral lesions. The imaging appearance of the most common congenital oral cavity neoplasms is outlined, including vascular anomalies, epulides, choristomas, congenital lingual thyroid anomalies, lingual hamartomas, and epignathi, and other conditions that mimic these at US. Also reviewed are perinatal management of masses that affect the fetal airway and the imaging features key to optimizing delivery outcomes. Online supplemental material is available for this article. ©RSNA, 2019.

A young woman with oligomenorrohea and dysphagia.

A 35-year-old house wife attended our clinic with oligomenorrhea for the last three months. She also complained of diffuse body ache, joint pain and decreased bowel movements. Very often she experienced choking sensation in the throat and had difficulty in swallowing solid food. On examination, goitre was absent but a globular pink colour mass was detected at the base of the tongue.

Transposition of lingual thyroid gland to the submandibular region by transoral approach.

The purpose of this case report is to demonstrate surgical technique of only functional but symptomatic lingual thyroid gland transposition to submandibular region by transoral approach without mandibulotomy and tongue-splitting. A 37-year-old female patient was admitted to our hospital with dysphagia and apnea symptoms. Physical examination revealed 3cm×3cm lingual thyroid gland was detected at the tongue base. The patient was euthyroid and thyroid gland was not detected in the neck. Under general anesthesia, right submandibular gland excision and transposition of lingual thyroid tissue to submandibular region with dorsal lingual artery axis flap were performed by transoral approach. Thyroid hormones remained normal in the postoperative period. In conclusion transoral transposition of lingual thyroid to submandibular region as a flap without mandibulotomy is a minimally invasive and function preserving alternative approach. Besides preserving thyroid functions, this transoral surgical technique can be preferred by patients who avoid skin incision for esthetic concerns.

Glándula tiroides lingual: diagnóstico y tratamiento / Lingual thyroid gland: diagnosis and treatment

La presencia de glándula tiroidea ectópica es una entidad rara. La tiroides lingual es la ectopía mas frecuente, predominando en mujeres. Este tejido glandular es pasible de sufrir todas las patologías que pueden afectar a la glándula normotópica, pudiendo ser sintomática o asintomática. Se presenta un caso de tiroides lingual en una paciente previamente tiroidectomizada que consultó por disnea y disfagia en la unidad de Cirugía de Cabeza y Cuello del Servicio de Otorrinolaringología del Hospital Central del Instituto de Previsión Social, Asunción, Paraguay. La paciente recibía tratamiento hormonal de reemplazo,mostrando examen funcional normal. La semiología permitió observar un abombamiento de la base de la lengua. La fibroscopía mostró un tumor en base de lengua de unos 3 cm de diámetro, que pudo evaluarse correctamente con una tomografía computada. Ante la sospecha de una tiroides lingual se realizó un centellograma que demostró captación en piso de cavidad oral. Se realizó excéresis tumoral a través de una faringotomía suprahioidea, previa traqueostomía proofiláctica. El informe de Anatomía Patológica confirmó el diagnóstico de bocio coloide ectópico.

The presence of ectopic thyroid gland is a rare entity. The lingual thyroid is the most frequent ectopy, predominating in women. This glandular tissue is capable of suffering all the pathologies that can affect the normotopic gland, being able to be symptomatic or asymptomatic. We present a case of lingual thyroid in a previously thyroidectomized patient who consulted for dyspnea and dysphagia in the Head and Neck Surgery Unit of the Otolaryngology Service of the Central Hospital of the Institute of Social Prevision, Asuncion, Paraguay. The patient received hormone replacement therapy, showing normal functional examination. Semiology allowed to observe a bulging of the base of the tongue. The fibroscopy showed atongue-based tumor about 3 cm in diameter, which could be correctly evaluated with computed tomography.Suspicion of a lingual thyroid was performed with a scintigram demonstrating uptake in the oral cavity floor.Tumor excision was performed through a suprahyoid pharyngotomy, following a prophylactic tracheostomy.The Pathologic Anatomy report confirmed the diagnosis of ectopic colloid goitre.

A 51-Year-Old Woman With Hypoacusia and Increased Respiratory Effort in the Supine Position and OSA.

A 51-year-old woman with a personal history of vitiligo, normal thyroid hormone studies, a simple hysterectomy for multiple uterine myomas at age 35 years, and childhood adenotonsillectomy was seen for progressive hearing loss. She reported mild asthenia, cold intolerance, mild dysphagia with frequent choking while eating and drinking, and a progressive increase in inspiratory effort, especially in the supine position. Her partner described a progressively worsening history of snoring and witnessed apneic episodes, mostly in the supine position. Mild to moderate daytime sleepiness was also present.

Lingual Thyroid Ectopia: Diagnostic SPECT/CT Imaging and Radioactive Iodine Treatment.

BACKGROUND: Lingual thyroid is a rare abnormality of thyroid development that is usually treated conservatively with levothyroxine replacement. Rarely, it becomes large enough to cause obstructive symptoms in the oral cavity, requiring definitive treatment. PATIENT FINDINGS: This study reports on three patients with lingual thyroid treated with radioactive iodine-131 ((131)I) with successful radioablation of their ectopic thyroid tissues. Measurement of 24-hour radioactive iodine uptake within thyroidal tissues and hybrid single-photon emission computed tomography/computed tomography imaging using either iodine-123 or technetium-99m pertechnetate scans were performed in all patients demonstrating the location and size of lingual thyroid and absence of an orthotopic thyroid gland. SUMMARY: The aim of this study was to describe nonsurgical management of obstructive lingual thyroid tissue with (131)I therapy for lingual thyroid radioablation. Patients were prepared with a low-iodine diet and levothyroxine withdrawal prior to radioablation for optimizing (131)I uptake in ectopic thyroid tissues. Hybrid single-photon emission computed tomography/computed tomography measurement of anatomic size of lingual thyroid tissue and radioactive iodine uptake guided the selection of therapeutic doses, resulting in administration of 10.7, 17.5, and 15.4 mCi of (131)I, respectively. There were no post-therapy complications, and clinical follow-up demonstrated resolution of obstructive oropharyngeal symptoms. CONCLUSIONS: Ectopic lingual thyroid tissue is rarely associated with obstructive oropharyngeal symptoms due to progressive enlargement. Radioiodine therapy with (131)I is an effective treatment modality for ablation of ectopic thyroid tissue as an alternative to surgery.

Differentiated thyroid carcinoma in lingual thyroid.

The lingual thyroid is the most common form of thyroid ectopy. The ectopic tissue may display any disease affecting the thyroid, including malignancies, which have an estimated incidence of less than 1%. To date only 51 cases of lingual thyroid cancer were reported. Analogously to what observed in orthotopic thyroid, papillary carcinoma is the predominant histotype in lingual thyroid carcinoma. The higher frequency of lingual follicular thyroid carcinoma previously reported is possibly related to histological misclassification in some early reports, prior to the standardization of histological typing of differentiated thyroid carcinomas. Nonetheless, the frequency of the follicular histotype is not negligible, accounting for about one-third of the reported cases. Both natural history and prognosis of lingual thyroid carcinoma are poorly known, likely because of the rarity of the disease and the heterogeneity in the therapeutic approach. However, among the cases more recently reported, surgical excision of the mass, either alone or followed by radioiodine ablation, is the first-line approach, with only two cases treated by radioiodine alone. The nonsignificant rate of neoplastic transformation in lingual thyroid should encourage efforts to obtain a widely accepted consensus for the management of this rare condition, along with standardization of either diagnostic or therapeutic handling of malignancies arising in ectopic thyroid.

[Ectopic thyroid basi-lingual: A case report].

Introduction: The thyroid ectopic gland is a rare anomaly, especially when it's a lingual thyroid. It is characterized by aspecific clinical presentation, causing a diagnostic problem. The diagnosis is based on a combination of imaging techniques as well as histological examination. Case presentation: We are presenting a case of a patient with thyroid basi-lingual treated surgically. Discussion: The low incidence of ectopic lingual thyroid , and their clinical variability requires radiological and isotopic investigations. Conclusion: The diagnosis of this disease is primarily histological. The management of these ectopic thyroid is surgical.

Incidental lingual thyroid informs surgery.

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.

Large mass on base of tongue. Diagnosis: lingual thyroid.

Our patient's tongue mass hadn't bothered her until she became pregnant; that's when it got larger and caused problems swallowing and breathing. A simple test confirmed our suspicions.

Lingual thyroid in a young female: role of imaging.

A 12-year-old girl presented with dysphagia and a feeling of fullness in the throat. On examination a midline smooth, rubbery and reddish mass was seen at the base of the tongue, which moved with deglutination and protrusion of the tongue. A thyroid function test was within normal limits. On ultrasonography, absences of thyroid gland in its normal position with a smooth-contoured, round-shaped nodular mass at the tongue base with internal vascularity within. The mass was hyperdense and homogeneously enhancing on postcontrast. A clinical diagnosis of ectopic lingual was made based on the ultrasonography and CT scan features.