Lingual thyroid

Case Discussion A lingual thyroid is the most common location for ectopic thyroid tissue (90% of cases). During development, thyroid tissue migrates caudially within the midline from the foramen cecum. Ectopic thyroid tissue may also be found in sublingual, prelaryngeal or mediastinal locations. In children, a lingual thyroid may rarely cause airway compromise.

• Prevalence in general population is 1 per 10,000 - 100,000 people ( • Historically, thyroid tissue has been found in the tongue in 10% of autopsies ( • F:M = 3 - 7:1 • Mean age at presentation is about 40 years, ranging from infancy to 83 years ( • Some studies report a bimodal age distribution, with peaks in 2nd and 4th decades ( • Failure of thyroid gland to descend from the foramen cecum to its normal prelaryngeal location • Pathogenesis is unclear, but there are speculations that maternal antithyroid immunoglobulin may stop thyroid gland descent ( • Hypothyroidism is commonly seen in patients with lingual thyroid and some have hypothesized that lingual thyroid is a hyperplastic physiologic response by small thyroid remnants in the tongue to a low thyroid hormone level • Mutation in the genes of thyroid specific transcription factors TTF1, TTF2 (FOXE1) and PAX8 might be involved in thyroid arrest in tongue, as was shown in animals ( • Most lingual thyroids are asymptomatic • Symptomatic lingual ectopia is often manifested in women during puberty, pregnancy or menstruation • Most common symptoms are dysphagia, dyspnea and upper airway obstruction; other symptoms are foreign body sensation, pain, hemoptysis, dysphonia, snoring and sleep apnea ( • In more than 75% of patients, orthotopic thyroid is absent (total migration failure) and lingual thyroid represents the only thyroid tissue; as a result, 70% of patients with symptomatic lingual thyroid are hypothyroid; hyperth...

Although easily examined, abnormalities of the tongue can present a diagnostic and therapeutic dilemma for physicians. Recognition and diagnosis require a thorough history, including onset and duration, antecedent symptoms, and tobacco and alcohol use. Examination of tongue morphology and a careful assessment for lymphadenopathy are also important. Geographic tongue, fissured tongue, and hairy tongue are the most common tongue problems and do not require treatment. Median rhomboid glossitis is usually associated with a candidal infection and responds to topical antifungals. Atrophic glossitis is often linked to an underlying nutritional deficiency of iron, folic acid, vitamin B 12, riboflavin, or niacin and resolves with correction of the underlying condition. Oral hairy leukoplakia, which can be a marker for underlying immunodeficiency, is caused by the Epstein-Barr virus and is treated with oral antivirals. Tongue growths usually require biopsy to differentiate benign lesions (e.g., granular cell tumors, fibromas, lymphoepithelial cysts) from premalignant leukoplakia or squamous cell carcinoma. Burning mouth syndrome often involves the tongue and has responded to treatment with alpha-lipoic acid, clonazepam, and cognitive behavior therapy in controlled trials. Several trials have also confirmed the effectiveness of surgical division of tongue-tie (ankyloglossia), in the context of optimizing the success of breastfeeding compared with education alone. Tongue lesions of un...

Lingual Thyroid A lingual thyroid gland may manifest as a globus sensation in an adolescent child when it enlarges as a result of the hormonal surges associated with pubescence. From: Head and Neck Imaging (Fourth Edition), 2015 Related terms: • Thyroid Gland • Patient • Lesion • Tongue • Tissues • Laceration • Ectopic Thyroid Gland Sagittal CECT shows a young woman with a tongue base mass. Multifocal midline hyperdense mass is consistent with lingual thyroid . Additional component of ectopic thyroid anterior to the hyoid body is shown. Axial CECT of a patient with lingual thyroid, at the level of thyroid cartilage , shows no visible thyroid tissue on either side. Axial CECT demonstrates a sharply defined submucosal mass in the midline floor of the mouth. Heterogeneous density suggests development of a goiter. Sagittal T1 MR shows a heterogeneous hyperintense mass in the midline base of the tongue. Note the narrowing of the oropharyngeal airway and posterior and inferior displacement of the epiglottis . Rebecca D. Chernock, Lester D.R. Thompson, in Head and Neck Pathology (Third Edition), 2019 Clinical Features Most thyroid ectopia is clinically occult and discovered incidentally in patients undergoing surgery for another indication. Lingual thyroid is the most common type of clinically detected thyroid ectopia (90% of cases). In addition, most patients have no other thyroid tissue in the neck (complete thyroid ectopia). It can present at any age and is more common in wome...

aDivision of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan (R.O.C.) bDivision of Endocrinology and Metabolism, Department of Internal Medicine, Taiwan Adventist Hospital, Taipei, Taiwan (R.O.C.). ∗Correspondence: Yi-Hsin Lin, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taiwan Adventist Hospital, Taipei, Taiwan (R.O.C.) (e-mail: [emailprotected]). Abbreviations: ETT = ectopic thyroid tissue, TSH = thyroid-stimulating hormone, T3 = triiodothyronine, T4 = thyroxine, Tc = technetium, CT = computed tomography, MRI = magnetic resonance imaging, FNAC = fine needle aspiration cytology. How to cite this article: Huang H, Lin YH. Lingual thyroid with severe hypothyroidism: a case report. Medicine. 2021;100:43(e27612). Informed consent was obtained from the patient included in the study. This study was conducted under the Declaration of Helsinki and was approved by the Institutional Review Board of Taiwan Adventist Hospital. The authors have no conflicts of interest to disclose. All data generated or analyzed during this study are included in this published article [and its supplementary information files]. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction: Ectopic thyroid tissue presenting at the base of the tongue, called lingual...