Lingual thyroid and hyperthyroidism: a new case and review of the literature

Ectopic thyroid carcinoma in the mandible with normally located goiterous thyroid gland: A case report

BACKGROUND

The presence of ectopic thyroid tissue is a developmental disorder that affects about one per 100,000-300,000 people. It is extraordinarily rare for ectopic thyroid to be out of the lines of its descent. This case is the first to report a cancerous ectopic thyroid in the mandibular bone with a goitrous orthotopic thyroid gland.

CASE PRESENTATION

80-year-old female of free medical background presented to our clinic with painless left mandibular swelling that recent increase in size after tooth extraction. Surprisingly the diagnosis of ectopic thyroid tissue with cancerous follicular cells was reached upon histological analysis. The goitrous thyroid gland was found in its expected cervical location, and the patient was euthyroid.

CONCLUSION

Because this diagnosis extremely rare, the possibility of ectopic thyroid carcinoma in cases of a pathological mass in the mandible must always be carefully thought out. A high degree of suspicion is essential as the unusual presentation could take.

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.

Papillary Microcarcinoma of Sublingual Thyroid Gland: A Case Report

Ectopic thyroid gland is a rare condition where the thyroid is not placed in the pre-tracheal region. Majority of cases are commonly located at the lingual portion. The malignant shift of ectopic thyroid is considered a rare manifestation with a challenging surgical approach. Here we report our management and surgical approach of a patient with papillary microcarcinoma of sublingual thyroid gland presented to our facility.

Lingual tonsils hypertrophy and possibility of its correction by physical factors

Introduction: The component of the lymphopharyngeal ring is the lingual tonsil (LT), located on the root of the tongue. With pathological changes in the lymphoid tissue of the pharynx, surgical removal of the tonsils, as a result of increased antigenic load, a compensatory increase in LT is observed – «lingual tonsillar hypertrophy». This is observed against the background of age-related involutive changes, when the remaining elements of the lymphopharyngeal ring begin to perform anti-antigenic and adaptive activity. The processes taking place in, the structure of the LT, which is familiar to the body, changes - the receptor apparatus creates pathological impulses from the organ. The severity of clinical manifestations correlates with the degree of increase in LT. The emphasis on these manifestations, psychosomatic conditions, create a complex of pathological sensations that violate the quality of patients’ life. The goal and objectives of the study are aimed at improving the quality of patients’ life with lingual tonsil hypertrophy (LTH), by developing effective methods of diagnosis and treatment, assessing the role of the immunoregulatory shift in the pathogenesis of LTH of the possibility of their correction by the action of a physical factor (cold destruction). Materials and methods: When examining 850 people who underwent complex research and instrumental diagnostics in connection with the pathology of ENT organs, 119 people (the main group) were diagnosed with different degrees of LTH, with control of 30 healthy people. Cryosurgical treatment was offered to 76 patients who used the method for treating of lingual tonsil hypertrophy by cryodestruction using a hook-shaped applicator with a heat-insulating nozzle on the back surface, an individual polyethylene cap, and a cryoapparatus. Results and discussions: With LTH, an increase in the volume and mass of tissues forming the morphological basis of the tonsil was detected: the main substance was an increase in the number and size of layers of coarse fibrous fibers, fields of fat cells, and the growth of mucous glands. The mucous membrane, thinning, undergoes dystrophic-degenerative changes. The rate of proliferation correlates with the severity of inflammation, the causes of which are multifactorial, individual. There is an increased sensitivity reaction to microbial and household allergens, an increase in the content of antibodies in the blood to LT tissues, a change in microbiocinosis of the pharyngeal mucosa, and vegetation of non-resident microflora. As a result of cryosurgical treatment in 56 (73.68%) cases, a decrease in the volume of LT tissue was observed. The deep layers, partially absorbed, were replaced by healthy tissues, the surface layers were rejected with the formation of an atrophic scar or regenerate, the structure of which was close to organotypic. The cause of pathological impulse was eliminated, clinical indicators were normalized, the quality of life of patients was improved. Conclusions: LTH should be considered as a continuation of the development of a productive process associated with immunoregulatory changes in chronic infectious and allergic conditions. Local cryogenicity on LTH was accompanied by normalization of the structure of its own substance, LT, and a decrease in inflammatory changes in surrounding tissues. The development of inflammatory changes in LT was a local manifestation of a general disturbance in the functioning of the immune defense system. Achieving a persistent positive effect in the treatment of LTH requires an integrated approach with mandatory systemic immune correction and hormonal correction.

[Ectopic tissue of the thyroid gland and the parathyroid glands]

Ectopic thyroid tissue results from developmental defects of the early stages of thyroid embryogenesis, in which the median thyroid anlage descends from the floor of the mouth to its final pre-tracheal position. The most common sites of ectopic thyroid tissue are accordingly in the area of the floor of the mouth and in the course of the thyroglossal duct. Rare localizations are intrathoracic (mediastinal, cardiac, pulmonary) and sub-diaphragmatic (including the adrenals, liver, gall bladder, and gastrointestinal tract). The most important differential diagnosis of ectopic thyroid is metastasis of differentiated thyroid carcinoma.By contrast, the term parathyroidectopy is not uniformly defined. Usually, the cervical-central localizations are referred to as "positional variants" (with the exception of the maxillary sinus and high parapharyngeal), whereas the cervical-lateral localizations (carotid sheath, vagus nerve) and those below the brachiocephalic and mediastinal positions (extraligamentary, aortopulmonary window, paravagal) and other rare localizations are classified as "ectopic parathyroid tissue". Parathyroidectomy is very common (in autopsy studies in 28 to 42.8% of all humans). In the context of primary hyperparathyroidism (pHPT), there is a prevalence of 6.3 to 16% of ectopic hyperfunctional parathyroid tissue (predominantly adenomas), which play an important role in the surgical treatment of pHPT.

The Pseudolesions of the Oral Mucosa: Differential Diagnosis and Related Systemic Conditions

Pseudolesions are defined as physiological or paraphysiological changes of the oral normal anatomy that can easily be misdiagnosed for pathological conditions such as potentially malignant lesions, infective and immune diseases, or neoplasms. Pseudolesions do not require treatment and a surgical or pharmacological approach can constitute an overtreatment indeed. This review aims to describe the most common pseudolesions of oral soft tissues, their possible differential diagnosis and eventual related systemic diseases or syndromes. The pseudolesions frequently observed in clinical practice and reported in literature include Fordyce granules, leukoedema, geographic tongue, fissured tongue, sublingual varices, lingual fimbriae, vallate papillae, white and black hairy tongue, Steno’s duct hypertrophy, lingual tonsil, white sponge nevus, racial gingival pigmentation, lingual thyroid, and eruptive cyst. They could be misdiagnosed as oral potential malignant disorders, candidiasis, Human Papilloma Virus (HPV)-related affections, oral autoimmune diseases, or benign and malignant tumors. In some cases, pseudolesions feature in a syndromic panel, for example, fissured tongue in Melkersson–Rosenthal syndrome. It is strictly fundamental for dentists to know and to distinguish oral pseudolesions from pathological conditions, in order to avoid overtreatment.

Thyrotoxicosis Associated with a Hypopharyngeal Toxic Nodular Thyroid

Ectopic thyroid is a rare developmental anomaly which may be either asymptomatic or present with thyroid dysfunction as well as pressure symptoms. Here we present a novel case of thyrotoxicosis associated with a hypopharyngeal multinodular thyroid in a female. Removal of the ectopic thyroid led to normalization of the thyroid status.

Follicular adenoma in ectopic thyroid. A case-report

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Ectopic thyroid is thyroidal tissue located far from its anatomic place.

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A patient under our observation displayed left submandibular swelling.

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The FNAC test report described a follicular adenoma.

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Based on the FNAC diagnosis, we surgically removed the mass.

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The post-operative follow-up was uneventful.

Introduction

The term ectopic thyroid refers to the presence of thyroid tissue located far from its usual anatomic placement and with no vascular connection to the main gland. The presence of swelling in atypical locations is diagnostically differentiated from other pathologies like pleomorphic adenoma or carcinoma, inflammatory lesions like sialadenitis, neurogenic tumors, paraganglioma, fibrolipoma and lymphadenopaties of diverse etiologies.

Presentation of case

Here we present the case of a submandibular ectopic thyroid in a 67 year old woman. She came to our attention for a left submandibular swelling. The anamnesis did not show related pathologies, as well as blood tests. Diagnostic image studies and a FNAC were performed. The mass was surgically removed and histopatology showed a follicular adenoma in the contest of the capsulated lesion.

Discussion

It is important to not underestimate these types of lesions and procede with hematochemical, instrumental tests and above all surgery that can eliminate any diagnostic uncertainty and on the whole be therapeutic.

Conclusion

It should not be forgotten that ectopic thyroid tissue can be a site for adenoma or papillary carcinoma and thus any watch and wait strategy should be avoided.

Ectopic Thyroid Tissue in the Mediastinum Characterized by Histology and Functional Imaging with I-123 SPECT/CT

Ectopic thyroid tissue is a rare entity and when discovered it is typically along the pathway of embryologic migration of the thyroid. We present a case of incidental finding of ectopic thyroid tissue within mediastinum in a 61-year-old female patient with a history of total thyroidectomy for thyroiditis and nodules. The patient presented to emergency room with cough and right chest pain and underwent a chest computed tomographic angiogram (CTA) to exclude pulmonary embolism as part of chest pain workup. One right paratracheal mediastinal soft tissue nodule was visualized on the images of CTA. This right paratracheal soft tissue mass was found to be ectopic benign thyroid tissue by histological analysis of the biopsied tissue samples. The function of this ectopic thyroid tissue was characterized by I-123 radioiodine uptake and single photon emission computed tomography/computed tomography (SPECT/CT) imaging. This case illustrates that ectopic thyroid tissue should be included for differential diagnosis of a hyperdense soft tissue mass located within mediastinum. I-123 SPECT/CT is useful for guiding tissue biopsy of ectopic thyroid tissue distant from orthotopic thyroid gland and functional and anatomic characterization of mediastinal ectopic thyroid tissue for surgical resection when it is medically necessary.

Coexistence of resistance to thyroid hormone and ectopic thyroid: ten-year follow-up

Resistance to thyroid hormone (RTH) coexisting with ectopic thyroid is rare. Here we report a case of RTH with ectopic thyroid. A ten-year-old girl had been misdiagnosed as congenital hypothyroidism and treated with levothyroxine since she was born. Ten-year follow-up showed that the elevated thyrotropin was never suppressed by levothyroxine and no signs indicating hyperthyroidism or hypothyroidism despite elevated FT3 and FT4 levels. Therefore the girl developed no defects in physical and cognitive development. Pituitary adenoma was excluded by magnetic resonance imaging. Ultrasonography did not find the thyroid gland in the normal place, while the thyroid scan found a large lingual thyroid gland. The octreotide inhibition test showed a reduction in thyrotropin by 41.98%. No mutation was detected in the thyroid hormone receptor (THR) β, THRα, thyrotropin receptor (TSHR), and GNAS1 genes. To our knowledge, it is an interesting RTH case coexisting with lingual thyroid.

Ectopic goitrous submandibular thyroid with goitrous orthotopic thyroid gland

Ectopic thyroid is a rare developmental anomaly with lingual thyroid accounting for majority of the cases. The presence of ectopic thyroid tissue lateral to the midline is very rare, and very few cases located in the submandibular region have been reported. The simultaneous finding of submandibular ectopic thyroid tissue and a functional orthotopic thyroid gland is even rarer. In the differential diagnosis of an ectopic submandibular thyroid, it is fundamental to exclude a metastasis from well-differentiated thyroid cancer, even when primary thyroid carcinoma is not demonstrable.

LINGUAL THYROID: 35-YEAR EXPERIENCE AT A TERTIARY CARE REFERRAL CENTER

OBJECTIVE

Lingual thyroid (LT) results from a developmental abnormality due to failure of the thyroid gland to descend to its pretracheal position. Given the low incidence of this disease, standardized management recommendations are lacking. We aimed to describe our institution's experience in LT management and to suggest a practice algorithm.

METHODS

We conducted a retrospective review of LT diagnosed at Mayo Clinic, Rochester, Minnesota, between 1976 and 2010. Demographics, clinical presentation, laboratory data, treatment received, and outcomes were collected.

RESULTS

We identified 29 patients with LT. Eighty-three percent were female; age at diagnosis ranged from 2 weeks to 68 years. Almost one-third of patients were symptomatic, with the most common symptoms being cough and hoarseness. The diagnosis of LT was incidental in 9 patients (31%). Seventy-two percent of patients developed hypothyroidism. Levothyroxine was the treatment of choice, followed by thyroidectomy. Two asymptomatic euthyroid patients were followed without any intervention.

CONCLUSION

Management of patients with LT should be individualized and guided by the patient's symptoms and thyroid hormone status.

Ectopic lingual thyroid

Ectopy of the thyroid gland is an abnormal embryological development. Its occurrence in children is rare. In this study, we report the case of a 12-year-old girl that presented with dysphagia and nocturnal dyspnea. Magnetic resonance imaging confirmed the presence of a lingual thyroid. Thyroid scintigraphy showed intense and elective uptake of radiotracer at the base of the tongue. Hormonal tests revealed hypothyroidism. Treatment consisted of opotherapy based on levothyroxine. Evolution has been favourable and the patient showed significant improvement with reduction of the dyspnea and the dysphagia and normalization of thyroid hormone tests.

Ectopic thyroid tissue in the head and neck: a case series

Background

Through a review of three cases, the etiopathogenetic, clinical-diagnostic, and therapeutic aspects of ectopic thyroid tissue are herein discussed to highlight the main presentations of this polymorphous disease.

Case presentations

The first case involved an ectopic thyroid gland in the lingual area in a 45-year-old Caucasian woman who presented with dysphagia and midline swelling at the base of the tongue. The second case involved a 22-year-old Caucasian woman with a submandibular mass comprising ectopic thyroid tissue. The third case involved a 33-year-old Caucasian man with a typical thyroglossal duct cyst characterized by the presence of thyroid tissue upon histological analysis.

Conclusion

Surgery seems to be the most appropriate treatment for patients with ectopic thyroid tissue showing clinical signs of upper airway obstruction or when the lesion shows signs of infection or malignant degeneration. When a site of ectopic thyroid tissue is the only such site in the body, removal of this tissue will usually lead to hypothyroidism that requires medical thyroid hormone replacement.

Redefining anatomy in a case of midline subhyoid ectopic thyroid

Ectopic thyroid is an uncommon embryological aberration of the thyroid descent. Subhyoid median ectopic thyroid gland is a result of incomplete descent of the thyroid anlage and is characterized by a cosmetically unacceptable ovoid mass of thyroid tissue in the midline overlying the thyroid cartilage and thyrohyoid membrane. A normally placed thyroid gland is not detectable and in most cases all functioning thyroid tissue is located within the mass. Most of the ectopic thyroids are usually mistaken for a thyroglossal cyst and excised. Severe myxedema follows removal. Many cases have been reported in the literature, none of which was recognized prior to operation. All patients were operated upon for removal of a thyroglossal duct cyst. The diagnosis was missed at operation and in these cases severe myxedema was universal. The cause of the myxedema was not always immediately recognized. Therefore, many diagnostic tests including thyroid function test, ultrasound of the neck, and thyroid scanning had been recommended in the preoperative evaluation of a thyroglossal cyst. Here, we present a case of ectopic thyroid mass which was the only thyroid tissue present in the neck. So, division and repositioning of the thyroid mass thereby redefining the anatomy was done with good cosmetic results.

A rare case of lingual thyroid with hyperthyroidism: A case report and review of the literature

Lingual thyroid is a rare embryological anomaly resulting from failure of normal thyroid tissue to descend from the foramen cecum at base of tongue to its orthotopic location in front of the lower neck. It is a rare anomaly with a reported incidence of 1 in 3000 of the thyroid disorders. Lingual thyroid is often asymptomatic but may cause local symptoms such as dysphagia, dysphonia with stomatolalia, upper airway obstruction, and often with hypothyroidism. Hyperthyroidism is extremely rare finding and till now there are very few case reports published. We present here a case of lingual thyroid with hyperthyroidism, which was treated successfully with radioiodine.

Ectopic thyroid tissue: anatomical, clinical, and surgical implications of a rare entity

Ectopic thyroid tissue is a rare entity resulting from developmental defects at early stages of thyroid gland embryogenesis, during its passage from the floor of the primitive foregut to its final pre-tracheal position. It is frequently found around the course of the thyroglossal duct or laterally in the neck, as well as in distant places such as the mediastinum and the subdiaphragmatic organs. Although most cases are asymptomatic, symptoms related to tumor size and its relationship with surrounding tissues may also appear. Any disease affecting the thyroid gland may also involve the ectopic thyroid, including malignancy. The clinician must distinguish between ectopic thyroid and metastatic deposits emerging from an orthotopic gland, as well as other benign or malignant masses. Thyroid scintigraphy plays the most important role in diagnosing ectopy, but ultrasonography contributes as well. In cases of symptomatic disease, surgery is the treatment of choice, followed by radioiodine ablation and levothyroxine suppression therapy in more refractory cases. This review provides current understanding about the wide clinical spectrum of this rare condition, also referring to optimal diagnostic approach, differential diagnosis, and management strategies.

Dual ectopic thyroid with normally located thyroid: a case report

Dual ectopic thyroid is a rare presentation of thyroid ectopia. Only a few cases have been reported in the world literature. Dual ectopic thyroid in the presence of a normally located thyroid is even rarer. We report a case of dual ectopic thyroid in the lingual and submandibular areas in a seventeen-year-old female with hypoplastic thyroid gland in its normal location. The patient presented with a midline swelling at the base of tongue with dysphagia. Thyroid function test revealed primary hypothyroidism. Ultrasonography of the neck showed hypoplastic thyroid in its normal location. A thyroid scan with Technetium-99 m pertechnate showed two intensely hyperfunctioning foci of ectopic thyroid tissue at a higher level in the midline consistent with dual ectopic thyroid, one at the base of tongue and the other in submental region. No uptake was seen in the normal bed.

Coblation assisted excision of lingual thyroid

Lingual thyroid (LT) tissue is the most frequent ectopic location of the thyroid gland. We report 5 cases of symptomatic LT and discuss the new surgical approach. Transoral approach and coblation assisted excision of LT was performed. Postoperative follow-up for all patients was like as tonsillectomy management without tracheotomy. It's seem that this approach is much better than other such as tongue-splitting, transcervical transhyoid, pharyngotomy, with an infrahyoid approach, combined cervical and intraoral approach, Mandibular midline osteotomy.

Ectopic lingual thyroid tissue and acquired hypothyroidism: case report

Ectopic thyroid tissue with thyroid gland in its normal location is an extremely rare phenomenon. We present a case of a 38-year-old woman who was referred to our hospital with symptoms of hypothyroidism. Thyroid hormone measurement revealed clinical hypothyroidism with elevated anti-thyroid antibodies, neck ultrasonography showed a small tissue with the characteristic of Hashimoto thyroiditis, while the scintigraphy demonstrated only a lingual thyroid. Treatment consisted in L-thyroxine replacement to the euthyroid state. We reviewed the literature with respect to the embryological background and the clinical management of such cases.

Ectopic intratracheal thyroid: an illustrative case report and literature review

A 19-year-old woman was treated with bronchodilators for new-onset dyspnea with exercise. Her symptoms progressively worsened, culminating 4 months later in acute shortness of breath at rest. Flow-volume loops suggested a fixed obstruction and a computed tomography scan of the neck revealed a large subglottic mass. The patient underwent emergent tracheostomy and laryngoscopy and a near-obstructing intratracheal mass was found. Biopsy showed ectopic thyroid tissue. Magnetic resonance imaging of the neck showed a 1.4-cm tracheal lesion and a normally located thyroid gland. The intratracheal mass was resected endoscopically. Pathology revealed hyperplastic ectopic thyroid tissue. The patient has been maintained on thyroid hormone suppression therapy for 2 years without growth of the residual intratracheal thyroid tissue. She recently underwent a surgical palate expansion. We present this case, along with a literature review of ectopic intratracheal thyroid, its epidemiology, possible etiologies, genetic underpinnings, presentation, and treatment. The co-occurrence of an ectopic thyroid, a functioning orthotopic gland, and a high arched palate is also discussed.

Development of the thyroid gland: lessons from congenitally hypothyroid mice and men

Congenital hypothyroidism is the most common congenital endocrine disorder (one newborn in 3000) and represents the most common cause of preventable mental retardation. In 10-20% of cases, it is due to autosomal recessive functional disorders leading to goiter formation (thyroid dyshormonogenesis). In the remainder, it is due to thyroid dysgenesis, which comprises usually isolated defects in: (1) migration of the median thyroid anlage, leading to a round cluster of ectopic cells (usually in a sublingual position) with no other thyroid tissue present; (2) differentiation or survival of the thyroid follicular cells leading to athyreosis; and (3) growth of a thyroid with the normal bilobed shape and in the normal cervical position (orthotopic hypoplasia). Mouse knock-outs have demonstrated that thyroid transcription factor-1 (TTF-1) and PAX8 are required for the survival and proliferation of thyroid follicular cell precursors, TTF-2 for their downward migration and the thyrotropin receptor (TSHR) for post-natal thyroid growth. In humans, thyroid dysgenesis is generally a sporadic malformation but an affected relative is found in 2% of cases, a figure 15-fold higher than by chance alone. Pedigree analysis is most compatible with dominant inheritance with variable penetrance. However, mutations in TTF-1, TTF-2, PAX8 and TSHR are found in <10% of patients with congenital hypothyroidism and these predominantly have orthotopic thyroid hypoplasia, often associated with other malformations. This low yield and the discordance of >90% of monozygotic twin pairs suggests that isolated thyroid ectopy or athyreosis most often results from early somatic mutations, epigenetic modifications or stochastic developmental events.