Lingual thyroid-conservative management or surgery? A case report

Ectopic lingual thyroid with subclinical hypothyroidism in children

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.

A Case of an Infantile Lingual Leiomyomatous Hamartoma

Lingual leiomyomatous hamartomas are rare lesions of the tongue with largely unknown mechanisms of formation. These lesions are often asymptomatic, though they may present with symptoms, particularly relating to swallow function. Workup should include imaging of the head and neck, and diagnosis should be made histologically. Treatment is surgical excision. This case is a report of a 4-week-old female who presented for evaluation of an asymptomatic 1 × 1 cm dorsal midline tongue mass discovered at birth. The patient was monitored until the age of 9 months, at which time the mass was surgically excised. The patient had an uncomplicated postoperative course. Pathological analysis yielded a diagnosis of leiomyomatous hamartoma.

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.

Lump at the back of my tongue. The lingual thyroid-A case report and narrative review of literature

Although the ectopic thyroid in adults is rarely symptomatic, biochemistry and imaging workup are essential. Treatment modality of choice is dependent on patient factors, institution factors and surgeon factors. The mainstay treatment involves hormone suppression treatment with exogenous thyroid hormone. If medical management is unsuccessful, surgical excision requires an experienced team including an anaesthetist and otolaryngologist. Anaesthetic considerations are important because intubation may be a potentially difficult procedure secondary to potential serious obstruction of the upper airway. We present a case report and narrative review of the literature regarding lingual thyroid workup and management.

Lingual Thyroid with Subclinical Hypothyroidism in a Young Female

Thyroid tissue presenting as a nodule in the base of the tongue due to the embryonic failure to descend to the anterior neck is a rare clinical entity, called lingual thyroid. Clinical presentation varies depending upon the degree of obstruction caused by an enlarged nodule or features related to thyroid function. We report a case of a 27-year-old female who presented with a foreign body sensation in the throat with mild dysphagia for 3 weeks. The patient was diagnosed as lingual thyroid with subclinical hypothyroidism based on clinical findings, imaging, and fine-needle aspiration cytology. Conservative management with hormone suppression can result in size reduction of ectopic thyroid tissue improving symptoms without surgery. Lingual thyroid with mild symptoms and subclinical hypothyroidism can be managed conservatively.

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.

Laryngo fiberscopy-guided suspension procedure for an ectopic lingual thyroid obstructing airway

BACKGROUND

Currently, there is no consensus regarding the optimal therapeutic strategy for the management of an ectopic lingual thyroid. A surgical approach is suggested when airway obstructive symptoms cannot be tolerated at all, or when bleeding or malignancy occurs. However, for patients in whom ectopic thyroid is the only functioning thyroid tissue, complete surgical excision needs to be followed by lifelong hormone replacement therapy. We report the case of an infant with ectopic lingual thyroid obstructing the airway that was treated using our novel surgical procedure.

CASE PRESENTATION

A 10-day-old male infant presented with symptoms of airway obstruction and subclinical hypothyroidism. Imaging tests revealed an ectopic lingual thyroid and the absence of a normal pretracheal thyroid gland. We administered oral levothyroxine to lower his thyroid stimulating hormone (TSH) level and reduce the volume of the lingual mass; however, his airway symptoms did not improve. Subsequently, we performed a surgical intervention when he was 2 months old. We split the hyoid bone, and then suspended the lingual thyroid by suturing it to the hyoid bone to elevate the epiglottis. We confirmed the degree of suspension using intraoperative laryngo fiberscopy. After the surgery, the symptoms of airway obstruction were resolved and the patient was clinically euthyroid on low-dose oral levothyroxine.

CONCLUSIONS

Our laryngo fiberscopy-guided suspension procedure can be an effective surgical procedure for the treatment of ectopic thyroid. This relatively simple surgical procedure could completely preserve the patient's thyroid tissue and resolve airway obstruction.

Ectopic Thyroid at the Base of the Tongue of a Young Patient

Lingual thyroid is defined as an ectopic thyroid gland tissue located in the midline of the tongue base and it is uncommonly observed in clinical practice and is rare in children. This paper describes the surgical treatment of ectopic thyroid at the base of the tongue in a child. The chief complaint of the 12-year-old, melanodermic female patient was the difficulty to swallow for 15 days. The intraoral physical examination barely showed a nodular lesion at tongue base. The CT scan showed a round, well defined hyperdense lesion of approximately 25.8 mm at its largest diameter, with infiltrative growth in the posterior region of the base of the tongue. The proposed treatment was complete resection of the lesion. The histopathological diagnosis was lingual thyroid. After the diagnosis was established, the patient was referred to an endocrinologist for exams and medical follow-up. Lingual thyroid is a rare condition and its diagnosis in children is even rarer. Its approach should be transdisciplinary and should take into consideration the hormonal aspects of the patient in addition to the clinical condition of the lesion. In the presented case, the removal of the alteration was performed via conservative surgical procedure followed by immediate referral of the patient to the endocrinologist for a follow-up.

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.

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.