Lingual thyroid presenting after previous thyroglossal cyst excision

Tongue Base Ectopic Thyroid Tissue-Is It a Rare Encounter?

Failure in the embryological development of the thyroid in adults is rarely seen. We present the case of a 79-year-old female patient who complained of dysphagia and progressive upper respiratory obstruction, which started 12 months prior to her admission. An ENT clinical exam revealed a tongue base, spherical, well-defined tumour covered by normal mucosa. Further assessments established the diagnosis of the tongue base ectopic thyroid tissue. Due to the patient's symptoms, a transhyoid tongue base tumour removal was performed. The selected patient gave consent for participation and inclusion in this paper, in compliance with the 1964 Helsinki declaration.

AGGRESSIVE PAPILLARY CARCINOMA OF THE LATERAL ABERRANT THYROIDE: A CASE REPORT AND REVIEW OF THE LITERATTUREggressive papillary carcinoma of the lateral aberrant thyroide: A case report and review of the literatture

INTRODUCTION

Ectopic thyroid tissue can be found in many sites. Ectopic thyroid tissue may also be involved in the same processes as normal thyroid gland. These processes include tumors, inflammation and hyperplasia. The appearance of such tissue in rare locations may lead to diagnostic and therapeutic dilemmas.

PRESENTATION OF CCASE

We report a rare case of primary papillary carcinoma in an ectopic thyroid in the jugulocarotid regionbased on the bifurcation of the carotid artery, in a 62-year-old woman with history of diabetes and high blood pressure, with a normal thyroid gland.

DISCUSSION

The origin of lateral ectopic thyroid tissue is not fully understood and controversial.The lateral localisation is a rare entity and debated extensively in the literature.

CONCLUSION

Though rare, the possibility of an ectopic thyroid carcinoma must always be considered by the surgeon in cases of a pathological mass in the neck.

Normal variations of oral anatomy and common oral soft tissue lesions: evaluation and management

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.

Medical management of thyroid ectopia:report of three cases

Thyroid ectopia (TE) is an embryological aberration of the thyroid gland migration most commonly observed in the lingual region followed by the sublingual, hyoid, and mediastinal regions. TE is often complicated by local compressive symptoms resulting in dysphagia, dysphonia, and dyspnea. Surgical removal of TE is frequently complicated by difficulties in intubation, increased perioperative bleeding, and severe primary hypothyroidism; on the other hand, I131 ablation is limited by high doses needed and the concern for long-term effects especially in children. We report three children with TE who all presented with compressive symptoms and were managed conservatively with levothyroxine resulting in resolution of compressive symptoms and favorable outcomes. Levothyroxine supplementation is effective and has an important role in managing TE, not only in correcting the associated hypothyroidism but also in resolving the associated compressive symptoms by reducing the size of the ectopic thyroid tissue.

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.

Modified approach for lingual thyroid transposition: report of two cases

Lingual thyroid is a rare congenital anomaly of thyroid development resulting from failure of the thyroglossal duct to migrate from the foramen cecum to the prelaryngeal site. The lingual thyroid associated with a fetal adenoma is even more unusual. We presented two cases of lingual thyroid, one associated with fetal adenoma. The ectopic gland was transposed into the muscle space at the floor of the mouth using an extraoral midline lower lip, mandible and tongue-splitting approach in case 1, and a transoral lower lip degloving and midline mandibulotomy and tongue-splitting approach in case 2. Sixteen-year follow-up of case 1 and 6-month follow-up of case 2 showed that the transposed thyroids achieved normal function. Case 2 had no visible scar in the lower lip and mental area. Surgical transposition of the lingual thyroid to the floor of the mouth with the vascular supply intact offers a promising approach for the treatment of this anomaly. The transoral lower lip degloving and midline-splitting approach is recommended because of its better cosmetic outcome.

Lingual thyroid: iodine 131: a viable treatment modality revisited

PURPOSE

Lingual thyroid has a reported incidence between 1:10 and 1:100,000. When symptomatic, patients may present with dysphagia, choking, and/or dyspnea. Current surgical treatment options range from tumor extirpation or transposition to excision and reimplantation. Tracheotomies are often performed postoperatively for reliable airway control. Iodine 131 (131I) has not been a popular modality of treatment for lingual thyroid because of theoretical fears of increased airway obstruction from thyroiditis. We believe that these fears were not substantiated, and that symptomatic patients needed a reliable, nonsurgical treatment option. Therefore, our goal was to further investigate the use of 131I for the treatment of symptomatic lingual thyroid.

PATIENTS AND METHODS

A 6-year retrospective chart review was performed. From 1994 to 2000, 2 patients with symptomatic lingual thyroid presented to the Arkansas Cancer Research Center Head and Neck Oncology clinic, University of Arkansas for Medical Sciences, Little Rock, AR. Patients underwent pretreatment computed tomography, and iodine 123 scans. They then received 1 oral dose of 131I. Doses ranged from 30 to 85 mCi. Patients were then followed daily for signs of airway compromise.

RESULTS

Complete resolution of symptoms was seen 2 months after treatment. Patients did not complain of any increased airway compromise during treatment initiation. Patients remain symptom-free and are maintained on thyroid hormone replacement.

CONCLUSIONS

Iodine 131 ablation of lingual thyroid is a safe and effective treatment in symptomatic patients and should be included in the algorithm when formulating a treatment plan.

Transposition of the lingual thyroid: A new alternative technique

BACKGROUND

In symptomatic lingual thyroid, surgical transposition of the gland with its vascular supply intact seems to have superior results to those obtained by surgical ablation and autotransplantation. However, the procedure should be simple, reproducible, reliable, and cause less morbidity as well as providing simple access to and evaluation of the gland postoperatively.

METHODS

We present the case of a 33-year-old female with lingual thyroid who was treated by transposing the whole gland to the lateral pharyngeal wall through a lateral pharyngotomy incision. The transposed lingual thyroid was nourished by a random tongue muscle pedicle flap.

RESULT

At the 5-month postoperative stage, iodine scanning reviewed the radioactivity uptake of the transposed gland. Even though the patient was not on postoperative thyroid hormone supplement, her thyroid function gradually returned to normal after initially showing hypothyroid postoperatively.

CONCLUSION

This new technique for transposition of lingual thyroid is simple and reliable and should be considered as an alternative method in the management of symptomatic patients.

Lingual thyroid gland: Clinical evaluation and comprehensive management

Although lingual thyroid gland is the most common benign mass found at the junction of the anterior two-thirds and the posterior one-third of the tongue, it is still a rare clinical entity. This developmental anomaly is the result of an arrested descent of the gland anlage early in the course of embryogenesis. Patients may have symptoms of dysphagia due to obstruction or even hemorrhage. These symptoms can occur at any time from infancy through adulthood. The clinical findings, laboratory tests, and radiographic imaging studies employed in confirming the diagnosis and in planning appropriate treatment have been evaluated. The primary therapeutic goal is to restore thyroid function. We describe a case of lingual thyroid gland and summarize the current management principles for this condition.

Conditions peculiar to the tongue

The tongue is the organ of taste, and it functions in speech, mastication, and the deglutition of food. This muscular organ is affected by many conditions and diseases, including a variety of developmental, traumatic, inflammatory, infectious, and neoplastic lesions.

Lingual thyroid: tongue-splitting incision for transoral excision

Two patients presenting to the Central Military Hospital of Beirut with symptomatic lingual thyroid are reported. I131 thyroid scanning revealed the lingual thyroid to be the only functional thyroid tissue present in each patient. Subsequent CT scanning demonstrated the large size of these ectopic thyroids causing significant mechanical obstruction. These were excised transorally using a posterior midline tongue-splitting incision and reimplanted in the rectus abdominis muscles. Details of this modified tongue-splitting surgical approach are described. A brief review of the literature concerning lingual thyroid and its surgical treatment is also presented as well as three patients operated on for lingual thyroid at the American University of Beirut Medical Centre between 1975 and 1994 using an external neck incision.