Evaluation and management of the lingual thyroid gland

Advances in Lingual Thyroid Management Using Coblation Technology: A Case Series Study

Lingual thyroid is a rare, abnormal ectopic thyroid tissue seen at the base of the tongue. It is a rare embryological anomaly caused by the failure of the descendence of the thyroid gland from the foramen caecum to its normal prelaryngeal area. The main aim of our study is to discuss recent advancements in the management of lingual thyroid using coblation technology. We are discussing the prospective study of 12 lingual thyroid cases that came to the government ENT hospital, Koti, in Hyderabad, from July 2016 to July 2023. All patients were assessed by a detailed history, blood investigations, fine needle aspiration cytology, radiological investigations, technetium-99 scintigraphy, and an endocrinologist opinion. In our study, all cases were hypothyroid and showed difficulty in swallowing and a few cases showed bleeding from the mouth, and difficulty in breathing, hence all 12 cases underwent coblation-assisted excision of swelling and with lifelong thyroxine supplementation. For all 12 cases, demographic, clinicopathological data and radiological data were recorded. Treatment depends on the age of the patient, the severity of symptoms, precipitating factors like puberty or pregnancy, or any other comorbidities with the disease. In our study, all cases were symptomatic and hypothyroid status, hence all 12 cases underwent coblation-assisted excision of swelling and lifelong thyroxine supplementation. All cases were followed up for 2 years with good recovery, minimal patient discomfort after surgery, and lifelong levothyroxine supplementation. Lingual thyroids have a female preponderance. In our study, all were female. Thyroid scintigraphy plays an important role in diagnosis, along with ultrasonography. In all symptomatic cases, surgery with Coblation-assisted excision of swelling is the treatment of choice, with good recovery, minimal patient discomfort after surgery and with lifelong levothyroxine supplementation.

Does surgical management still play a role in the management of ectopic lingual thyroid: Institutional experience and systematic review of the literature

OBJECTIVE

Management of ectopic lingual thyroid (ELT) must balance the morbidity of disease with the morbidity of treatment. We investigate clinical outcomes associated with modern treatment options and analyze the role of transoral surgery in the treatment algorithm for ELT.

METHODS

This was a retrospective chart review of ELT patients treated at a tertiary care center from 1/1/1979 to 12/31/2019. In addition, a systematic review of the literature from 1979 to 2021 for reports of ELT was performed. Symptoms defined as high-risk were dysphagia, dysphonia, dyspnea, neck swelling, bleeding, and obstructive sleep apnea (OSA).

RESULTS

36 patients within the institutional cohort (IC) and 224 cases in the systematic review (SRC) met criteria. The most common presenting symptoms for both cohorts were dysphagia, globus sensation, and dysphonia. One third of each cohort were hypothyroid, while 3% (n = 1) and 9% (n = 21) of the IC and SRC, respectively, had clinical suspicion of malignancy at presentation. 27% (n = 10) of the IC and 55% (n = 121) of the SRC underwent surgical therapy. There was a 4% (3/72) transoral bleed rate for all patients undergoing transoral surgery. Other reported complications were minor. There were no tracheostomies, and no deaths. Among observed, medically treated, and surgically treated patients, symptoms improved during follow up for 43% or 68% in the IC and SRC, respectively. Following surgery, symptoms improved or resolved for 86% or 93% in the IC and SRC, respectively.

CONCLUSIONS

Asymptomatic ELTs with no concern for malignancy can be managed with observation. Patients with mild symptoms or hypothyroidism may trial thyroid suppressive therapy or RAI. RAI can be considered for patients with high-risk symptoms. For patients with symptoms resistant to conservative therapy, concern for malignancy or high-risk symptoms not conducive to RAI, surgery should be considered. Transoral approaches offer acceptable morbidity, and most patients experience resolution of symptoms following this approach.

Enlarged hemorrhagic lingual thyroid managed with transoral robotic surgery

PURPOSE

Lingual thyroid glands are rare embryologic variants of undescended tissue centered in the base of the tongue. Despite notable size, many lingual thyroids can be asymptomatic, though intervention is warranted for progressive or emergent symptoms. We report a rare manifestation of a hemorrhagic lingual thyroid addressed with both interventional radiology and robotic techniques.

METHODS

A previously asymptomatic 41-year old female presented to the emergency department with massive hematemesis after significant binge drinking and vomiting. Emergent intubation was performed and gastroenterology workup ruled out Mallory-Weiss tears or ruptured esophageal varices. Fiberoptic laryngoscopy and imaging revealed a bleeding tongue base mass concerning for malignancy.

RESULTS

Aberrant feeding vessels with identifiable blush were embolized by Neurointerventional Radiology and the patient underwent tracheostomy for airway protection. Lingual thyroid was confirmed by biopsy and the mass was definitively resected via transoral robotic surgery. The patient had no further bleeding events and was decannulated uneventfully.

CONCLUSIONS

Lingual thyroid glands can present with life-threatening hematemesis and obstruction that may masquerade as entities of vascular or neoplastic origin. Management encompasses multidisciplinary diagnostic confirmation, airway protection, and minimally invasive resection that minimizes functional morbidity.

Lingual Hamartomas: Clinical Characteristics, Diagnostic Evaluation, Treatment, and Outcomes

OBJECTIVES/HYPOTHESIS

To further clinically characterize lingual hamartomas, and to consolidate literature by analyzing clinical presentation, diagnostic evaluation, treatment, and outcomes.

STUDY DESIGN

Retrospective chart review and literature review.

METHODS

Case series from 1989 to 2020 at a tertiary pediatric center; follow-up ranging from 2 months to 12 years. Patient demographics, clinical presentations, physical examination findings, surgical pathology, operative methods, pre-operative imaging, and follow-up. A review of English-language literature from 1945 to 2020 was conducted.

RESULTS

Seven patients (four male, three female) with nine lingual hamartomas were identified. Average age at surgical excision was 7.9 months (SD 3.5 months, range 3 to 14 months). Follow-up ranged from 2 months to 12 years, with all patients having no recurrence. Physical examination identified five pedunculated hamartomas and two sessile hamartomas. One patient had a neck CT, one had neck ultrasound, and two had facial MRIs. CT and ultrasounds confirmed presence of cervical thyroid. MRI suggested no muscular invasion for one patient, whereas motion artifact obscured findings for the other patient. Most patients who presented with dysphagia or poor weight gain achieved post-surgical improvement. The present cases combined with the literature review identified 57 patients with 63 lingual hamartomas.

CONCLUSIONS

Lingual hamartomas appear as hypovascular pedunculated masses near the foramen cecum. There is no demographic predisposition, and most are identified during infancy. Imaging is not necessary, unless there is concern for lingual thyroid, in which case thyroid ultrasound should be performed. Surgical excision is curative, with dysphagia resolution and low likelihood for recurrence.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E2080-E2088, 2021.

ECTOPIC LINGUAL THYROID PRESENTING WITH MASSIVE HEMATEMESIS

Ectopic lingual thyroid is a rare developmental abnormality caused by aberrant embryogenesis during thyroid migration. Even though, most patients are asymptomatic, uncommonly the mass can be enlarged and cause dysphagia, dyspnea, upper airway obstruction, dysphonia, hypothyroidism. We report a very rare case of ectopic lingual thyroid presenting with massive hematemesis.

Congenital Neck Masses

Congenital neck masses can be a developmental anomaly of cystic, solid, or vascular origin. They can also constitute neoplasms, including malignancies, although this is rare in the pediatric population. The history and examination can help quickly narrow the differential diagnosis. Imaging also plays an essential role in defining the characteristics and likely cause of neck masses. The most common neck masses in young children are thyroglossal duct cysts, branchial cleft anomalies, and dermoid cysts. Also important to consider in the differential diagnosis are solid tumors, such as teratomas, or vascular lesions, such as hemangiomas.

Diagnostic evaluation of a case of lingual thyroid ectopia

Thyroid ectopia can occur when the process of thyroid embryogenesis fails. Here, we present the case of a 30-year-old woman with thyroid ectopia that was discovered during magnetic resonance imaging of cervical spine for referred neck pain. Imaging revealed the presence of an encapsulated mass at the base of her tongue. The patient was not symptomatic for any compression of the airways. Diagnosis of ectopic lingual thyroid was confirmed by ^99mTC scintigraphy. Incidental diagnosis of thyroid ectopia in asymptomatic adult patients is rare, and it should be considered on diagnostic imaging in case of an anterior midline cervical mass.

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.

A large lingual thyroid extending to the epiglottis

A 22-year-old man presented to our department with a mass on the base of his tongue. He had a cavernous voice causing a moderate speech disorder, and he had some difficulty in swallowing. He had severe problems with sleep, associated with apnoea. In a fibreoptic laryngoscopic examination, a large 4×5 cm vascular mass was detected extending from the base of the patient's tongue to his epiglottis. It covered the epiglottis. Thyroid scintigraphy showed only thyroid tissue on the base of the tongue. Surgery was initiated transorally under the guidance of a rigid endoscope, but as the mass continued extended to the epiglottis, a transhyoid approach was taken. At a 3-month follow-up, the patient was symptom free. Electrocautery-assisted resection under the guidance of a rigid endoscope can reliably be used in surgery of a lingual thyroid. However, a transhyoid approach provides a better view and also helps in achieving haemostasis.

[Goiter on pre-sternal thyroid dysgenesis]

L'hétérotopie thyroïdienne est une localisation anormale de tissus thyroïdiens normaux coexistant avec un organe normal et de localisation normale. Elle se distingue de l'ectopie thyroïdienne et d'une métastase du cancer de la thyroïde. Nous rapportons un cas d'hétérotopie thyroïdienne pré-sternale chez une femme de 65 ans afin de discuter le mécanisme de la migration de la thyroïde, le problème diagnostique et thérapeutique posé par cette topographie exceptionnelle. L'origine thyroïdienne de la masse est confirmée par l'histologie. Dans les lieux isolés, la chirurgie d'exérèse reste le seul moyen pour avoir le diagnostic et pour traiter les patients.

Transoral robotic excision of ectopic lingual thyroid: Case series and literature review

BACKGROUND

Surgical excision of an ectopic lingual thyroid has traditionally been associated with significant morbidity and has therefore been reserved for patients with severe obstructive symptoms or suspected malignancy. Transoral robotic surgery (TORS) has provided a minimally invasive approach to completely and safely excise ectopic lingual thyroid.

METHODS

Three index cases were identified from the detailed clinical database of TORS patients. A systematic review of the management of ectopic lingual thyroid in the English literature was performed.

RESULTS

TORS-assisted excision of a lingual thyroid gland was successfully performed in 3 patients with excellent functional outcomes

CONCLUSION

TORS-assisted excision of an ectopic lingual thyroid is a safe and feasible treatment modality with minimal morbidity, and, in experienced hands, should be offered as a valid treatment for this pathology.

Lingual Thyroid Excision with Transoral Robotic Surgery

Ectopic thyroid gland may be detected at any place between foramen caecaum and normal thyroid localization due to inadequacy of the embryological migration of the thyroid gland. It has a prevalence varying between 1/10.000 and 1/100000 in the community. Usually follow-up without treatment is preferred except for obstructive symptoms, bleeding, and suspicion of malignity. Main symptoms are dysphagia, dysphonia, bleeding, dyspnea, and obstructive sleep apnea. In symptomatic cases, the first described method in surgical treatment is open approach since it is a region difficult to have access to. However, this approach has an increased risk of morbidity and postoperative complications. Transoral robotic surgery, which is a minimally invasive surgical procedure, has advantages such as larger three-dimensional point of view and ease of manipulation due to robotic instruments. In this report, a case at the age of 49 who presented to our clinic with obstructive symptoms increasing within the last year and was found to have lingual thyroid and underwent excision of ectopic thyroid tissue by da Vinci surgical system is presented.

Differentiation of benign and malignant lesions of the tongue by using diffusion-weighted MRI at 3.0 T

OBJECTIVES

Diffusion-weighted MRI (DWI) has been introduced in head and neck lesions and adds important information to the findings obtained through conventional MRI. The purpose of this study was to assess the role of DWI in differentiating benign and malignant lesions of the tongue at 3.0-T field strength imaging.

METHODS

78 patients with 78 lingual lesions underwent conventional MRI and DWI with b-values of 0 and 1000 s mm(-2) before therapy. The apparent diffusion coefficient (ADC) maps were reconstructed, and the ADC values of the lingual lesions were calculated and compared between benign and malignant lesions of the tongue.

RESULTS

The mean ADC values of the malignant tumours, benign solid lesions and cystic lesions were (1.08±0.16)×10(-3), (1.68±0.33)×10(-3) and (2.21±0.35)×10(-3) mm2 s(-1), respectively. The mean ADC values of malignant tumours were significantly lower (p<0.001) than those of benign solid lesions, and the mean ADC values of benign solid lesions were significantly lower (p<0.001) than those of cystic lesions. Receiver operating characteristic analysis showed that when an ADC value<.31×10(-3) mm2 s(-1) was used for predicting malignancy, the highest accuracy of 95.3%, sensitivity of 92.6% and specificity of 97.3% were obtained.

CONCLUSIONS

ADC values of benign and malignant lesions are significantly different at 3.0-T imaging. DWI can be applied as a complementary tool in the differentiation of benign and malignant lesions of the tongue.

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.

Radionuclide imaging of dual ectopic thyroid in a preadolescent girl

Ectopic thyroid is a congenital defect in which the thyroid gland is located away from the usual pretracheal location. Dual ectopic thyroid, which consists of two foci of thyroid tissue, is very rare. In this case dual ectopic thyroid with subclinical hypothyroidism in a 10-year-old-girl was reported. The absence of the thyroid gland in the pretracheal location was revealed by ultrasonography (USG). Two foci of ectopic thyroid tissue located at the base of the tongue and infrahyoid region were determined by Technetium-99m pertechnetate thyroid scintigraphy. It can be concluded that if the thyroid gland is not visible by USG, ectopic thyroid tissue should be evaluated with scintigraphy.

The prevalence of thyroglossal tract thyroid tissue on SPECT/CT following (131) I ablation therapy after total thyroidectomy for thyroid cancer

OBJECTIVE

To determine the prevalence of thyroglossal tract thyroid tissue on SPECT/CT and to assess the contribution of this tissue to total neck radioactive iodine (RAI) activity in patients given (131) I ablation therapy after total thyroidectomy for thyroid cancer.

PATIENTS AND METHODS

Eighty-three consecutive patients with thyroid cancer treated with total thyroidectomy underwent whole-body planar and SPECT/CT imaging of the neck following initial RAI ablation. On SPECT/CT, thyroglossal tract thyroid tissue was defined as RAI in the anterior neck, superior to the thyroid bed in close proximity to the midline without evidence of localization to lymph nodes. Quantification was performed using region of interest analysis on planar imaging following localization on SPECT/CT. SPECT/CT, and planar images were classified by two reviewers as positive, negative or equivocal with interobserver agreement quantified using a Kappa score. Disagreement was resolved using a third reviewer.

RESULTS

Thyroglossal tract thyroid tissue was present in 39/83 (47%; 95%CI: 36-58%) patients on SPECT/CT. In these 39 patients, this tissue contributed to a significant amount of total neck activity (median = 50%; IQR 19-74%). Interobserver agreement for the presence of thyroglossal tract thyroid tissue was substantial on SPECT/CT (Kappa = 0.73) and fair on planar imaging (Kappa = 0.31).

CONCLUSION

Thyroglossal tract thyroid tissue was present in one half of our study population and contributed to a significant amount of total neck RAI activity. Given the high prevalence of this tissue, our results suggest that total neck RAI activity on planar imaging may not be suitable to assess the completeness of thyroid bed surgery.

Lingual thyroid-conservative management or surgery? A case report

A Lingual thyroid is relatively rare. Of all ectopic thyroids 90 % are found to be Lingual thyroids. We report a case of 32 year old female who presented to us with history of mass on back of the tongue with history of dysphagia.The clinical, biochemical and radioisotope scanning confirms the diagnosis of lingual thyroid with hypothyroidism. Patient was treated with levothyroxine. After treatment, Lingual thyroid reduced in size and patient improved symptomatically.

Ectopic thyroid masquerading as submandibular tumour: a case report

An ectopic thyroid gland may be present in any location along the path of migration from the foramen caecum to the mediastinum. The most common locations for an ectopic thyroid are the lingual thyroid followed by median cervical cysts. An ectopic thyroid in the submandibular region is extremely rare. We present the case of a 44-year-old patient with ectopic thyroid tissue in submandibular space and a review of the literature related to it.

Lingual thyroid: A case report

INTRODUCTION

Lingual thyroid (LT) gland is a rare clinical entity which was found to occur due to the failure of the thyroid gland to descend to its normal cervical location during embryogenesis. The presence of an ectopic thyroid gland located at the base of the tongue may present with symptoms like dysphagia, dysphonia, upper airway obstruction or even hemorrhage at any time from infancy through adulthood.

PRESENTATION OF CASE

We are presenting a case of 5-year-old girl who presented with lingual thyroid, treated with Suppression treatment followed by elective surgical resection.

DISCUSSION

Incidence of ectopic lingual thyroid gland is reported as 1:100,000. It is more common in females. Most of presentations due to oropharyngeal obstruction, including dysphagia, dyspnea and dysphonia. Investigations include thyroid function tests, neck US, Technetium scanning and C.T.

CONCLUSION

Lingual thyroid is a rare anomaly. Dysphagia and dysphonia are common presenting symptoms. Pathogenesis of this ectopic is unknown. Different types of surgical approaches have been described in the management.

Anatomy of thyroid and parathyroid glands and neurovascular relations

Historically, thyroid surgery has been fraught with complications. Injury to the recurrent laryngeal nerve, superior laryngeal nerve, or the parathyroid glands may result in profound life-long consequences for the patient. To minimize the morbidity of the operation, a surgeon must have an in-depth understanding of the anatomy of the thyroid and parathyroid glands and be able to apply this information to perform a safe and effective operation. This article will review the pertinent anatomy and embryology of the thyroid and parathyroid glands and the critical structures that lie in their proximity. This information should aid the surgeon in appropriate identification and preservation of the function of these structures and to avoid the pitfalls of the operation.

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.

Lateral ectopic thyroid goiter with a normally located thyroid

BACKGROUND

Midline ectopic thyroid tissue is a common pathological entity. In contrast, laterally located ectopic thyroid tissue with a normally located thyroid gland is a very rare condition in head and neck surgery.

SUMMARY

We report the association of laterally located multinodular thyroid tissue and a normally located multinodular goiter. A woman was seen in the otolaryngology clinic with a right submandibular mass. Clinical examination and investigations confirmed the presence of a multinodular goiter in an ectopic thyroid gland.

CONCLUSION

Laterally located ectopic thyroid tissue is a very rare condition. Ectopic thyroid tissues can undergo the same pathological changes as a normally located thyroid gland. Ectopic thyroid goiter together with a normally located multinodular goiter is a rare entity, and this is the first to be reported in North America.

Multinodular goitre in lingual thyroid: case report

Objective:

We report a case of a multinodular goitre developing in a lingual thyroid.

Method:

Case report, and discussion of the embryology and treatment of lingual thyroids.

Case report:

A 66-year-old woman presented with dysphagia secondary to a multinodular lingual goitre. A previously silent lingual thyroid had undergone multinodular change to cause dysphagia and eventually airway compromise. The goitre was excised via a midline, mandible-splitting approach.

Conclusion:

Lingual thyroids have an incidence of one in 3000 to 10 000. There has not previously been a reported case of such an ectopic gland undergoing multinodular changes and presenting in later life.

Iodine 131 ablation of an obstructive lingual thyroid

A 48-year-old woman undergoing surgery could not be intubated because of an oropharyngeal mass. CT and MRI revealed a 3 cm possible lingual thyroid mass, confirmed by Iodine-123 SPECT/CT. The patient underwent successful Iodine-131 ablation and has done well on thyroid hormone-replacement therapy. This case also demonstrates how modern cross-sectional imaging like SPECT/CT can appropriately be used in the patient diagnosis and management, and is of additional interest for including pre- and post-therapy MRI documenting efficacy morphologically.

Obstructive sleep apnea syndrome in an adolescent girl with hypertrophic lingual thyroid

We present a 14-year-old girl whose initial diagnosis was obstructive sleep apnea syndrome (OSAS) with symptoms of habitual snore, sleep breath holding, shortness of breath, and lump in throat. Lingual thyroid was diagnosed by thyroid scan and histology, and was treated by radioactive iodine therapy and endoscopic carbon dioxide laser therapy. Her OSAS completely subsided after lingual thyroid surgery. Physicians should be aware of rare causes of OSAS in children, such as lingual thyroid and certainly if accompanied by difficulties in swallowing and speech problems.

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.

Variations of structure and appearance of the oral mucosa

Among the most important factors in a thorough clinical examination is the dentist's ability to recognize and make distinctions among normal oral structures, variations of normal structures, and pathologic entities. The practitioner's diagnostic acumen is essential to this process and is a skill gained and refined by clinical experience and continuing education. In this introductory article, the authors describe normal entities, anomalies, and benign soft tissue lesions of interest to the clinician. For presentation, these structures are organized according to their location within the oral cavity.

Hypothyroidism caused by a nonvisible lingual thyroid

BACKGROUND

Lingual thyroid is a developmental anomaly caused by failure of migration of the thyroid gland to its normal position in the neck. This anomaly is usually manifested in childhood as hypothyroidism or local symptoms.

METHODS

We present a case of a 32-year-old patient in whom lingual thyroid was diagnosed after complaints of a chronic cough. Thyroid-stimulating hormone levels were significantly elevated. Sonograms of the neck revealed atrophy of both thyroid lobes, with nonhomogeneous consistency and no lymphadenopathy. Technetium-99m scan revealed uptake at the tongue base, with no uptake at the neck or other locations.

RESULTS

L-thyroxine treatment was begun, with progressive decrement in thyroid-stimulating hormone levels and cessation of the cough.

CONCLUSION

This case is unique in both the advanced age of the patient and the unusual clinical presentation.

Lingual thyroid causing dysphonia: evaluation and management. Case report

CONTEXT

Lingual thyroid gland is a rare clinical entity that is caused by the failure of the thyroid gland to descend to a normal cervical location during embryogenesis. The occurrence of an ectopic thyroid gland located at the base of the tongue may cause problems for the patient, with symptoms of dysphagia, dysphonia, upper airway obstruction or even hemorrhage at any time from infancy through adulthood.

CASE REPORT

We report on a case of lingual thyroid gland in a 41-year-old female patient. The embryology and diagnosis of ectopic thyroid are discussed and its management is outlined. Features of the diagnostic and therapeutic evaluation are described with attention to the clinical findings, laboratory tests, thyroid scan and computed tomography imaging studies employed in the confirmation of diagnosis and planning of appropriate treatment. The history of the condition is reviewed and a treatment strategy is outlined. Surgical excision of the gland is reserved for cases of gland enlargement that result in compromised airways (dysphagia or dysphonia) or recurrent hemorrhage.

Cysts and tumors of the oral cavity, oropharynx, and nasopharynx in children

A wide variety of developmental and neoplastic lesions arise in the oral cavity, oropharynx, and nasopharynx in children. The clinical manifestations and cross-sectional imaging findings provide complementary information, which is used to establish a probable or definitive diagnosis. This article describes imaging techniques and findings for developmental cystic masses and solid tumors in the pediatric population.

Oral lesions in young children

Oral lesions in very young children usually have a benign presentation, and only rarely contribute to significant aerodigestive symptomatology. Management begins with early recognition of the pathology and appropriate diagnosis. Hemangiomas, lymphangiomas, and teratomas may present with airway compromise or feeding difficulties, necessitating early intervention.

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.