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

Management of Lingual Thyroid with Second Thyroid Anomaly: An Institutional Experience

Patients diagnosed with Lingual thyroid (LT) may have second thyroid anomaly (STA).Given rarity of dual ectopics/anomalies, standardized management recommendations are lacking. We aimed to describe our experience in management of LT with STA and suggest a management algorithm. We conducted a retrospectivechart review of patients diagnosed with LT between Jul-2013 and Dec-2019. Data regarding demographics, clinical presentation, endocrine-profile, associated STA treatment received, and outcomes were collected and analyzed. Eight patients (female-7 cases, male-1 case, adult-4 cases, children-4 cases, mean age-18.1 years, range 6-43 years) with LT were identified. Four(50%) cases had STA in addition to LT (thyroglossal cyst in two-cases, sublingual thyroid in one-case and sub-mental thyroid in one-case) and presented as neck mass. Diagnosis was confirmed with flexible-nasopharyngoscopy,ultrasonography,thyroid-scintigraphy and computed-tomography. Ectopic thyroid(s) was/were only functional thyroid gland with absence of normal thyroid in all cases. Two- cases had symptomatic for LT and were managed by coblation assisted excision of LT in one and I131 ablation in one-case.All adult patients were hypothyroidand received thyroxin.All pediatric cases were euthyroidand received no surgical intervention for LT.Three patients required surgery for STA; Sistrunk surgery in two and excision of submental thyroid in one. All cases were asymptomatic. These results were utilized to suggest a management algorithm for LT with STA. LT patients with STA are more symptomatic and required more surgical interventions in compare to isolated LT. When appropriate, excision of STA with/without intervention for LT and thyroxin is advocated as the treatment modality of choice in LT patients with STA.

Papillary Thyroid Carcinoma with Cervical Lymph Node Metastasis Arising from Lingual Thyroid

Although lingual thyroid is the most common site for ectopic thyroid gland but carcinomas originating from lingual thyroid are extremely rare, accounting only for 1% of all ectopic thyroids. Here we represent a young female with a bleeding mass at the base of her tongue and review the diagnostic approach towards papillary thyroid carcinoma of lingual thyroid. The surgical treatment and follow up are discussed. A combination of radiological studies and histological evaluation should be deployed to investigate suspicious lingual thyroids. The perspective of diagnostic and therapeutic approaches for carcinomas of lingual thyroid is the same as orthotopic thyroid tissue.

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.

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.

Conservative management for lingual thyroid ectopic

Lingual thyroid gland is a rare clinical entity. The presence of an ectopic thyroid gland located at the base of the tongue may be presented with symptoms like dysphagia, dysphonia, and upper airway obstruction. We are introducing a case of an 8-year-old girl who had lingual thyroid that presented dysphagia and foreign body sensation in the throat. The diagnostic was reached with clinical examination, thyroid scintigraphy with Tc^99m and ultrasound. A laryngoscopy was performed which confirmed a spherical mass at base of tongue. Investigation should include thyroid function tests. In this case we observed subclinical hypothyroidism. There are different types of surgical approaches for the treatment of this condition; however, the treatment with Levothyroxine Sodium allowed the stabilization of TSH levels and clinical improvement of symptoms in a follow-up of 2 years.

Ectopic lingual thyroid with vascular anomalies

Background

Lingual thyroid represents 90% of ectopic thyroid tissue localizations. The first case was described by Hickman in 1869. An ectopic thyroid is often asymptomatic, but pathological or physiological conditions inducing hyperproduction of thyroid-stimulating hormone can lead an ectopic thyroid to become symptomatic. Treatment of the symptomatic ectopic thyroid can be medical, with hormone-suppressing therapy, or surgical.

Case presentation

A 17-year-old female presented to our outpatient clinic complaining of a sensation of a lump in her throat. Ear, nose, and throat (ENT) examination identified a swelling of the base of the tongue in the glossoepiglottic area. Thyroid scintigraphy showed a single contrast enhancement in the sublingual region, instead of in the normal anatomical position of the thyroid. She was treated surgically after failed hormone-suppressing therapy. An arteriography performed before the surgery showed vascular anomalies and was useful in surgical planning.

Conclusion

Recognition of vascular anomalies in an ectopic thyroid is fundamental before surgical planning, therefore, accurate radiological study of the vasculature should always be planned before surgical treatment of this disease.

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.

Hashimoto's thyroiditis: an accidental discovery of a lingual thyroid in a 7-year-old child

An ectopic thyroid located at the base of the tongue is a rare entity, resulting from early developmental defects of thyroid gland embryogenesis during its descent from the foramen caecum to its normal eutopic pretracheal site. This condition is the main cause of congenital primary hypothyroidism, even though signs and symptoms of thyroid dysfunction may also appear later in childhood. Lingual thyroid may sometimes present with symptoms of respiratory obstruction or feeding difficulties. We illustrate the case of a 7-year-old girl with subclinical hypothyroidism due to Hashimoto's thyroiditis arising in a lingual thyroid. She had never suffered from upper airway obstructive symptoms, but did refer a 3-month history of cough. Rapid normalisation of thyroid-stimulating hormone levels and termination of the cough were attained when the L-thyroxine treatment started. After 6 months a significant reduction of lingual thyroid size was also noted. The diagnostic procedures and therapeutic options in childhood are discussed.