Tiroides Ectópica Lingual: caso Clínico / Lingual Ectopic Thyroid: a clinical case

La tiroides ectópica lingual es una patología muy poco frecuente, producida por la detención en el descenso normal de la glándula durante el desarrollo embrio-nario. La localización lingual de tejido tiroideo es la más común entre las tiroides ectópicas o aberrantes. Esta enfermedad puede ser asintomática pero, cuan-do los signos y síntomas están presentes, guardan estrecha correlación con la localización de la lesión y son proporcionales a su tamaño. El diagnóstico debe realizarse clínicamente y con el complemento de es-tudios por imágenes y endocrinológicos. En los aná-lisis de laboratorio se debe incluir dosaje de las hor-monas TSH, T4 libre y T3, vinculadas con la función tiroidea. Las biopsias deben evitarse ya que causan desequilibrio en la producción hormonal de la glándu-la y peligro de profusas hemorragias. En este artículo se desarrolla una descripción de las generalidades de la tiroides ectópica lingual, y se presenta un caso clínico de un niño con un tumor lingual, que fue deri-vado por su médica pediatra a cirugía para realizar una biopsia. Asimismo, se comenta la importancia que tiene para el odontólogo conocer esta patología a fin de poder evitar sus posibles complicaciones (AU)

Lingual thyroid is a rare disorder produced by a failure in the descent of thyroid gland to its normal position during embryological development. Lingual localization of thyroid tissue is the most common among the ectopic or aberrant thyroids. This condition can be asymptomatic, although when symptoms take place, they are connected to the lesion location and depend on its size. Diagnosis should be made clinically and complemented with imaging and endocrine studies. Laboratory analysis must include dosage of TSH, free T4 and T3, thyroid function-linked hormones. Due to the possible imbalance in the gland hormone production and the risk of massive bleeding, biopsy should be avoided. In this article, a brief description of lingual ectopic thyroid generalities is developed and a clinical case of a 7-years old child is provided. Additionally, dentistry importance of knowing this condition is commented, in order to prevent its possible complications (AU)

Resección transoral endoscópica de tiroides lingual / Endoscopic transoral resection of lingual thyroid

La presencia de tejido tiroideo ectópico en la base de la lengua es muy infrecuente, y la mayoría de los pacientes tienen hipotiroidismo. La indicación de tratamiento depende de la presencia o no de síntomas; la cirugía es la primera elección. Diversas técnicas quirúrgicas han sido descriptas, pero para nosotros el abordaje transoral con endoscopios constituye la mejor opción, por la buena exposición y la mínima morbilidad que produce. Se describe el caso clínico de una mujer que consultó por odinofagia, con diagnóstico de tiroides lingual y que fue tratada con éxito mediante un abordaje transoral con asistencia de endoscopios. (AU)

The presence of ectopic thyroid tissue at the base of the tongue is very rare, and most patients have hypothyroidism. The indication of treatment depends on the presence or not of symptoms, surgery being the first choice. Various surgical techniques have been described, being for us the transoral approach with endoscopes the best option, due to the good exposure, and minimum morbidity that it produces. The clinical case of a woman who consulted for odynophagia, with a diagnosis of lingual thyroid and who was successfully treated by a transoral approach with endoscopic assistance is described. (AU)

Lingual thyroid with hypothyroidism in a child

Ectopic thyroid is an uncommon embryological abnormality characterized by the presence of thyroid tissue in a site other than its usual pretracheal location. Of all ectopic thyroids 90% are found to be lingual. Lingual thyroid is estimated to occur in 0.2 per cent of normal children, being more common in females. It is a rare congenital anomaly appearing with prevalence of 1:100000. This embryological anomaly originates from failure of thyroid gland to descend from foramen caecum to its normal pre laryngeal site. Interestingly, only 0.01% of these patients present with any overt symptoms. If symptomatic: dyspnoea dysphagia, dysphonia and stomatolalia are some common clinical features associated with it. In females these symptoms manifest during stress as in pregnancy, puberty and menstruation. Some rare clinical presentations reported in literature are hyperthyroidism, malignancy and hemoptysis. Hereby authors are reporting a 7-year-old female child who presented to our department with dysphagia who on evaluation diagnosed to have lingual thyroid with hypothyroidism.

Tiroides ectópica dual hiperfuncionante: abordaje quirúrgico dual / Dual hyperfunctioning thyroid ectopia: dual surgical approach

RESUMEN Paciente de 36 años en tratamiento de leucemia mieloide crónica con nilotinib a quien se le diagnostica hipertiroidismo por síntomas clínicos y exámenes de laboratorio. Se inicia tratamiento con metimazol más propanolol. Los estudios imagenológicos muestran un tejido ectópico tiroideo cervical infrahiodeo lateralizado a la izquierda y un nódulo en la base de la lengua. Presentó toxicidad hepática atribuida al tratamiento por lo que se decide extirpación quirúrgica de tiroides ectópica dual. Por la edad de la paciente y preocupación acerca del resultado estético, se realiza una tiroidectomía videoasistida por via axilar de la tiroides ectópica cervical y una resección transoral de la tiroides ectópica lingual. La patología confirma tejido tiroideo en ambas localizaciones sin signos de malignidad. La paciente se recuperó sin complicaciones y sin cicatriz cervical.

ABSTRACT A 36-year-old female patient with chronic myeloid leukemia being treated with nilotinib who was diagnosed with hyperthyroidism both on clinical and laboratory examination is presented. Imaging studies found left lateralized ectopic thyroid tissue of infrahyoid localization and a nodule at the base of the tongue. Hepatic toxicity was attributed to medical treatment, surgical removal of the dual thyroid ectopia was proposed. Due to the patients age and cosmetical concerns, a minimally invasive surgery was undertaken thru a video assisted transaxillary thyroidectomy for the cervical thyroid ectopia and a video assisted trans oral approach for the lingual thyroid ectopia. Post op pathology confirmed thyroid tissue at both locations and also excluded malignancy. The patient fully recovered without any complicaction and witout a residual cervical scar.

Diagnosis and treatment of ectopic thyroid / 国际外科学杂志

Objective To explore the clinical features,diagnosis and treatment of ectopic thyroid lesions.Methods Retrospectively reviewed the clinical data of 15 patients with ectopic thyroid tissue from Oct.2002 to Jun 2017 in Beijing Tongren Hospital,Capital Medical University and Beijing Anzhen Hospital,Capital Medical University,and figured out the clinical features,therapy and prognosis.Among the 15 patients,there were 2 males and 13 females.There were 8 cases of lingual ectopic thyroid,3 cases of endotracheal ectopic thyroid,3 cases of thyroglossal duct ectopic thyroid,and 1 case of retropharyngeal ectopic thyroid.Follow-up were conducted during outpatient review or by telephone.Results Twelve patients received surgical treatment and the lesions were pathologically confirmed as ectopic thyroid tissue,including 2 cases of papillary thyroid carcinoma.These patients were followed up for 1 to 6 years.Their main symptoms were alleviated and the malignant patients had no recurrence or metastasis.Three patients with lingual ectopic thyroid selected observation and follow-up without any treatment and no progress was observed.Conclusions The incidence of ectopic thyroid is low and the forms are diverse.The clinician should take the possibility of ectopic thyroid and its associated pathological changes into account to avoid the complete removal of the only functional thyroid tissue without preparation.

Cáncer diferenciado de tiroides en tiroides lingual, presentación de un caso / Differentiated thyroid cancer in the lingual thyroid, presentation of a case

The lingual thyroid carcinoma is very uncommon neoplasia with an incidence of less than 1 percent. The papillary variant is the most frequent. Cervical MRI helps differentiate muscle from thyroid tissue. The definitive diagnosis is given by histology. Management is similar to that of orthotopic thyroid cancer. We present the case of a 23-year-old woman with hypothyroidism undergoing treatment with dysphagia and sensation of pharyngeal foreign body and malodorous oral bleeding. Nasopharyngoscopy showed a rounded mass at the base of the tongue; the biopsy was compatible with thyroid neoplasia. Image study with ultrasound confirms empty thyroid bed with presence of lingual ectopic thyroid. The team of surgeons performed surgery with Trotter Technique, they removed a tumor of 4 centimeters of diameter. The definitive biopsy concludes minimally invasive follicular carcinoma. The treatment was completed with 100 mCi of radioiodine. Systemic screening at 7 days was negative, as the post-operative thyroglobulin (Tg)

Diagnosis and therapy of lingual ectopic thyroid / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the strategy of diagnosis and therapy of lingual ectopic thyroid(LET). METHODS We retrospectively reviewed the clinical data of6 cases of LET, and figured out the clinical features, imaging characteristics, therapy and prognosis.RESULTS 6 lingual ectopic thyroids were diagnosed by the Tc-99m thyroid static imaging; 3 cases accepted surgery, one only took oral levothyroxine, and one selected watch and see. 3 cases of lingual ectopic thyroid accepted the ectopic thyroid transposition and took oral levothyroxine postoperatively. Pharynx foreign body sensation and sleep snoring disappeared one month later. The lingual ectopic thyroid carcinoma resection was performed by direct laryngoscope in one case which was lost to follow up.CONCLUSION The thyroid static imaging is specific to the diagnosis of the LET. The indications of the surgery were obvious symptoms such as airway obstruction, snoring and pharyngeal foreign body sensation, and mass hemorrhage, cystic degeneration and carcinogenesis. The principle of therapy is to retain thyroid function as far as possible and comprehensive use of surgery, thyroid hormone replacement and iodine radiotherapy to improve symptoms, prevention and treatment of hypothyroidism.

Glándula tiroides lingual: diagnóstico y tratamiento / Lingual thyroid gland: diagnosis and treatment

La presencia de glándula tiroidea ectópica es una entidad rara. La tiroides lingual es la ectopía mas frecuente, predominando en mujeres. Este tejido glandular es pasible de sufrir todas las patologías que pueden afectar a la glándula normotópica, pudiendo ser sintomática o asintomática. Se presenta un caso de tiroides lingual en una paciente previamente tiroidectomizada que consultó por disnea y disfagia en la unidad de Cirugía de Cabeza y Cuello del Servicio de Otorrinolaringología del Hospital Central del Instituto de Previsión Social, Asunción, Paraguay. La paciente recibía tratamiento hormonal de reemplazo,mostrando examen funcional normal. La semiología permitió observar un abombamiento de la base de la lengua. La fibroscopía mostró un tumor en base de lengua de unos 3 cm de diámetro, que pudo evaluarse correctamente con una tomografía computada. Ante la sospecha de una tiroides lingual se realizó un centellograma que demostró captación en piso de cavidad oral. Se realizó excéresis tumoral a través de una faringotomía suprahioidea, previa traqueostomía proofiláctica. El informe de Anatomía Patológica confirmó el diagnóstico de bocio coloide ectópico.

The presence of ectopic thyroid gland is a rare entity. The lingual thyroid is the most frequent ectopy, predominating in women. This glandular tissue is capable of suffering all the pathologies that can affect the normotopic gland, being able to be symptomatic or asymptomatic. We present a case of lingual thyroid in a previously thyroidectomized patient who consulted for dyspnea and dysphagia in the Head and Neck Surgery Unit of the Otolaryngology Service of the Central Hospital of the Institute of Social Prevision, Asuncion, Paraguay. The patient received hormone replacement therapy, showing normal functional examination. Semiology allowed to observe a bulging of the base of the tongue. The fibroscopy showed atongue-based tumor about 3 cm in diameter, which could be correctly evaluated with computed tomography.Suspicion of a lingual thyroid was performed with a scintigram demonstrating uptake in the oral cavity floor.Tumor excision was performed through a suprahyoid pharyngotomy, following a prophylactic tracheostomy.The Pathologic Anatomy report confirmed the diagnosis of ectopic colloid goitre.

A Case of Schwannoma of the Tongue Base / 대한이비인후과학회지

Schwannomas are benign peripheral nerve sheath tumors. It is found rarely in the oral cavity but most commonly in the tongue followed by the palate, floor of mouth, buccal mucosa, and mandible. Because schwannoma of the base of tongue is exceedingly rare, it is often not immediately included in the differential diagnosis, causing delay in identification and treatment. We report here, with a review of the literature, a case of schwannoma of the base of tongue, which was misdiagnosed as a lingual thyroid. A 28-year-old man presented with a base of tongue mass, which was first detected a month ago. The preoperative diagnosis was lingual thyroid on the basis of the physical findings and computerized tomographic findings. The permanent pathologic report of the mass was schwannoma. Postoperatively, the patient showed no problem with tongue function and wound healing.

Ectopic Lingual Thyroid Presenting with Nasal Twang and Hemoptysis

Ectopic lingual thyroid is a rare developmental anomaly. It is caused by aberrant embryogenesis during the thyroid descent to the neck. It may remain asymptomatic or present with dysphagia, hemoptysis, dyspnoea or dysphonia. Clinically, it presents as a mass lesion on the base of the tongue. The most important diagnostic tool for an ectopic lingual thyroid is the 99mTc radionuclide scan, but imaging modalities such as computed tomography scan and magnetic resonance imaging may also help to assess its location and extent and to rule out the presence of normal thyroid tissue in the thyroid bed. The management of an ectopic thyroid remains controversial. No treatment is required for asymptomatic patients in the euthyroid state. Patients with hypothyroidism should be treated with thyroid hormone substitution therapy. Malignant transformation is an indication for complete surgical resection. Ablative radioiodine therapy can be considered for older patients and those who are unfit for surgery. In complicated cases, surgical resection is recommended through the transoral, transhyoid or lateral pharyngectomy approach. We report a case of ectopic lingual thyroid in a 35-year-old man who presented with nasal twang and hemoptysis.

A Case of Ectopic Lingual Thyroid with Situs Inversus Totalis / 대한갑상선학회지

Situs inversus totalis (SIT) is a rare congenital condition in which the viscera are transposed as a mirror of normal physiologic arrangement. We describe a rare case of lingual thyroid associated with SIT. A 64-year-old female who was diagnosed with SIT, visited our clinic due to pharyngeal foreign body sensation. Physical examination revealed a 2.5x2.5x2.0 cm sized, pinkish, round mass in the base of the tongue. Computed tomography suggested the diagnosis of lingual thyroid. She has been on regular follow up with levothyroxine therapy. To our best knowledge, this is the first case of lingual thyroid (LT) associated with SIT. The literature is reviewed and clinical features about LT and SIT are presented.

A Case of Contemporaneous Occurrence of Thyroglossal Duct Cyst and Lingual Thyroid without the Orthotopic Thyroid Gland / 대한이비인후과학회지

Thyroglossal duct cyst (TGDC) and lingual thyroid (LT) are two relatively common anomalies of thyroid gland development. Each may occur without the orthotopic thyroid gland, although the co-existence of these three anomalies is very rare. The thyroidal function may be abnormal in both anomalies, and careful evaluation of thyroid function is essential for the management of these lesions. A 71-year-old woman was admitted to our department for removal of midline neck mass. She underwent the classical Sistrunk's operation, but after the surgery, her hypothyroidism became aggravated. We report, along with a literature review, an extremely rare case of co-existence of TGDC and LT in the absence of orthotopic thyroid gland.

A Case of Non-functioning Lingual Thyroid Excised with CO₂ Laser Via Transoral Approach / 대한내분비외과학회지

Lingual thyroid, characterized by presence of thyroid tissue at the base of the tongue in the region between the circumvallate papillae and the epiglottis, is the most common location for ectopic thyroid tissue. Excision of the lingual thyroid is rarely necessary. When a lingual thyroid becomes symptomatic, removal is advocated. Minimally invasive surgical techniques have been proposed for more than two decades. The use of CO₂ laser for removal of lingual thyroid offers advantages over traditional open approaches. We experienced a case of non-functioning lingual thyroid which caused dysphagia in the patient. We successfully excised it with CO₂ laser via transoral approach without any complications.

A Case of Lingual Thyroid Treated by 131I Ablation

A lingual thyroid is a rare developmental anomaly caused by the failure of the descent of the thyroid gland anlage early in the course of embryogenesis. The incidence of lingual thyroid has been reported to be 1/100,000. Lingual thyroid is often asymptomatic but may cause dysphagia, dysphonia, upper airway obstruction and hemorrhage. In this report, we described the case of a 50-year-old women experiencing lingual thyroid who had subclinical hypothyroidism. She underwent successful 131I ablation and has done well on thyroid hormone replacement therapy.

Functional lingual thyroid in an adolescent female: a case report and brief literature review.

Background: Lingual thyroid is a rare clinical entity that represents faulty migration of normal thyroid gland. It commonly presents as a benign mass found at the junction of the anterior two-thirds and posterior one-third of the tongue. Although usually asymptomatic, glandular hypertrophy can cause dysphonia, dysphagia, bleeding, or stridor at any time from infancy through adulthood. We report a case that we encountered, discuss the diagnosis and its management, and review the literature. An otherwise asymptomatic 14 year-old girl presented with a posterior tongue mass that had been present since childhood but was never investigated. She was clinically and biochemically euthyroid, with normal thyroid function tests. Physical examination revealed a smooth, globular mass occupying the whole tongue base and valleculae. The epiglottis was slightly displaced posteriorly but the laryngeal inlet was patent. A 99mTcradioisotope scan showed accumulation of tracer in the tongue base and no uptake in the neck. MRI revealed a 1.8-cm diameter soft tissue mass in the posterior part of the tongue. To date she has not required suppressive therapy or surgical intervention. Conclusions: Treatment of lingual thyroid depends on patient symptoms. Most importantly, patients should be followed at regular intervals and educated on the possibility of developing complications.

Tiroides lingual, revisión del tema / Lingual thyroid: subject review

La presencia de tiroides lingual es una entidad clínica poco común, que corresponde a una alteración embriológica incluida dentro del grupo de variantes de localización de tejido tiroideo ectópico. En el diagnóstico de esta entidad, la clínica se apoya fuertemente en los estudios de imaginología como metodología confirmatoria. Ante la infrecuencia de esta alteración, a continuación presentamos un caso sin sintomatología alguna y cuyo diagnóstico confirmatorio se realizó por medio de la gammagrafía de tiroides.

Lingual thyroid is an unusual entity corresponding to an embryological disorder included in the group of variants of ectopic thyroid tissue. Diagnosis is based strongly on imaging as confirmatory methodology. Given the infrequent occurrence of lingual thyroid, we report an asymptomatic case in which confirmatory diagnosis was made by radionucleotide thyroid scan.

A Case of Transoral Excision Using CO2 Laser in Management of Lingual Thyroid with Oral Bleeding / 대한이비인후과학회지

Lingual thyroid is an uncommon developmental anomaly and is the result of failure of the thyroid to descend from the foramen cecum to its prelaryngeal site during embryogenesis. Massive bleeding from a lingual thyroid is an unusual symptom and occasionally fatal. Current surgical treatment options range from tumor extirpation or transposition to excision and reimplantation. The use of CO2 laser for removal of lingual thyroid offers advantages over traditional surgical managements. We experienced a case of lingual thyroid which was successfully excised via transoral approach using CO2 laser. We discussed rationale for the use of the CO2 laser for this lesion.

Tireóide lingual / Lingual thyroid

A tireóide lingual é uma doença rara, definida como presença de tecido glandular tireóideo localizado ectopicamente em base de língua. Deve ser suspeitada em paciente que apresente massa de aspecto submucoso em base de língua, sem tireóide identificada no pescoço. Apresenta-se o relato do caso de uma paciente de 45 anos, discutindo-se as características clínicas, diagnóstico e opções terapêuticas.

Lingual thyroid is a rare disease, defined as the presence of ectopic glandular thyroid tissue localized in the base of tongue. It must be suspected in a patient who presents a mass of submucous aspect in the base of tongue without the thyroid gland identifiable in the neck. It is presented a case report of a 45-year-old woman patient discussing the clinical aspects, diagnose and therapeutic options.

Adenomatous Hyperplasia Arising from Dual Ectopic Thyroid

Ectopic thyroid tissue is an uncommon embryologic aberration characterized by the presence of thyroid tissue in a site other than its usual pre-tracheal location. Single ectopic thyroid tissue is the most common variant, and the base of the tongue is the most frequent ectopic location. Dual ectopic thyroid is extremely rare, and only eleven cases have been reported in the English literature. Furthermore, adenomatous hyperplasia has never been reported to arise from dual ectopic thyroid. There has been only one reported case of adenomatous hyperplasia arising from a single intratracheal ectopic thyroid. We report a case of adenomatous hyperplasia arising from dual ectopic thyroid tissue that presented as a sublingual mass in a 37-yr-old woman. The diagnosis was made through pathologic examination after surgical resection. We also discuss the diagnosis and treatment of ectopic thyroid, along with a review of the literature.

Tiroides lingual como causa de disfagia: Caso clínico / Disphagia caused by a lingual thyroid: Report of one case

We report all year-old boy who presented with difficulty in swallowing without symptoms of hypothyroidism. The physical examination revealed a mass at the base of the tongue. The thyroid hormone profile showed a primary hypothyroidism (a serum TSH of 10.8 IU/mL with normal-low thyroxin of 6.0 fig/dL and low triiodothyronine of 57.8 ng/ dL). Antithyroid antibodies were negative. The fiberoptic endoscopy showed a reddish mass, without evidence of haemorrhage or ulceration, confirmed as a well circumscribed, hypodense mass in the base of the tongue by computed tomography of the oropharynx and neck. Tc-99-pertechnetate scanning showed an abnormal area of uptake at the base of the tongue and no uptake in the normal thyroid location, concordant with an ectopic lingual thyroid gland. Levothyroxine in a suppressive dose was started that resulted in a reduction of the size of the mass and disappearance of dysphagia.