Home | About Us | Editorial Board | Current Issue | Archives | Search | Instructions | Subscription | Feedback | e-Alerts | Login 
Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
 Users Online: 2101  
 
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size


 
  Table of Contents    
CASE REPORT
Year : 2011  |  Volume : 29  |  Issue : 3  |  Page : 270-272
 

Lingual thyroid in children


1 Department of Pedodontics and Preventive Dentistry, HP Govt Dental College, Shimla, Himachal Pradesh, India
2 Department of Oral Pathology and Microbiology, HP Govt Dental College, Shimla, Himachal Pradesh, India

Date of Web Publication10-Oct-2011

Correspondence Address:
P Singhal
Department of Pedodontics and Preventive Dentistry, HP Govt Dental College, Shimla, Himachal Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.85840

Rights and Permissions

 

   Abstract 

Lingual thyroid is a rare embryological anomaly and originates from failure of the thyroid gland to descend from the foramen caecum to its normal eutopic pre-laryngeal site. The ectopic gland located at the base of the tongue is often asymptomatic but may cause local symptoms such as dysphagia, dysphonia with stomatolalia, upper airway obstruction and haemorrhage, often with hypothyroidism. One case is presented, in a 5 year-old girl patient, who complained of sensation of a foreign body and progressive dysphagia and dyspnoea caused by ectopic lingual thyroid. The diagnosis of lingual thyroid is usually made clinically and radionuclide scanning is used to confirm the diagnosis. In this case report, presentation, diagnosis and management of this condition is highlighted.


Keywords: Dysphagia, hypothyroidism, lingual thyroid


How to cite this article:
Singhal P, Sharma K R, Singhal A. Lingual thyroid in children. J Indian Soc Pedod Prev Dent 2011;29:270-2

How to cite this URL:
Singhal P, Sharma K R, Singhal A. Lingual thyroid in children. J Indian Soc Pedod Prev Dent [serial online] 2011 [cited 2019 Sep 19];29:270-2. Available from: http://www.jisppd.com/text.asp?2011/29/3/270/85840



   Introduction Top


Lingual thyroid is a rare embryological anomaly that originates from failure of the thyroid gland to descend from the foramen caecum to its normal prelaryngeal site. The ectopic gland located at the base of the tongue is often asymptomatic but may cause local symptoms such as dysphagia, dysphonia with stomatologia, upper-airway obstruction, and haemorrhage, often with hypothyroidism. A 4-year-old girl patient was presented with complaints of sensation of a foreign body and progressive dysphagia and dyspnoea caused by ectopic lingual thyroid. In this case report, the presentation, diagnosis, and management of this condition are highlighted.


   Case Report Top


A 5-year-old female patient presented with complaints of swelling on the base of tongue and associated dysphagia for the last 6 months. There was insignificant medical history and history of decreased apatite and constipation and no history of dyspnoea, delayed milestones, and mental retardation. She weighed 14 kg and her height was 95 cm. Physical examination revealed a solid, pink, spherical mass, covered with intact mucosa, located at the base of the tongue, measuring 2.5 cm × 2 cm × 2 cm, obstructing the visualization of the larynx, which was nontender, fixed, and appeared to be vascular [Figure 1]. Examination of the neck revealed no palpable thyroid gland in the normal pretracheal position and no cervical adenopathy. Ultrasonographic scan of the neck showed nonvisualisation of the thyroid in its normal anatomic position. Thyroid function tests showed normal T3 (161.76 ng/dl) and T4 (5.79 μg/dl) while TSH was elevated (9.05 IU/ml). Other laboratory tests were within normal range. Thyroid scan with technetium Tc-99m sodium was performed, showing no tracer uptake in the region of thyroid bed and two focal areas of tracer uptake were seen in the lingual and sublingual region [Figure 2]. She was diagnosed with dual ectopic lingual thyroid with subclinical hypothyroidism. Substitutive hormone therapy was started in order to maintain the euthyroid state placed on thyroxine sodium 50 μgOD. Patient was advised re-evaluation after 3 months to titrate the thyroxine dosage. After 3 months thyroid function tests were done, which were within normal range. There was no change in swelling size with H/O dysphagia still present. Dosage of thyroxine was increased to 75 μg OD for next 3 months and patient showed decrease in the size of swelling with no difficulty during swallowing.
Figure 1: Solid, pink, spherical mass, covered with intact mucosa, located at the base of the tongue, measuring 2.5 × 2 × 2 cm

Click here to view
Figure 2: Thyroid scan with technetium Tc-99m sodium showing tracer uptake in base of tongue and sublingual region

Click here to view



   Discussion Top


Embryologically, the thyroid gland develops as the first pharyngeal derivative by an endodermal diverticulum, in the midline of the ventral pharynx between the first and second pharyngeal pouches. A diverticulum descends caudally into the loose prepharyngeal connective tissue and passes anterior to the developing hyoid bone and forms most of the thyroid parenchyma. However, parafollicular C-cells reach the thyroid by ultimobranchial bodies, which are the product of the fourth and fifth branchial pouches and form 1-30% of the thyroid weight. [1] Failure of descent of either the medial anlage of the thyroid, or the ultimobranchial bodies, and the incomplete obliteration of its vertical tract, lead to ectopic thyroid development. The ectopic thyroids are usually located in the midline from the base of tongue to the diaphragm, but can be also be present laterally. Lingual thyroid is not a very common lesion; carcinomatous change in it is very rare. The majority of carcinomas observed in the lingual thyroid are reported to be follicular. [2] Lingual thyroid is the most frequent ectopic location of the thyroid gland, although its prevalence varies between 1 : 100 000 and 1 : 300 000 and its clinical incidence is reported to range from 1 : 4000 to 1 : 10000.

Ectopic thyroid tissue can also occur between the geniohyoid and mylohyoid muscles (sublingual thyroid), above the hyoid bone (prelaryngeal thyroid) and in other rare sites such as the mediastinum, precardial sac, heart, breast, pharynx, oesophagus, trachea, lung, duodenum, and mesentery of the small intestine, adrenal gland. [3] CT (computerized tomography) or MR (magnetic resonance) scans show a midline mass extending from the midline mucosal surface of the tongue base into the medial sublingual space that can resemble a thyroglossal cyst. However, nuclear scans are better to demonstrate the location of ectopic glands. [4] Thyroid scan can also reveal whether there are other sites of thyroid tissue; in approximately 75% of patients the ectopic tissue is the only functioning thyroid tissue in the body. [5] Management of lingual thyroid is still controversial. No treatment is required when the lingual thyroid is asymptomatic and the patient is in a euthyroid state; the patient has to be followed to be aware of development of complications. Malignant transformation has been described [1],[2] and, for this reason, some authors consider complete surgical removal of the gland as an appropriate treatment. [6],[7] For patients with no or only mild clinical symptoms and elevated TSH concentration, substitutive therapy with thyroid hormone may be successful, producing a slow reduction of the mass. Ablative radioiodine therapy is an alternative approach recommended in older patients or patients who are deemed unfit for surgery. This treatment should be avoided in children and young adults since the systemic doses required have potentially damaging effects on the gonads or other organs. [8] Surgical excision or radioiodine therapies are effective treatments for lingual thyroid, but no treatment should be attempted until a radioisotope scan has determined that there is adequate thyroid tissue in the neck. In patients, those with lacking thyroid tissue in the neck, the lingual thyroid can be excised and autotransplanted to the muscles of the neck. If emergency surgery is not necessary, suppression therapy should be tried first in order to decrease the dimensions of the mass. The general conditions of the patient, the size of the lesion, and presence of local symptoms or complications, such as hemorrhage, cystic degeneration, or malignancies, are the most important conditions for planning the choice of treatment. [9]

 
   References Top

1.Collins P. Embryology and development. In: Williams PL, Bannister LH, Berry MM, Gray H. editors. Gray's Anatomy - The Anatomical Basis of Medicine and Surgery. 38 th ed. New York: Churchill Livingstone; 1995. p. 174-99.   Back to cited text no. 1
    
2.Gooder P. Follicular carcinoma in a lingual thyroid. J Laryngol Otol 1980;94:437-9.  Back to cited text no. 2
[PUBMED]    
3.Di Benedetto V. Ectopic thyroid gland in the submandibular region simulating a thyroglossal duct cyst: A case report. J Pediatr Surg 1997;32:1745-6.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Elprana D, Manni JJ, Smals AG. Lingual thyroid. ORL J Otorhinolaryngol Relat Spec 1984;46:147-52.  Back to cited text no. 4
[PUBMED]    
5.Baik SH, Choi JH, Lee HM. Dual ectopic thyroid. Eur Arch Otorhinolaryngol 2002;259:105-7.  Back to cited text no. 5
[PUBMED]    
6.Galizia G, Lieto E, Ferrara A, Castellano P, Pelosio L, Imperatore V, et al. Ectopic thyroid: Report of a case. G Chir 2001;22:85-8.   Back to cited text no. 6
[PUBMED]    
7.Shah BC, Ravichand CS, Juluri S, Agarwal A, Pramesh CS, Mistry RC. Ectopic thyroid cancer. Ann Thorac Cardiovasc Surg 2007;13:122-4.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Alderson DJ, Lannigan FJ. Lingual thyroid presenting after previous thyroglossal cyst excision. J Laryngol Otol 1994;108:341-3.  Back to cited text no. 8
[PUBMED]    
9.Toso A, Colombani F, Averono G, Aluffi P, Pia F. Lingual thyroid causing dysphagia and dyspnoea. Case reports and review of the literature. Acta Otorhinolaryngologica ital 2009;29:213-7.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]


This article has been cited by
1 Enfermedades de las vías respiratorias superiores
M. François
EMC - Pediatría. 2013; 48(3): 1
[Pubmed] | [DOI]
2 Pathologie des voies aériennes supérieures
M. François
EMC - Pédiatrie - Maladies infectieuses. 2013; 8(2): 1
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
 

    

 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (3,761 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
   Case Report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed5460    
    Printed144    
    Emailed1    
    PDF Downloaded280    
    Comments [Add]    
    Cited by others 2    

Recommend this journal


Contact us | Sitemap | Advertise | What's New | Copyright and Disclaimer 
 © 2005 - Journal of Indian Society of Pedodontics and Preventive Dentistry | Published by Wolters Kluwer - Medknow 
Online since 1st May '05