A rare case presentation of a common condition: A large laryngeal gouty tophus

Laryngeal gout is an exceedingly rare manifestation of advanced, poorly controlled gout. It is characterized by the deposition of gouty tophi within various laryngeal structures. Similar to peripheral joints, monosodium urate crystals develop due to high concentrations of serum uric acid. When localized to the laryngeal region, tophi can induce a range of symptoms and complications, including hoarseness, dysphagia, respiratory distress, and infection. Alternatively, it may present as an asymptomatic anterior neck mass. The thyroid cartilage, true vocal cords, arytenoids, and cricoarytenoid joints have all been previously described as areas of involvement. In this case report, we describe the presence of a large, asymptomatic laryngeal gouty tophus situated between the hyoid bone and thyroid cartilage that was initially interpreted as ectopic thyroid tissue on CT imaging. Management typically includes urate-lowering therapy, reduction in alcohol and red meat consumption, and potential surgical intervention for obstructive symptoms. This case underscores the importance of considering laryngeal gouty tophi in patients with chronically uncontrolled hyperuricemia presenting with anterior neck masses.