Lingual Thyroid: Diagnostic and Therapeutic Insights. A Case Report

Ectopic Thyroid (ET) predominantly locates at the tongue base (~90%) but is easily misdiagnosed due to non-specific symptoms. Most cases are complicated with hypothyroidism, and blind surgery may lead to permanent hypothyroidism. This case report is a typical yet easily missed presentation, providing practical diagnostic and therapeutic references for clinicians facing similar unexplained pharyngeal symptoms.

A 44-year-old female presented with unexplained pharyngeal foreign body sensation and was initially suspected of a tongue base mass. Multimodal examinations (fibrolaryngoscopy, neck CT, thyroid ultrasound, scintigraphy, and thyroid function tests) revealed a semicircular tongue base bulge, absent normal thyroid tissue in the anatomical site, and decreased thyroxine (T4), confirming lingual ET. She received thyroid hormone replacement therapy and was followed up regularly.

Clinicians should consider lingual ET in patients with unexplained pharyngeal symptoms. Multimodal examinations are essential for accurate diagnosis, and individualized treatment (prioritizing hormone replacement over blind surgery) is critical to avoid irreversible hypothyroidism. Standardized management ensures a favorable prognosis, highlighting the value of differential diagnosis for atypical head and neck symptoms.