The gland that never descended: Preoperative transarterial embolization of a symptomatic lingual thyroid

Ectopic lingual thyroid is a rare vascular developmental anomaly that frequently represents the patient's sole functioning thyroid tissue. We report a 43-year-old euthyroid woman (baseline TSH 1.32 µIU/mL, free T4 1.12 ng/dL) with a symptomatic lingual thyroid measuring 2.1 × 1.6 × 2.4 cm on CT presenting with progressive dysphagia, hoarseness, and globus sensation. Because the hypervascular tongue-base mass required resection, preoperative transarterial embolization of its bilateral lingual arterial supply (right-dominant) was performed via a right transfemoral approach using a Scepter C 4 × 10 balloon microcatheter with 1 vial of 300-500 µm polyvinyl alcohol (PVA) particles followed by Onyx 18 (1 cc per pedicle, total 3 cc; 0.5 cm reflux tolerated), achieving near-complete devascularization without complications (fluoroscopy time: 40.7 minutes; cumulative reference air kerma: 1160 mGy). Single-port transoral robotic-assisted resection followed the next day; intraoperative direct laryngoscopy demonstrated marked mucosal blanching, and excision was completed with an estimated blood loss of only 5 mL without transfusions. Total resection of the ectopic tissue produced expected postsurgical hypothyroidism (TSH 11.0 µIU/mL, free T4 0.61 ng/dL), successfully managed with levothyroxine 100 µg daily; at two-month follow-up she remained euthyroid on a stable dose, with improved swallowing and resolution of globus. Transarterial embolization served as an effective preoperative devascularization adjunct that reduced intraoperative hemorrhage during transoral robotic resection of a hypervascular tongue-base lesion.