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Lingual thyroid and hypothyroidism. Report of a case in a middle aged woman
F Borgoni1, E Liberatori, M Giambagli
1Department of Internal Medicine USL 32, Ospedale di Casteldelpiano, Grosseto, Italy.
Insights
Lingual thyroid (LT) is rare, primarily affecting children and potentially causing airway obstruction. This case highlights LT discovered in adulthood due to hypothyroidism, not typical childhood symptoms.
Area of Science:
- Endocrinology
- Otolaryngology
- Medical Genetics
Background:
- Lingual thyroid (LT) is a congenital anomaly where thyroid tissue is located in the tongue.
- It predominantly affects pediatric patients, often presenting with symptoms like dysphagia, dyspnea, or airway obstruction due to gland hypertrophy stimulated by thyrotropin (TSH).
- Diagnosis typically involves indirect laryngoscopy and thyroscintigraphy.
Observation:
- This report details a rare case of lingual thyroid in a middle-aged adult.
- The anomaly was asymptomatic throughout the patient's life until the recent development of hypothyroidism.
- The hypothyroidism is presumed to be secondary to silent thyroiditis affecting the ectopic thyroid gland.
Findings:
- Lingual thyroid can remain clinically silent into adulthood.
- Ectopic thyroid tissue is susceptible to thyroid pathologies, such as thyroiditis, even when asymptomatic.
- Progressive hypothyroidism can be a late-presenting sign of an undiagnosed lingual thyroid.
Implications:
- This case expands the known clinical spectrum of lingual thyroid presentation.
- It underscores the importance of considering ectopic thyroid tissue in the differential diagnosis of hypothyroidism, regardless of age.
- Further investigation into the long-term function and potential complications of asymptomatic lingual thyroid in adults may be warranted.
Abstract:
There are approximately 400 reported cases of lingual thyroid (LT) with a clear cut prevalence in paediatric age. These glands are probably quantitatively deficient and function at marginal levels. Thyro-stimulating hormone (TSH) causes hypertrophy producing local symptoms and in younger patients may induce dangerous obstruction. The presumptive diagnosis is usually made by indirect laryngoscopy and thyroscintigraphy. The authors describe a case of LT in a middle aged patient in whom the anomaly remained undiscovered, being without local symptoms, and permitting a normal life. The discovery was made possible by the development in the last four years of a progressive, frank hypothyroidism, probably induced by silent thyroiditis into the ectopic gland.