The Journal of Emergency Medicine, Vol. 48, No. 4, pp. e103–e104, 2015 Copyright Ó 2015 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter
http://dx.doi.org/10.1016/j.jemermed.2014.10.025
Visual Diagnosis in Emergency Medicine
LINGUAL THYROID Huan-Wen Chen, MD* and Chih-Cheng Lai, MD† *Department of Internal Medicine, Lotung Poh-Ai Hospital, Yi-Lan, Taiwan and †Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan Reprint Address: Chih-Cheng Lai, MD, Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
tongue (Figure 1, arrow). Thyroid tissue was not seen by ultrasound. Hypothyroidism was diagnosed on the biochemical findings: a serum thyrotropin level of 178 uIU/mL (normal reference, 0.25–4 uIU/mL), a free thyroxine level (free T4) of 0.16 ng/dL (normal reference, 0.6–1.8 ng/dL), and a total triiodothyronine level of 0.9 ng/dL (normal reference, 60–190 ng/dL). Radioactive iodine (131I) thyroid scan revealed 131I uptake at the base of the tongue but no uptake in the normal thyroid
CASE REPORT A 50-year-old woman presented with progressive dysphagia, especially for solid food. She had a history of hypothyroidism, however, she did not receive regular medical treatment. Oropharyngeal examination revealed a nodular lesion at the tongue base. Computed tomography (CT) scan of the neck showed a 2.2-cm heterogeneous enhancing nodule, noted in the base of the
Figure 1. Computed tomography scan of the neck showing a 2.2-cm heterogeneous enhancing nodule noted in the base of the tongue (arrow) in the axial (A) and sagittal (B) views.
RECEIVED: 11 July 2014; ACCEPTED: 8 October 2014 e103
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H.-W. Chen and C.-C. Lai
location. This was compatible with lingual thyroid. Levothyroxine was prescribed to treat the hypothyroidism. After 6 months of treatment, euthyroidism was achieved with a marked shrinkage in the size of the lingual thyroid. In addition, the condition of dysphagia improved at the same time. DISCUSSION Ectopic thyroid is defined as the presence of thyroid tissue at a site other than the normal location, and lingual thyroid is the most common type of this clinical entity. Clinical presentations of lingual thyroid include cough, pain, dysphonia, dyspnea, hemorrhage, and dysphagia (1,2). However, only one third of patients have hypothyroidism (2). The diagnostic modalities include
radionuclide thyroid imaging, ultrasonography, CT, magnetic resonance image, and thyroid function test. Although patients who are asymptomatic and are in the euthyroid status do not require treatment, suppressive therapy is indicated for hypothyroidism patients with symptomatic lingual thyroid. In addition, surgical excision is indicated when there are severe obstructive symptoms, bleeding, ulceration, cystic degeneration, or development of malignancy.
REFERENCES 1. Yoon JS, Won KC, Cho IH, Lee JT, Lee HW. Clinical characteristics of ectopic thyroid in Korea. Thyroid 2007;17:1117–21. 2. Rahbar R, Yoon MJ, Connolly LP, et al. Lingual thyroid in children: a rare clinical entity. Laryngoscope 2008;118:1174–9.
http://dx.doi.org/10.1016/j.jemermed.2014.10.025
Visual Diagnosis in Emergency Medicine
LINGUAL THYROID Huan-Wen Chen, MD* and Chih-Cheng Lai, MD† *Department of Internal Medicine, Lotung Poh-Ai Hospital, Yi-Lan, Taiwan and †Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan Reprint Address: Chih-Cheng Lai, MD, Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
tongue (Figure 1, arrow). Thyroid tissue was not seen by ultrasound. Hypothyroidism was diagnosed on the biochemical findings: a serum thyrotropin level of 178 uIU/mL (normal reference, 0.25–4 uIU/mL), a free thyroxine level (free T4) of 0.16 ng/dL (normal reference, 0.6–1.8 ng/dL), and a total triiodothyronine level of 0.9 ng/dL (normal reference, 60–190 ng/dL). Radioactive iodine (131I) thyroid scan revealed 131I uptake at the base of the tongue but no uptake in the normal thyroid
CASE REPORT A 50-year-old woman presented with progressive dysphagia, especially for solid food. She had a history of hypothyroidism, however, she did not receive regular medical treatment. Oropharyngeal examination revealed a nodular lesion at the tongue base. Computed tomography (CT) scan of the neck showed a 2.2-cm heterogeneous enhancing nodule, noted in the base of the
Figure 1. Computed tomography scan of the neck showing a 2.2-cm heterogeneous enhancing nodule noted in the base of the tongue (arrow) in the axial (A) and sagittal (B) views.
RECEIVED: 11 July 2014; ACCEPTED: 8 October 2014 e103
e104
H.-W. Chen and C.-C. Lai
location. This was compatible with lingual thyroid. Levothyroxine was prescribed to treat the hypothyroidism. After 6 months of treatment, euthyroidism was achieved with a marked shrinkage in the size of the lingual thyroid. In addition, the condition of dysphagia improved at the same time. DISCUSSION Ectopic thyroid is defined as the presence of thyroid tissue at a site other than the normal location, and lingual thyroid is the most common type of this clinical entity. Clinical presentations of lingual thyroid include cough, pain, dysphonia, dyspnea, hemorrhage, and dysphagia (1,2). However, only one third of patients have hypothyroidism (2). The diagnostic modalities include
radionuclide thyroid imaging, ultrasonography, CT, magnetic resonance image, and thyroid function test. Although patients who are asymptomatic and are in the euthyroid status do not require treatment, suppressive therapy is indicated for hypothyroidism patients with symptomatic lingual thyroid. In addition, surgical excision is indicated when there are severe obstructive symptoms, bleeding, ulceration, cystic degeneration, or development of malignancy.
REFERENCES 1. Yoon JS, Won KC, Cho IH, Lee JT, Lee HW. Clinical characteristics of ectopic thyroid in Korea. Thyroid 2007;17:1117–21. 2. Rahbar R, Yoon MJ, Connolly LP, et al. Lingual thyroid in children: a rare clinical entity. Laryngoscope 2008;118:1174–9.
