Lingual Thyroid: 35-Year Experience at a Tertiary Care Referral Center

Barbara G. Carranza Leon, MD; Adina Turcu, MD; Rebecca Bahn, MD; Diana S. Dean, MD

Disclosures

Endocr Pract. 2016;22(3):343-349. 

In This Article

Results

Mayo Clinic LT Cases

Twenty-nine cases of LT were identified between 1976 and 2010 (Table 1). Eighty-three percent of patients were female. Age at diagnosis varied widely, from 2 weeks to 68 years. Three patients were found to have LT after being diagnosed with congenital hypothyroidism. Thirty-two percent of patients were diagnosed during childhood or adolescence. Nine cases were diagnosed incidentally on routine exam, during evaluation for upper respiratory infections, or tonsillectomy. Eight patients presented with local symptoms and five with hypothyroidism. In those symptomatic (28%), cough and hoarseness were the most common complaints. One patient suffered from severe obstructive sleep apnea thought to be due to a 7-cm LT. All patients had at least one imaging test (neck ultrasound, computed tomography neck, or RAI scan), and only 1 patient had orthotopic thyroid tissue present. Sixteen of 22 (72%) patients in whom subsequent thyroid function assessment was available eventually became hypothyroid. No patient developed thyroid cancer.

Nineteen (65%) of the patients received thyroid hormone replacement, one of whom was euthyroid before receiving thyroid hormone for gland suppression. Surgical removal of the LT tissue was performed in 6 patients (21%). One patient had significant dysphagia post–transoral robot-assisted resection (Fig. 1 and 2) and experienced mucosal bleeding from the tongue base, ultimately requiring cauterization 6 days postoperatively. All patients approached surgically required intubation for airway protection, and 1 patient required temporary tracheostomy. RAI was administered to 2 patients (Fig. 3) who achieved gland shrinkage, and 2 patients were followed without intervention. Two other patients were initially managed conservatively but ultimately underwent surgery: a 10-year-old boy with congenital hypothyroidism and persistent hoarseness and an 11-year-old euthyroid boy with dyspnea, persistent after treatment with levothyroxine.

Figure 1.

Endoscopic view of a lingual thyroid.

Figure 2.

Pathologic specimen of a surgically removed lingual thyroid.

Figure 3.

123I radioactive iodine uptake of 4.8% at 4.2 hours showing a lingual thyroid.

Literature Review of LT Cases

We identified 22 articles that reported at least 2 cases of LT published between 1965 and 2015. Table 2 includes a detailed summary of the management of those patients. Eight of the 22 case series included only surgical cases, and of these, four reported new surgical techniques or approaches for the management of LT.[11–14] Surgery was the most common therapeutic option, closely followed by thyroid suppressive therapy (when the exclusively surgical reports were excluded). Dysphagia was the most common symptom that led to surgery. In 3 publications, surgery was performed after patients had failed thyroid suppressive therapy.[15–17]

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