Ectopic Lingual Thyroid Presenting with Massive Hematemesis

Abstract

Ectopic lingual thyroid is a rare developmental abnormality caused by aberrant embryogenesis during thyroid migration. Even though, most patients are asymptomatic, uncommonly the mass can be enlarged and cause dysphagia, dyspnea, upper airway obstruction, dysphonia, hypothyroidism. We report a very rare case of ectopic lingual thyroid presenting with massive hematemesis.

Lingual Thyroid with Subclinical Hypothyroidism in a Young Female

“…Failure to descend to the normal anatomical position results in the ectopic location of the thyroid tissue. A few authors state that maternal antithyroid immunoglobulins might be responsible for impaired descend during early life [ 5 , 6 , 9 ]. The commonest location of the ectopic thyroid tissue (ETT) in the head and neck region is the lingual [ 1 ] and sublingual location followed by the trachea, submandibular gland, lateral cervical region, maxilla, palatine tonsils, carotid bifurcation, iris of the eye, and pituitary gland.…”

“…Reported histotypes are papillary, follicular, mixed follicular and papillary, Hurthel cell, and medullary [ 2 , 3 ]. Increased demand for thyroxine during puberty and pregnancy increases the work of the only functional ectopic tissue and, hence, increases LT size [ 2 , 6 , 8 , 11 ]. This explains why the reported lingual thyroid is common among females.…”

“…Examination of the oral cavity to look for the nodule in the base of the tongue and palpation of the neck to assess the thyroid gland in orthotopic location is an essential initial evaluation [ 7 , 11 ]. High-resolution ultrasonography (USG) is a readily available and noninvasive tool in the evaluation of the thyroid gland in the orthotopic location and detection of the ectopic thyroid nodule [ 6 ]. Color Doppler can aid to demonstrate the vascularity of the nodule.…”

“…The exact prevalence of lingual thyroid is unknown since many asymptomatic patients never come to medical attention; however, a study among 200 consecutive routine necropsies on Caucasian individuals suggested that 10% of adults may harbor asymptomatic thyroid tissue along the path of the thyroglossal duct [ 3 ]. Among the patients with thyroid disease, the overall prevalence of lingual thyroid is 1 in 3000 cases [ 5 , 6 ]. Lingual thyroid is common among females (70–80%) [ 2 , 5 , 6 ].…”

“…Among the patients with thyroid disease, the overall prevalence of lingual thyroid is 1 in 3000 cases [ 5 , 6 ]. Lingual thyroid is common among females (70–80%) [ 2 , 5 , 6 ]. Most cases of LT are asymptomatic [ 4 – 9 ] unless an increase in gland size occurs resulting in dysphagia, dysphonia, foreign body sensation in the throat, cough, pain, bleeding, and dyspnea [ 2 ].…”