Hashimoto's thyroiditis: an accidental discovery of a lingual thyroid in a 7-year-old child

Abstract

An ectopic thyroid located at the base of the tongue is a rare entity, resulting from early developmental defects of thyroid gland embryogenesis during its descent from the foramen caecum to its normal eutopic pretracheal site. This condition is the main cause of congenital primary hypothyroidism, even though signs and symptoms of thyroid dysfunction may also appear later in childhood. Lingual thyroid may sometimes present with symptoms of respiratory obstruction or feeding difficulties. We illustrate the case of a 7-year-old girl with subclinical hypothyroidism due to Hashimoto’s thyroiditis arising in a lingual thyroid. She had never suffered from upper airway obstructive symptoms, but did refer a 3-month history of cough. Rapid normalisation of thyroid-stimulating hormone levels and termination of the cough were attained when the L-thyroxine treatment started. After 6 months a significant reduction of lingual thyroid size was also noted. The diagnostic procedures and therapeutic options in childhood are discussed.

Acute infectious thyroiditis in ectopic lingual thyroid causing dysphagia and dyspnoea: a case report and discussion

“…Enlargement of the thyroid gland can occur at all ages, but it occurs most often during puberty, gestation or while experiencing upper respiratory tract infections. 1 , 3 If symptomatic, the clinical presentation may vary, depending on the location of the thyroid gland. A lingual thyroid gland can manifest as dysphagia, dyspnoea or dysphonia.…”

Is Transoral Robotic Surgery the Best Surgical Treatment for Lingual Thyroid? A Case-Report and Literature Review

“…3,4 Ectopias, which are mostly single, can be found in 4 distinct anatomical sites: intralaryngeal, thyroglossal, sublingual and lingual, which is the most frequent localization. 1,2 Patients with lingual thyroid (LT) usually experience 2 types of symptoms, either related to thyroid dysfunction, 5,6 or obstructive symptoms when the gland size increases. 1,2 Moreover, it has been reported that LT can be the site of carcinoma.…”

“…Due to the rarity of this condition, there is no current recommendation for LT management, but a consensus seems to emerge in several situations. 1,2,6,8 -10 Careful follow-up can be proposed for asymptomatic and euthyroid patients. Suppressive (and substitutive) thyroxine replacement therapy is appropriate for patients with mild obstructive symptoms and/or hypothyroidism but should also be considered in asymptomatic and euthyroid patients to prevent hypothyroidism, and even obstructive goiter for which this treatment remains controversial.…”

“…11 Notably, surgery should be chosen for patients with massive lesions that cause severe obstructive symptoms, for LT carcinoma, or when complications have already occurred. 1,2,6 Of course, the patient’s health status, co-morbidities, and preference must be taken into account in determining the treatment strategy.…”

Ektopia tarczycy — wyzwania diagnostyczne i terapeutyczne przed wprowadzeniem przesiewowego badania TSH noworodków i po nim

“…nodular goitre [40], Hashimoto's thyroiditis [41], or Graves' disease [42]. The incidence of differentiated thyroid cancer in lingual thyroid and thyroglossal duct cyst is estimated at approximately 1% of affected patients [43].…”