Lingual thyroid gland: Clinical evaluation and comprehensive management

Abstract

Althou gh lingual thyroid gland is the most comm on benign mass f ound at the jun ction ofthe ant erior two-thirds and the posterior one-third of the tongue, it is still a rare clinical entity. This developmental anomaly is the result of an arrested descent of the gland anlage early in the course of embryogenesis. Patients may have symptoms of dysphagia due to obstruction or even hemorrhage. These symptoms can occur at any time from inf ancy throu gh adulthood. The clini cal findin gs, laboratory tests, and radiograph ic imaging studies emplo yed in confi rming the diagn osis and in planning appropriate treatm ent hav e been evaluated. The primary therap eutic goal is to restore thyroid fun ction. We describ e a case of lingual thyroid gland and summarize the current man agement pr incipl es f or this condition.

Transoral robot-assisted excision of a lingual thyroid gland

“…Careful airway management is required regardless of approach. Ablation with iodine-131 is reserved for patients who are not surgical candidates, given its unpredictable and inconsistent results [11].…”

Radiofrequency ablation as a novel treatment for lingual thyroid

“…In 70% of reported cases, the lingual thyroid is the only functioning thyroid tissue and hypothyroidism occurs in 33% [2]. Age at time of diagnosis is from 6 to 74 years [1].…”

“…However, common presenting symptoms include dysphonia, foreign body sensation in throat, cough, dysphagia, pain in throat or referred ear pain, hemorrhage, stridor, or airway obstruction [1,5]. On physical examination, lingual thyroid will appear as a smooth dome shaped mass located in the midline base of the tongue between the circumvallate papillae and the epiglottis, commonly in addition to absence of a palpable thyroid [5].…”

“…MRI is the study of choice due to its good soft tissue resolution and its ability to allow for multiplanar imaging [4]. Biopsy carries a risk of hemorrhage and acute thyrotoxicosis and when the above tests are utilized, biopsy may be unnecessary due to the low risk of malignant transformation [1].…”

“…Failure of this process can result in ectopic deposition of thyroid tissue anywhere along the path of descent [1]. Ectopic thyroid tissue has been reported to be found in the oropharynx, larynx/trachea, esophagus, mediastinum and heart.…”