Background: Ectopic thyroid tissue can be found anywhere along the normal path of thyroid descent, but is most commonly found at the base of the tongue, in which case it may be referred to as a lingual thyroid. Although the patients are usually asymptomatic, it can lead to symptoms such as dysphonia and dysphagia. We present a child patient with a lingual thyroid resulting in severe dysphagia that was cured surgically.
Case presentation: An 4-year-old male child presented to our department for failure to thrive estimate at less 2 DS. He Present a severe dysphagia to food, some episodes of transitional dyspnea, hypothyroidism treated since 1 year with lévothyrox. Examination of the neck revealed no palpable thyroid gland in the normal prétrachéale position, no cervical adenopathy and normal oral cavity.
Thyroid hormone tests showed elevated TSH, TG (thyroglobulin) concentrations and decreased FT3, FT4 concentrations. The ultrasound exam shows an oval mass lobed echogenic and homogeneous measuring 1.4 x 1.0 cm without discernable isthmus. The thyroid scintigraphy with 99mTc-Pertechnetate showed an uptake region at the base of the tongue representing a lingual thyroid. There was no thyroid uptake in the usual site in the neck. CT image showing intensely enhancing mass in the base of tongue and absent native thyroid issue in the thyroid bed.
Increased dose L-thyroxine was started and surgery because sever dysphagia was performed. The patient made a good post-operative recovery and the clinically symptoms decreased.
Conclusion: An ectopic thyroid should be considered in any child with presence of hypothyroidism and surgical indication is to be expected after exploring all dyspnea and /or dysphagia.
Keywords: lingual thyroid, hypothyroidism, child, dysphagia, surgical indication.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology