ECE2014 Poster Presentations Clinical case reports Thyroid/Others (72 abstracts)
From hemoptysis to diagnosis of congenital hypothyroidism: a diagnostic pitfall
Malgorzata Szkudlarek 1 , Ewelina Szczepanek-Parulska 1 , Katarzyna Ziemnicka 1 , Katarzyna Piatek 1 , Monika Golab 1 , Jaroslaw Kaluzny 2 , Rafal Czepczynski 1 & Marek Ruchala 1
1Department of Endocrinology, Metabolism and Internal Medicine, University of Medical Sciences, Poznań, Poland; 2Department of Otolaryngology, Head and Neck Surgery, University of Medical Sciences, Poznań, Poland.
Introduction: Congenital hypothyroidism (CH) is the most common congenital endocrine disorder. It occurs in Europe with an incidence of 1:3000–1:4000.Thyroid dysgenesis – agenesis, hypoplasia or ectopy – is responsible for 80–90% of CH cases. An ectopic thyroid gland is an uncommon inborn anomaly and is typically located along the thyroglossal duct. To date only few cases of CH due to lingual thyroid diagnosed in adulthood were reported in the literature.
Case report: A 31-year-old man was admitted to the Department of Pulmonology with hemoptysis without cough. Bronchofiberoscopy did not provide the explanation of the reason for hemoptysis. The CT scan of the chest revealed multiple small nodules in both lungs. Suspicion of metastasis to the lungs has been raised. The patient was referred for PET–CT, which demonstrated marked regression of size and number of lung nodules and additionally increased uptake of 18F-FDG in the region of right tonsil. Head MRI was performed and disclosed a tumor of the base of tongue (size 37×32×35 mm), compressing the tonsil and epiglottis. After ENT consultation and microlaryngoscopy patient was referred to endocrinologist with suspicion of lingual thyroid. The neck ultrasound revealed absence of orthotropic thyroid gland and presence of ectopic thyroid in sublingual region. At the time of diagnosis the patient was hypothyroid with TSH level 21.8 μIU/ml. Autoimmune etiology of hypothyroidism was excluded. Due to compressive symptoms and contraindication for surgery, 22 mCi of 131-radioiodine was administered and L-T4 replacement therapy have been introduced.
Conclusions: The reported case is exceptional because of advanced age of diagnosis and unusual clinical presentation. Bleeding and hemoptysis, next to local symptoms, dyspnea, dysphagia and dysphonia, can be a manifestation of a lingual thyroid. The described case indicates that PET–CT may provide useful information in diagnostic process of ectopic thyroid gland.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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