Endocrine Abstracts

Introduction: Lingual thyroid ectopia is a rare congenital abnormality affecting embryogenesis of the gland descent from foregut through pre-tracheal region in the neck. Most cases have an asymptomatic course but may occasionally produce local obstructive symptoms. Diagnostic methods are ^99mTc, ¹³¹I or ¹²³I radionuclide scan, computed tomography scan, magnetic resonance, and ultrasound. Surgery is the elective treatment for cases presenting complaints or complications. Radioactive iodine ablation is an alternative for patients who refuse surgical intervention or unfit for anesthesia. We report 49-year-old women with an ectopic lingual thyroid presented as oral hemoptysis with high surgical risk, successfully treated with ¹³¹I.

Materials and methods: A case report description conducted with the consent of the patient and with provisions of the Declaration of Helsinki.

Results: 49-year women with relevant medical history such as primary hypothyroidism under thyroid hormone replacement, well controlled type 2 diabetes, HTA and morbid obesity (BMI 58). Presented to Emergency department with a 12-h history of upper gastrointestinal bleeding, mild dysphagia, and no respiratory symptoms. Gastroscopic examination demonstrates a jet arterial bleed above the epiglottis at the base of the tongue. Intubation was performed with surgical hemostasis by means of pharyngeal packing containing and resolving the hemorrhage. CT of the neck confirmed a well-defined rounded occupational image at the base of the tongue and floor of the mouth, in the midline, with intense and homogeneous enhancement, measuring 35x37x39mm, compatible with ectopic lingual thyroid that imprints on the oropharyngeal lumen. Thyroid ^99mTc combined with single-photon emission computed tomography/computed tomography confirmed an increased radiotracer homogeneous activity on at this location. Hospitalization was complicated with bilateral pneumonia and bilateral acute pulmonary embolism (PESI 59, class I). Surgical option was denied because of patients’ comorbidities and associated complications due to this conventional tongue surgery. She was treated with 16.5 mCi of ¹³¹I remaining asymptomatic.

Conclusion: Lingual thyroid ectopia is a rare congenital anomality in population, that warrants treatment when it produces obstructive or compressive symptoms or complication arrives. Scintigraphy methods plays a major role in establishing the diagnosis, even though US and TC or RM may also be helpful in the process of differential diagnosis with other cervical masses. Surgery has been the conventional approach to remove ectopic thyroid gland. However, other strategies such as RAI are safe and efficient strategy for high risk surgical and comorbid patients, remaining them asymptomatic.