Lingual Thyroid in Children: A Rare Clinical Entity

Lingual thyroid is an uncommon developmental anomaly and is the result of failure of the thyroid to descend from the foramen caecum to its prelaryngeal site. The lingual thyroid with a functioning thyroid gland in the neck is even more rare. In this report, we describe a 40-year-old female patient with a foreign body sensation and progressive dysphagia caused by ectopic lingual thyroid that is 5 x 4 x 3 cm in size. Here we present a patient with functional lingual thyroid gland who had had thyroidectomy 20 years ago. Lingual thyroid, which is like a malignant mass, was excised by external approach without complications.

Journal of Inherited Metabolic DiseaseVolume 29, Issue 6 p. 764-764 ErratumFree Access X-linked creatine transporter defect: A report on two unrelated boys with a severe clinical phenotype This article corrects the following: X-linked creatine transporter defect: A report on two unrelated boys with a severe clinical phenotype I. M. Anselm, F. S. Alkuraya, G. S. Salomons, C. Jakobs, A. B. Fulton, M. Mazumdar, M. Rivkin, R. Frye, T. Young Poussaint, D. Marsden, Volume 29Issue 1Journal of Inherited Metabolic Disease pages: 214-219 First Published online: February 1, 2006 I. A. Anselm, I. A. Anselm Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USASearch for more papers by this authorF. S. Alkuraya, F. S. Alkuraya Division of Genetics and Metabolism, Children's Hospital Boston, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115 USASearch for more papers by this authorG. S. Salomons, G. S. Salomons Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam, The NetherlandsSearch for more papers by this authorC. Jakobs, C. Jakobs Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam, The NetherlandsSearch for more papers by this authorA. B. Fulton, A. B. Fulton Department of Ophthalmology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USASearch for more papers by this authorM. Mazumdar, M. Mazumdar Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USASearch for more papers by this authorM. Rivkin, M. Rivkin Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USASearch for more papers by this authorR. Frye, R. Frye Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USASearch for more papers by this authorT. Young Poussaint, T. Young Poussaint Department of Radiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USASearch for more papers by this authorD. Marsden, Corresponding Author D. Marsden deborah.marsden@childrens.harvard.edu Division of Genetics and Metabolism, Children's Hospital Boston, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115 USA deborah.marsden@childrens.harvard.eduSearch for more papers by this author I. A. Anselm, I. A. Anselm Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USASearch for more papers by this authorF. S. Alkuraya, F. S. Alkuraya Division of Genetics and Metabolism, Children's Hospital Boston, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115 USASearch for more papers by this authorG. S. Salomons, G. S. Salomons Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam, The NetherlandsSearch for more papers by this authorC. Jakobs, C. Jakobs Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam, The NetherlandsSearch for more papers by this authorA. B. Fulton, A. B. Fulton Department of Ophthalmology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USASearch for more papers by this authorM. Mazumdar, M. Mazumdar Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USASearch for more papers by this authorM. Rivkin, M. Rivkin Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USASearch for more papers by this authorR. Frye, R. Frye Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USASearch for more papers by this authorT. Young Poussaint, T. Young Poussaint Department of Radiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USASearch for more papers by this authorD. Marsden, Corresponding Author D. Marsden deborah.marsden@childrens.harvard.edu Division of Genetics and Metabolism, Children's Hospital Boston, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115 USA deborah.marsden@childrens.harvard.eduSearch for more papers by this author First published: 12 October 2006 https://doi.org/10.1007/s10545-006-9997-4 The online version of the original article can be found at https://doi.org/10.1007/s10545-006-0123-4 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume29, Issue6December 2006Pages 764-764 RelatedInformation

To evaluate the efficacy and safety of radiofrequency ablation (RFA) for benign nonfunctional thyroid nodules or functional lingual thyroid gland in a pediatric population. Four pediatric patients (four female; mean age 13.50 ± 4.04, range 8-17 years) with either benign thyroid nodules or mildly obstructive lingual thyroid glands were treated with RFA from 2020 to 2021 were evaluated. The inclusion criteria for RFA therapy were (i) age < 18 years; (ii) benign cytopathological results on ultrasound guided fine needle aspiration; (iii) pressure or pain symptoms caused by the thyroid nodules; (iv) dysphagia or obstruction caused by the lingual thyroid tissue; (v) follow up for >6 months with otolaryngology or endocrinology. Two patients had benign non-functioning thyroid nodules and two had mildly obstructive functioning lingual thyroid glands. Mean follow up was 10.75 ± 4.79 months. Each patient underwent one RFA session with no complications. For the patients with thyroid nodules, there was >74% reduction in nodule size at last follow up with improvement in neck swelling and pain. For the patients with lingual thyroid glands, both did not have any other functional thyroid gland identified. Both had visible decrease in size of the gland as visualized transorally with improvement in dysphagia and obstructive symptoms when lying flat. RFA is a safe and effective option for managing benign thyroid nodules and lingual thyroid glands in a pediatric patient population. 4.

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IntroductionThe lingual thyroid gland refers to ectopic thyroid tissue situated at the base of the tongue. This rare condition occurs when the thyroid gland fails to descend to its usual position in the pre-tracheal area during embryonic development. Case presentationWe present a case of a 23-year-old female who presented with throat discomfort and progressive difficulty of swallowing upon examination there was a mass at the level of the base of the tongue. She was investigated with a thyroid function test, neck ultrasound, at the tongue's base, and head and neck CT scan. With a diagnosed lingual thyroid she was managed initially with suppression therapy followed by elective surgical removal. The work has been reported in line with the SCARE criteria. Clinical discussionThe incidence of lingual thyroid is reported to be 1 in 100,000, with a higher prevalence among females, in a ratio of 3:1 compared to males. Symptoms can vary and may include difficulty swallowing (dysphagia), voice changes (dysphonia), upper airway obstruction, or occasional bleeding, and can manifest from infancy to adulthood. ConclusionLingual thyroid is a rare clinical anomaly treatment depending on the severity of symptoms, size of the lesion, sex and age of the patient, and thyroid function.

Background: Lingual thyroid is a rare clinical entity that represents faulty migration of normal thyroid gland. It commonly presents as a benign mass found at the junction of the anterior two-thirds and posterior one-third of the tongue. Although usually asymptomatic, glandular hypertrophy can cause dysphonia, dysphagia, bleeding, or stridor at any time from infancy through adulthood. We report a case that we encountered, discuss the diagnosis and its management, and review the literature. An otherwise asymptomatic 14 year-old girl presented with a posterior tongue mass that had been present since childhood but was never investigated. She was clinically and biochemically euthyroid, with normal thyroid function tests. Physical examination revealed a smooth, globular mass occupying the whole tongue base and valleculae. The epiglottis was slightly displaced posteriorly but the laryngeal inlet was patent. A 99mTcradioisotope scan showed accumulation of tracer in the tongue base and no uptake in the neck. MRI revealed a 1.8-cm diameter soft tissue mass in the posterior part of the tongue. To date she has not required suppressive therapy or surgical intervention. Conclusions: Treatment of lingual thyroid depends on patient symptoms. Most importantly, patients should be followed at regular intervals and educated on the possibility of developing complications. Key words: Lingual thyroid, ectopic thyroid, thyroid gland. DOI: http://dx.doi.org/10.3329/bjms.v10i3.8370 BJMS 2011; 10(3): 216-219

Lingual thyroid is a very rare anomaly and is usually incidentally found in patients that have hypothyroidism or mass in throat. This case however had another mass in the submandible with diagnosis of thyroglossal cyst. Thyroglossal duct cyst is the most common congenital neck mass. About 50% of cases present before the age of 10 and second group age present in young adulthood. We present a 27-year-old man who presented with sub-mental mass. The patient had also hypothyroidism. A CT scan was performed to confirm the diagnosis. The CT scan confirmed submental cyst and incidentally discovered lingual thyroid along with absence of thyroid tissue in its normal pretracheal position. The patient had symptoms of hypothyroidism and he was treated with levothyroxin. Our case report highlights a rare and unusual situation because of the coexistence of a thyroglossal cyst and a partially functional lingual thyroid.

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Mediastinal ectopic thyroid mass with normal thyroid function and location: Case report

There are numerous reported cases of lingual thyroid with an obvious prevalence in pediatric age. Such ectopic thyroid glands are probably quantitatively deficient and thyroid function may be low or at a low normal level. Apparently, most cases of ectopic thyroid tissue develop congenital hypothyroidism, the so-called cretinism. In this report, we describe a very rare adult male case of lingual thyroid who developed hypothyroidism in adulthood; the anomaly remained undiscovered, being without local common symptoms, and permitted a normal life.

Thyroid surgery at Children's Hospital Boston: a 35-year single-institution experience

Back to table of contents Previous article Next article Members in the NewsFull AccessPsychiatrist's Deafness Opened Doors to Wider WorldAaron LevinAaron LevinPublished Online:7 Aug 2009https://doi.org/10.1176/pn.44.15.0022Sanjay Gulati, M.D., practices psychiatry in a silent world, a world he resisted, then grew accustomed to, then embraced. His deafness has given child psychiatrist Sanjay Gulati, M.D., a deeper insight into the worlds of his patients.Credit: Aaron LevinFor Gulati, now a child psychiatrist in Cambridge, Mass., the silence arrived on tiptoes: a move to the front row in high school; good grades in small, advanced classes in college and poor ones in large introductory ones; an unexamined preference for the quiet dinner for two rather than the boisterous party.Finally there was the failed audiogram, the diagnosis of hearing loss, the steady loss of five decibels a year."Otosclerosis is not supposed to strike this hard, or this young," he recalled in a recent interview. The disease is hereditary but, unlike his father's case, was not correctable by surgery. A hearing aid compensated enough to get through undergraduate school at the University of Virginia. In retrospect, he is amazed at how unaware he was of the vast number of adaptations to hearing loss he had made without ever recognizing them as such.He made a late decision to go to medical school."I think it says a lot about how much medicine my parents taught me that I scored the same in the MCAT on physics, my college major, and biology, which I didn't study at all!" he said.Gulati's father was a surgeon (who later retrained as a neuroradiologist) and his mother an anesthesiologist. Their families left Pakistan for India after the two countries were partitioned in 1947, and the couple eventually settled in Nottingham, England, where Sanjay was born. They sailed to the United States in the 1960s, when Gulati was 9."At that point, I was already starting to lose hearing, but I was not yet aware of it," he recalled. "My piano teacher complained that I wasn't playing pianissimo, even when I was sure that I was."His deafness, although progressive, was incremental. He adapted to hearing loss, but still felt cut off from much of the life going on around him. Before passage of the Americans With Disabilities Act, medical schools rarely accommodated the needs of the deaf or others with disabilities, he noted."I remember offering to pay for a better microphone during an observation class and being told no," he said. "As I went through med school and residency, it felt like I just barely slipped through each door as it shut behind me."His increasing deafness might have isolated him from the world, but it had the opposite effect. He became more attuned to body language and other visual cues to behavior. Watching sports prompted his own inner game, trying to intuit what move the pitcher or quarterback would make on the next play. Gulati applied the same skill later during shifts in the emergency room to judge if patients were dangerous.In medical school, he let go of an early interest in surgery—in the OR, everyone talks and everyone wears masks, precluding lip reading. Other logical choices for a doctor losing his hearing, such as pathology and radiology, seemed socially isolating. That led Gulati to his specialty."Psychiatry offered a chance to explore the subjective world, a nice mirror image to my college interest in deeply understanding the objective one," he said.Gulati graduated from Eastern Virginia Medical School in Norfolk in 1988, completed his internship there a year later, did his residency in psychiatry at Albany Medical College, and then held a child psychiatry fellowship at Cambridge Hospital. Today, he is an instructor in psychiatry at Harvard Medical School, works at the Cambridge Health Alliance and Children's Hospital Boston, and is a consultant to the American School for the Deaf in West Hartford, Conn. He has co-edited, with Neil Glickman, Ph.D., a textbook, Mental Health Care for Deaf People: A Culturally Affirmative Approach (Laurence Erlbaum Associates, 2003).Gulati did not seek out deaf patients in residency, but had his epiphany during his child psychiatry fellowship at Cambridge Hospital, recalled Terrell Clark, Ph.D., director of the Deaf and Hard of Hearing Program in the Department of Otolaryngology at Children's Hospital Boston, under whom he trained."He accompanied a child to the hospital and saw for the first time the specialty clinic here," said Clark in an interview. "He was still coping with his own hearing loss but had not yet identified with being deaf. I know of other deaf physicians and other psychiatrists with signing skills but not of another deaf psychiatrist. He's been an inspiration for others."He was not fluent in sign language when he began, but he soon became comfortable, she said. Learning to practice medicine in another language was difficult."For patients, baring your soul through a third party creates an artificial barrier," she said. "You're not sure if what you said and how you said it came across. So having a therapist with whom you can communicate is important."Gulati's personal and professional experience gives him an edge when helping patients and families understand complex information they may not want to hear, said Lauren Esposito, Ph.D., director of the Deaf and Hard of Hearing Service in the Department of Psychiatry at Cambridge Hospital, and one of Gulati's former trainees."He is good at working in a system that is not used to working with the deaf," said Esposito in an interview. "The treatment process can be anxiety-provoking for both patient and staff, especially if the staff doesn't know about deafness."When appropriate, he will share his own experience with his patients and their parents, which can inspire and validate patients, she said.Issues shared by all psychiatrists take on an added dimension for a psychiatrist who is deaf. Take the matter of transference."I have to deal with transference related to my lucky status as a late-deafened person who was able to squeak through medical school at a time when other deaf people could not," he said." Countertransferentially, I often have to deal with feelings of guilt around the same issue. I know a young man, for example, who cleans hotel rooms. It's clear to me that had he had appropriate language exposure and educational opportunity, he could have gone to college and graduate school as I did. I think one has to try to turn this anger into appropriately aimed activism. As a practicing psychiatrist, I keep my activism fairly quiet, but my current project is to seek wider recognition of the syndrome of language deprivation."Gulati has spoken out about the central role of language itself in the development of young people who are deaf. He believes that early training for those children in American Sign Language prepares neural pathways in the brain for general language development and for later acquisition of English.However, sign language doesn't always lend itself well to diagnostic language. There are currently four or five different signs in use now for autism, for example. So Gulati is working with others to agree on conventional technical terms in American Sign Language.Beyond the science, though, Gulati appreciates the fluidity and expressiveness of signing.He also appreciates the insights of deaf humor in sign language, often used to get through life's hardships, as it is for other minority groups.Deaf humor is hard to describe, he said, but often it involves acute awareness of the divide between the deaf and hearing worlds, sometimes with a touch of aggression toward the dominant (or oppressive) culture. Usually, there's some artistic or creative signing involved.He remembers one deaf woman, signing with her right hand, who momentarily forgets a word: "She slaps her right hand with her left, as if it were a malfunctioning television set."Eventually, the experience that shaped his own life would help shape that of his patients. What others might see as a handicap and a constriction, Gulati came to embrace as an opening door into a wider world."Had I not lost my hearing, I'd probably have become a competent, somewhat disconnected physicist," he concluded. "I have instead become a deeply involved and thoroughly fulfilled physician. It is difficult, in looking back over the journey so far, to see my hearing loss solely as loss or affliction. It has brought more into my life than it has taken away."▪ ISSUES NewArchived

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