[The problem of lingual goiter].
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The authors present a case of 60-year-old woman who suffered from a mycosis (Candidosis) infection of the ectopic lingual thyroid gland. Intensive inflammatory process caused enlargement of lingual goiter and dysphagia occurred consequently. Right diagnosis was made after scyntygraphic examination (the presence of lingual thyroid gland only), as well as histopathological and microbiological examinations which revealed the presence of Candida forms. Recovery was achieved after 5 weeks of antifungal treatment--Diflucan during a 2-week initial period, then followed by 3 weeks of local treatment with nystatin.
The clinical course of 15 patients with overt primary hypothyroidism manifested in childhood were studied. Nine female patients with goitrous hypothyroidism due to chronic thyroiditis showed almost normal height and became euthyroid spontaneously during iodine restriction. The other 6 nongoitrous patients (3M and 3F) (atrophic thyroiditis in 2, lingual goiter in 2 and probable hypoplastic thyroid in 2) showed physical growth retardation and remained irreversibly hypothyroid requiring replacement therapy. In the reversible group, the characteristic findings were high thyroidal radioactive iodine uptake (58 +/- 19%/24 h, N = 8) and positive perchlorate discharge test. Serum nonhormonal iodine levels were high in 4 of 6 patients measured. During the long-term follow-up period of 6 years in 6 patients, 2 patients remained euthyroid with normal growth and regular menstrual cycle and 4 patients became hypothyroid again (after eating seaweed in 1, despite iodine restriction in 2 and after the episode of painless thyroiditis in 1). Transient retardation of growth was observed during the second episode of hypothyroidism. In the irreversible group, one patient with blocking type TSH binding inhibitor immunoglobulin (TBII) became thyrotoxic 4 years later with the decrease in activity of blocking type TBII. These results suggested that reversible recovery of the thyroid function could be expected in patients with juvenile hypothyroidism due to chronic thyroiditis after (1) iodine restriction, (2) improvement of immunological perturbation, or (3) disappearance of blocking type TBII. However, careful follow-up is necessary, because hypothyroidism would recur again with transient retardation of growth in children.
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A case of thyroid lingual ectopy is reported. Medical therapy was at first sufficient to control the progressive increase in thyroid volume, but adolescence and pregnancies induced a further increment in the volume of the lingual goiter, accompanied by an impairment of swallowing and respiration. Such obstructive symptoms were resolved by surgical intervention followed by continued substitutive medical therapy.
An ectopic thyroïd gland causing hypothyroïdism was found in a 7 years old girl. The treatment was stopped six months later, nevertheless the growth rate was not affected. Sudden mechanical airway obstruction caused by the lingual goiter needed at the age of 16 years a surgical management. A thyröid nodule auto-transplantation was performed with a rather good success. Special comments about some physiopathological aspects of this original case.
Lingual thyroid is a rare cause of upper airway obstruction, dysphagia or hypothyroidism symptoms. This report describes three cases of lingual thyroid arising in women. One was in pregnancy and developed a lingual goiter and hemorrhages with hypothyroidy. The second case have been diagnosed because of a dysphagia and the third was asymptomatic and have been diagnosed during physical examination for cervical nodes. Diagnosis and possible therapeutic options are discussed regarding these three cases. Surgical therapy is appropriate for patients with clinical signs of upper airway obstruction or when malignant degeneration is suspected. Without of clinical sign, substitutive therapy with thyroid hormone allows the stabilization or the regression of the ectopic thyroid.
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