Lingual thyroid associated with Zenker's and vallecular diverticula. Report of a case and review of the literature.
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Biopsy↗
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Diagnosis of ectopic thyroid: value of pretracheal soft-tissue measurements.
Thyroid ectopia, dysgenesis, or agenesis has been conventionally diagnosed with the use of radioisotope scanning procedures. This report proposes the use of a conventional lateral radiograph of the neck to determine the presence or absence of the thyroid gland in its normal anatomic position. The thyroid gland is ensheathed by the pretracheal layer of the deep cervical fascia anterior to the trachea. The gland's presence or absence can be determined by calculating the ratio of the soft-tissue measurements between the anterior wall of the trachea and both the outer margin of the skin and the margin of the subcutaneous fat as determined from a lateral radiograph of the neck. This "pretracheal ratio" may be used to accurately differentiate between a lingual thyroid and other masses at the base of the tongue.
Adolescent↗
[Sublingual thyroid gland associated with polycystic ovaries].
OBJECTIVE: To describe a young woman with polycystic ovary syndrome and a lingual thyroid gland. CLINICAL HISTORY: A 19-year old woman with secondary amenorrhea whose previous history had been uneventful. She had a normal spontaneous puberty with menarche at 13 years, followed by cyclical menstruations until six months before, when a period of four months of amenorrhea occurred. Physical exploration disclosed a normal young adult woman, without goiter, galactorrhea, acne, nor hirsutism. A pelvic ultrasound showed bilateral enlargement of the ovaries. Hormonal studies showed FSH 4 mUl/mL (nl = 2-12), LH 6 mUl/mL (nl = 2-14) and PRL 12 ng/mL (nl = < 25); TSH 8 microU/mL (nl < 5) and a free thyroxine level of 8.4 ng/dl (nl = 0.75-1.8). A thyroid gammagram with radioiodine disclosed a 6% caption (nl = 8.15%) and a small nodular gland at the base of the tongue. TREATMENT: Levothyroxine 100 micrograms/day was initiated and a month later the TSH level was normal but cyclical menstruations were not established after six months of follow up. COMMENT: The polycystic ovary syndrome is the main endocrine cause of secondary amenorrhea in young women.
Adolescent↗
The importance of thyroid scanning in neck lumps--a case report of ectopic tissue in the right submandibular region.
We describe the case of a 50-year-old previously well female, who presented with a slowly growing mass in the right submandibular region. Imaging confirmed the absence of a normally placed thyroid and the presence of a lingual thyroid. The submandibular mass was excised and histological examination confirmed ectopic thyroid tissue. The embryological descent of the thyroid and the Sistrunk procedure are discussed as well as the importance of thyroid scanning in neck lumps.
Choristoma↗
[Clinic and therapy of the lingual thyreoid (author's transl)].
A case of a lingual thyreoid without any orthotop thyreoideal tissue is presented. Dystopia of thyreoideal tissue is due to disturbances in the embryological development of the thyreoid gland. The clinical picture, diagnosis and differential diagnosis, therapy and prognosis are discussed in regard of cases of literature.
Choristoma↗
Imaging of huge lingual thyroid gland with goitre.
We present the CT and MRI findings in a 75-year-old woman with a huge pathologically proven lingual thyroid which underwent goitrous degeneration. CT and MRI showed a midline, tongue-based, exophytic mass with areas of necrosis and heterogeneous contrast enhancement, as seen in large goitres in the normal thyroid gland.
Aged↗
[Intra-laryngeal ectopic thyroid tissue. Report of one case and review of the literature].
A Ectopic thyroid is any thyroid tissue not located in his normal anatomic situation. There have been described four general groups within the upper aerodigestive tract: lingual, sublingual, thyroglossal and intralaryngotracheal. Intralaryngotracheal thyroid tissue is rare and constitute 7 per cent of all intratracheal tumours, and it represents a problem of diagnosis and management. The controversy about the genesis of this tumours remains. There are two established theories: "the malformation theory" and "the ingrowth theory". These tumours affect more frequently adult female. Intralaryngotracheal thyroid have been mainly reported on the posterior-left wall of the trachea. The most common clinical feature is stridor due to progressive upper airway obstruction. Up to 75% of the intralaryngotracheal goiters are associated with and external goiter. This paper reports a case of ectopic subglotic thyroid in a 42 year-old-female. The embryology, diagnosis and management of this tumours are discussed.
Adult↗
Poorly differentiated oxyphilic (Hürthle cell) carcinoma arising in lingual thyroid: a case report and review of the literature.
Clinically significant lingual thyroid is an unusual developmental anomaly, and carcinoma arising in lingual thyroid, an extremely rare entity. Here we describe the cytologic, histologic, immunohistochemical, and ultrastructural findings of the first poorly differentiated oxyphilic (Hürthle cell) carcinoma described in lingual thyroid along with a review of the literature. Carcinoma arising in lingual thyroid was reported in 12 males and 21 females age 12 to 86 yr (mean age: 40). Because in nonneoplastic lingual thyroid there exists an intimate and irregular relationship of normal follicles with the surrounding skeletal muscle fibers, unequivocal infiltration, with desmoplastic response, and/or vascular invasion should be demonstrated before making a diagnosis of carcinoma. Immunostain for thyroglobulin is the most useful marker for the differential diagnosis. Although, in some older cases, the precise histologic type is difficult to determine, follicular carcinoma seems to be prevalent. This contrasts with the predominance of the papillary type in thyroglossal duct associated carcinoma. This fact is probably related to the history of hypothyroidism and compensatory hyperplasia secondary to the absence of the orthotopic gland, like that occurring in areas of endemic goiter.
Adenoma, Oxyphilic↗
Thyrotrophin estimation in diagnosis and treatment of childhood thyroid disorders.
Serum thyrotrophin (TSH) was estimated by double-antibody radioimmunoassay in 200 children aged 2 months to 16 years with normal thyroid function. There was no apparent variation in TSH with age or sex and only 4 children had TSH levels greater than 5 muU/ml. High TSH values were obtained in 9 children with primary hypothyroidism, in 3 children with thyroiditis, and in one girl with a lingual thyroid. Moderately raised TSH was found in 3 girls with thyroiditis, 2 brothers with goitres due to enzyme defect, and a girl with an ectopic thyroid. In one girl with a defect of iodine organification and in 3 boys with thyroxine binding globulin deficiency the TSH levels were normal despite very low serum thyroxine values. Serum TSH was also estimated in 20 children during treatment for primary hypothyroidism. 3 of these children showed slightly raised TSH levels despite apparently adequate replacement therapy with L-thyroxine. One girl showed a very high TSH level 3 weeks after treatment had been temporarily withdrawn.
Adolescent↗
Cataracts, goitre and infertility in cattle grazed on an exclusive diet of Leucaena leucocephala.
Gross and histopathological changes and serum thyroxine levels were determined in 10 heifers fed an exclusive diet of Leucaena leucocephala from 10 months of age until slaughter, 23 months later. Normal ovarian activity and mating were observed during a 7-month mating period. Cataracts, goitre, lingual epithelial ulceration and gingival atrophy were present at slaughter. Only one of the heifers was pregnant. Histologically, severe vacuolation and disruption of lens fibres and focal hyperplasia of lens epithelium were present. Both follicular hyperplasia and colloid accumulation were found to varying degrees in the thyroid glands and serum thyroxine levels were higher than in a comparable group of animals not fed L. leucocephala. Morphologically normal trophoblast was present in the uteri of 6 animals even though no embryo or foetus was present. Embryonic death and resorption may have been due to the anti-mitotic effect of mimosine or the goitrogenic effect of DHP.
Animals↗
[123I-scintigraphy and perchlorate depletion test in the diagnosis of congenital hypothyroidism].
AIM: Thirty eight children suffering from congenital primary permanent hypothyroidism were studied to determine the diagnostic impact of 123I scintigraphy in comparison to laboratory findings and ultrasonography. METHODS: In all patients 123I scintigraphy was performed after intravenous administration of 3.7 MBq 123I. If accumulation of the radiotracer in thyroid tissue occurred a perchlorate discharge test was performed subsequently. RESULTS: Scintigraphy revealed athyrosis in 7 children. In 9 children a lingual thyroid was observed. Deficiency in iodine organification was diagnosed by a significant discharge of 123I in 15 patients. In four of these children the diagnosis of Pendred's syndrome could be established. Ectopic thyroid tissue could be demonstrated only by scintigraphy where clinical examination and sonography failed in the diagnosis in all cases. Hypoplasia of the thyroid gland as it was diagnosed in 2 cases by ultrasonography appeared to be unlikely because a normal 123I uptake was seen in these patients. In 2 patients with scintigraphic proven athyrosis an orthotopic gland had been falsely considered by ultrasound. In 44% of our patients the final diagnosis could only be established if 123I scintigraphy and perchlorate discharge test were performed. CONCLUSION: This findings suggest that scintigraphy is indispensible in the correct diagnostic work up of congenital hypothyroidism.
Child↗