Visual Diagnosis in Emergency Medicine| Volume 48, ISSUE 4, e103-e104, April 2015

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Lingual Thyroid

      A 50-year-old woman presented with progressive dysphagia, especially for solid food. She had a history of hypothyroidism, however, she did not receive regular medical treatment. Oropharyngeal examination revealed a nodular lesion at the tongue base. Computed tomography (CT) scan of the neck showed a 2.2-cm heterogeneous enhancing nodule, noted in the base of the tongue (Figure 1, arrow). Thyroid tissue was not seen by ultrasound. Hypothyroidism was diagnosed on the biochemical findings: a serum thyrotropin level of 178 uIU/mL (normal reference, 0.25–4 uIU/mL), a free thyroxine level (free T4) of 0.16 ng/dL (normal reference, 0.6–1.8 ng/dL), and a total triiodothyronine level of 0.9 ng/dL (normal reference, 60–190 ng/dL). Radioactive iodine (131I) thyroid scan revealed 131I uptake at the base of the tongue but no uptake in the normal thyroid location. This was compatible with lingual thyroid. Levothyroxine was prescribed to treat the hypothyroidism. After 6 months of treatment, euthyroidism was achieved with a marked shrinkage in the size of the lingual thyroid. In addition, the condition of dysphagia improved at the same time.
      Figure thumbnail gr1
      Figure 1Computed tomography scan of the neck showing a 2.2-cm heterogeneous enhancing nodule noted in the base of the tongue (arrow) in the axial (A) and sagittal (B) views.
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