PEDIATRIC RADIOLOGY
Lingual Thyroid Causing Dysphagia in a Child
S. H. Chandrashekhara
&
Ashu S. Bhalla
&
Subramanian Subramanian
&
Arun Kumar Gupta
&
V. Jyotsna
&
C. V. Karthikeyan
Received: 3 August 2010 / Accepted: 21 October 2010 / Published online: 6 November 2010
#
Dr. K C Chaudhuri Foundation 2010
Sir,
An eight-year-old girl presented with progressive dysphagia
of 6 months duration. On clinical examination, there was a
small midline mass covered with normal mucosa at the base
of the tongue. The thyroid gland was nonpalpable.
Systemic examination was normal. He had normal devel-
opment history. His height and weight were at the 25th and
95th percentile for age respectively. Serum T3, T4 levels
were decreased (Free T3-2.5 g/ml and Free T4-0.3 ng/ml)
and serum TSH was increased (5 μU/ml). Other biochem-
ical parameters were non-contributory. CT scan of the neck
showed well defined intensely enhancing mass in the base
of tongue in the midline with absent thyroid in the
pretracheal region (Fig. 1a and b). A radionuclide scan
was carried out using 99m Tc pertechnetate intravenously.
Anterior and right lateral static views of the head and neck
region were obtained after 20 min of intravenous injection
Tracer accumulation was seen in the lingual region in
midline confirming the presence of lingual thyroid (Fig. 1).
There was no activity present in the thyroid bed. She was
diagnosed as a case of lingual thyroid with hypothyroidism.
She subsequently received thyroxine therapy and the
clinically symptoms decreased.
Discussion
The lingual thyroid is a relatively rare condition with an
incidence of 1 in 3000 persons [1]. It is a developmental
anomaly, in which thyroid tissue is seen at the base of the
tongue between circumvallate papillae and epiglottis. The
thyroid analage, which arises from the ventral pharynx
between first and second pharyngeal pouch fails to descend
leading to development of this anomaly [2]. Lingual thyroid
is the only functional thyroid tissue in 70% of these patients
[2]. This was also noted in the present patient, on
radionuclide scan. Majority of patients with lingual thyroid
are asymptomatic. Symptomatic lingual thyroid is com-
monly seen in women in a ratio of 7:1 over men [2]. It has
two peak ages of presentations, one during childhood
(mean 12.5 y) and other is in adult life (mean 50 y) [3]. It
may present with complaints of dyspnoea, dysphagia,
dysphonia or bleeding [4, 5]. The symptoms are related to
the size of the ectopic thyroid [2]. Diseases of normal
thyroid may also occur in lingual thyroid. In the present
patient T3, T4 levels were decreased and TSH level was
increased suggestive of sub clinical hypothyroidism.
CT scan in these patients’ reveals a well defined lesion
which is hyperdense on non contrast scans due to increased
iodine content [6]. The lesion shows uniform enhancement.
In addition the thyroid gland is not visualized in the normal
location (Fig. 1), suggesting the diagnosis. The diagnosis
S. H. Chandrashekhara
:
A. S. Bhalla
:
S. Subramanian
:
A. K. Gupta
Department of Radio-diagnosis,
All India Institute of Medical Sciences,
New Delhi, India
V. Jyotsna
Department of Endocrinology,
All India Institute of Medical Sciences,
New Delhi, India
C. V. Karthikeyan
Department of Otorhinolaryngology,
All India Institute of Medical Sciences,
New Delhi, India
A. S. Bhalla (*)
Department of Radiology, All India Institute of Medical Sciences,
New Delhi 110029, India
e-mail: ashubhalla1@yahoo.com
Indian J Pediatr (March 2011) 78:360–361
DOI 10.1007/s12098-010-0290-z