| disease | Lingual Thyroid |
| alias | Vagus Thyroid, Parathyroid Gland |
During embryonic development, if the thyroid gland partially or completely fails to descend and remains at the foramen cecum of the tongue, it becomes a lingual thyroid. When there is a normally positioned thyroid in the neck accompanied by a lingual thyroid, it is referred to as an accessory thyroid. If all thyroid tissue is concentrated at the base of the tongue with no thyroid in its normal position in the neck, it is called a wandering thyroid. This condition is rare in children but more common in women during sexual maturity, pregnancy, and lactation.
bubble_chart Clinical Manifestations
In the early stages, there are often no symptoms, and the following symptoms may only appear when the mass grows rapidly:
1. Obstructive symptoms such as difficulty swallowing, foreign body sensation in the throat, unclear speech, difficulty breathing, or dyspnea.
2. Sore throat and bleeding, sometimes the first symptom is bleeding.
3. Symptoms resembling thyroid diseases such as hyperthyroidism or hypothyroidism.
Examination may reveal:
1. A mass located at the foramen cecum of the tongue, varying in size, not adherent to the epiglottis, with a broad base, semicircular or oval in shape, covered with normal mucosa or with small blood vessel dilation, and a small amount of blood can be aspirated by puncture. Biopsy may cause surface erosion, infection, and bleeding, so biopsy is generally not recommended.
2. Administration of the radioactive isotope 131I, through isotope scanning to determine whether the mass at the base of the tongue is thyroid tissue and whether the thyroid is present in its normal position in the neck.
The diagnosis can be easily made based on typical clinical symptoms, examination findings, and isotope scanning. However, it is important to differentiate from tumors such as hemangioma of the tongue base, tongue base cysts, and fibromas.bubble_chart Treatment Measures
1. No Treatment Required: If the mass is small and the patient is asymptomatic, treatment may not be necessary.
2. Conservative Treatment: For ectopic thyroid or patients with pharyngeal obstruction symptoms and hyperthyroidism symptoms, conservative treatment can be initially administered. Methods include local injection of sclerosing agents, radioactive isotope 131 iodine therapy, and iodine medication.
3. Surgical Treatment: For patients with thyroid in the normal neck area, a total lingual thyroidectomy can be performed. For those without thyroid in the normal neck area and poor response to conservative treatment, a partial lingual thyroidectomy can be considered. There are two surgical approaches.
1. Transoral Lingual Thyroidectomy: Performed under general anesthesia. The tongue is sutured on both sides to expose the base of the tongue. An arc-shaped incision is made along the edges of the lingual thyroid to separate the thyroid membrane from surrounding tissues, followed by removal of the lingual thyroid and suturing of the incision.
2. Transcervical Lingual Thyroidectomy: Approaches include suprahyoid, infrahyoid, hyoid splitting, and lateral pharyngotomy. The transcervical approach provides clear exposure but involves greater injury, making transoral lingual thyroidectomy more common in clinical practice.
