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A young woman with oligomenorrohea and dysphagia

Published:August 20, 2016DOI:https://doi.org/10.1016/j.ejim.2016.08.009

      Abstract

      A 35-year-old house wife attended our clinic with oligomenorrhea for the last three months. She also complained of diffuse body ache, joint pain and decreased bowel movements. Very often she experienced choking sensation in the throat and had difficulty in swallowing solid food. On examination, goitre was absent but a globular pink colour mass was detected at the base of the tongue.

      1. Indication

      A 35-year-old house wife attended our clinic with menstrual irregularities in the form of oligomenorrohea for last three months. She also complained of diffuse body ache, joint pain and decreased bowel movements. Very often she experienced choking sensation in the throat and had difficulty in swallowing solid food. On examination, goitre was absent but a globular pink colour mass was detected at the base of the tongue (Fig. 1A ). Thyroid function test revealed hypothyroidism, free T4 — 0.6 ng/dl (0.80–1.90), TSH — 24 μIU/ml (0.4–4.00, chemiluminescence method), and anti-TPO antibody — 10 U/ml (positive >35 U/ml).
      Fig. 1
      Fig. 1A: Lingual thyroid.
      B: 99 m TC scan of thyroid showed lingual thyroid with absent radio tracer at the neck.
      What is the diagnosis?

      2. Diagnosis

      Lingual thyroid. Technetium (99 m TC) scan of thyroid gland showed the presence of thyroid tissue in the lingual region with absent radio tracer in the neck (Fig. 1B). Accordingly patient was put on levothyroxine supplementation.
      Lingual thyroid is a developmental abnormality of the thyroid gland in which thyroid tissue fails to migrate from foramen cecum to the normal pretracheal location [
      • Braverman L.E.
      • Cooper D.S.
      The thyroid: a fundamental and clinical text.
      ]. It is much more common in women and particularly detected at the time of puberty or early adulthood. Among the various ectopic locations of thyroid gland, the presence of functioning thyroid tissue in the lingual region is considered the most common one. Clinical presentation is varied and often incidentally detected as a mass at the base of the tongue. Hypothyroidism is detected in one third of patients, however, hyperthyroidism is very unusual [
      • Jameson J.L.
      • De Groot L.J.
      Endocrinology: Aadult and paediatric.
      ]. Depending on the size, patient may experience obstructive symptoms e.g. dysphagia, dysphonia, and dyspnoea especially at recumbent position [
      • Braverman L.E.
      • Cooper D.S.
      The thyroid: a fundamental and clinical text.
      ].
      Levothyroxine supplementation is required to treat the accompanied hypothyroidism as well as to reduce the size of the mass. Surgery is rarely considered as a primary modality of treatment until it is complicated by ulceration, haemorrhage or suspicion of malignancy. The diagnosis of lingual thyroid is often missed and should be considered when a mass is found at the base of the tongue. Definitive diagnosis is made by radio isotope scanning [
      • Jameson J.L.
      • De Groot L.J.
      Endocrinology: Aadult and paediatric.
      ].

      Consent

      Informed consent of the patient was taken.

      Authorship

      All authors participated equally in patient management, literature review and manuscript writing.

      Funding

      Nothing to declare.

      Conflicts of interest

      All authors declare no conflicts of interest.

      References

        • Braverman L.E.
        • Cooper D.S.
        The thyroid: a fundamental and clinical text.
        10th ed. vol. 2. Lippincott Williams, Philadelphia2013 (p. 557)
        • Jameson J.L.
        • De Groot L.J.
        Endocrinology: Aadult and paediatric.
        6th ed. vol. 2. Elsevier, Saunders2010 (p-1777)