This 20 year-old woman presented with "hot potato speech", difficulty in breathing and swallowing. On examination, she had a red fleshy mass at the base of the tongue.
The mass was removed via an anterior pharyngotomy approach.
In the first trimester of embryonic development, the thyroid gland originates in the back of the tongue and migrates to the front of the neck. If it fails to migrate properly, it can remain high in the neck or even in back of the tongue. In rare instances, the thyroid gland can also migrate too far into the mediastinum; it is then called a substernal thyroid.
When migration fails and the gland remains in the base of the tongue, it is called lingual thyroid or ectopic lingual thyroid. Lingual thyroids are four times more common in females than in males. Initially, they are asymptomatic midline nodules in the posterior aspect of the tongue. They are usually less than a centimeter in size but can sometimes reach more than 4 cm. Large lesions can interfere with swallowing and breathing, but most patients are unaware of the mass at the time of diagnosis, which is usually in the teenage or young adult years. Up to 70% of patients with lingual thyroid have hypothyroidism and 10% suffer from cretinism.
This lingual thyroid was asymptomatic. It was discovered on a routine examination of the pharynx.
Sagittal reconstruction of CT scan of the neck, showing the lingual thyroid at the base of the tongue.
Lingual thyroid seen on axial CT scan of the neck.