Condition Overview

Lingual thyroid tissue is a rare condition where thyroid tissue is located at the base of the tongue instead of (or in addition to) the usual location in the neck. This ectopic thyroid tissue results from an embryological anomaly where the thyroid gland does not descend properly during fetal development. Lingual thyroid tissue can sometimes be the only functioning thyroid tissue in an individual, making its management particularly important.

Patients with lingual thyroid tissue may be asymptomatic, or they might experience symptoms due to the mass effect of the tissue. Symptoms can include difficulty swallowing (dysphagia), a sensation of a lump in the throat, difficulty breathing (dyspnea), voice changes (dysphonia), or bleeding from the tissue. In some cases, the ectopic thyroid tissue can become hyperfunctional or hypofunctional, leading to hyperthyroidism or hypothyroidism, respectively.

Diagnosis typically involves imaging studies such as ultrasound, CT scan, or MRI to confirm the presence and location of the thyroid tissue. Additionally, a flexible laryngoscopy in the office is usually utilized, and perhaps a direct laryngoscopy will be used in the operating room to do a biopsy. This should be done with extreme caution, as bleeding can be significant. Most of the time, a presumptive diagnosis can be reached without a biopsy. A radionuclide thyroid scan can help determine the functional status of the ectopic thyroid tissue. Fine-needle aspiration biopsy may be performed to rule out malignancy.

Treatment Options

  1. Radiofrequency Ablation (RFA)
    • Description: RFA is a minimally invasive procedure that uses heat generated by radiofrequency energy to destroy abnormal thyroid tissue. This technique can reduce the size of the ectopic thyroid tissue and alleviate symptoms without the need for open surgery. This technique is performed differently than is performed with traditional thyroid nodules, as it requires a direct laryngoscopy in the operating room to access the tissue. It is not the standard treatment recommendation for most people.
    • Indications: Symptomatic lingual thyroid tissue, patients seeking non-surgical treatment options.
  2. Removal of Lingual Thyroid Tissue
    • Description: In this procedure, the thyroid tissue at the base of the tongue is removed, usually with endoscopic or robotic visualization. This is the most definitive therapy, and the one that is most often recommended.
    • Indications: Lingual thyroid tissue that is symptomatic, growing, or may house malignancy.
    • Thyroid Arterial Embolization
    • Description: In some cases, it may be advantageous to shrink the tissue without removing it. In such situations, thyroid arterial embolization (TAE) can cause a blockage in the arteries that go to the lingual thyroid tissue. There is a small risk of stroke with this procedure, and surgery may also be required.
    • Indications: poor surgical candidate, desire for non-surgical therapy

Management of lingual thyroid tissue requires a multidisciplinary approach, involving endocrinologists, otolaryngologists, and radiologists to ensure accurate diagnosis and appropriate treatment planning. Having an experienced team such as that at the Russell Center ensures that you will have access to the widest range of options for your lingual thyroid tissue.