 A rare entity resulting from developmental defects

 1 per 100.000-300.000 persons

 75%-80% cases occur in females  4:11
 mean age at presentation is about 40.5 years
 Transcription factors (TITF/NKX2-1, PAX8, HHEX, AND FOXE1) might be involved in
thyroid arrest in tongue, as was shown in animals however, no mutation in known genes
has so far been associated with the human ectopic thyroid2
 • thyroid-specific expression of thyroglobulin (Tg)

TITF1/NKX2-1 • Controls survival at the beginning of organogenesis

• genes specific for thyroid follicular cells in adults life.

• functional differentiation, genetic regulatory cascade,

PAX8 which control thyroid development

• maintained expression of PAX 8

HHEX
• Migration thyroid gland

FOXE 1
 Thyroid function  present with Hypothyroidism
 Italy Methods Time

• 3092 patient • January 2000- • January 2000-

with thyroid December December
disease 2013 2013
• 28 has ectopic
thyroid
lingual
 IR, Female, 15 yers old
 Chief Complain: Mass at the base of tongue
 No History of dysphonia, Dysphagia, Dyspneu
 No past medications history and growth development disturbances
 • lump spherical shaped on base of tongue size 4x3 cm with redness
appearance, slippery surface
Physical
Examination • No lymph node enlargement.

• elevated TSH level 13.52 (Normal: 0.4-4.2)

Laboratory
Examination

• USG two thyroid lobes on the base of tongue with normal size and shaped.
USG • No present of thyroid gland in neck region

• a mass on the base of tongue size 4x3 cm

MSCT
Thyroid
 Levothyroxin 300 mg/day for 3 days used for lowered TSH Level
 After 3 days TSH Level 5.1 uIU/L with F T3: 5.87 PmoL/L, F T4: 20.12 Pmol/L

Decided To:
Total Excision of Thyroid Gland
On Operation Bed
• Lump spherical shaped on base of tongue size 4x3
cm with redness appearance, slippery surface.

Head MSCT examination

• shows round-shape mass sized 4x3 cm on base of
tongue

USG
• shows round-shape mass sized 4x3 cm on base of
tongue.
• No present of thyroid gland in neck region
Intraoperation
• Lump spherical shaped, with redness appearance,
slippery surface has been totally excisied

Histophatological Examination
• Consists of follicle lined by a cuboidal epithelium
and filled with pink, homogenous colloid.

After Operation
• Shows no scar present on the base of with redness
appearance, slippery surface has been removed
 Normal: Located in the anterior neck region between 2nd and 5th tracheal rings
 Developed on approximately 24th of gestation
 No sign of lingual thyroid, except it’s cause upper airway obstruction, dysphonia,
dysphagia in some cases.
 Diagnosed from History Taking  Physical Examination  support Examination
 USG and MSCT done to support examination
 scanning Thyroid with Tc-99 to diagnosed.
 Rare Case
 No record in Indonesia, including Manado itself
 Female case  in agreement with literature about ectopic thyroid (60-80%) in
women
 15 y.o. in literature lower age for lingual location (mean age 6 years), while the
highest mean age (74 years) was found for the tract along the thyroglossal duct.
 Radionuclide thyroid imaging with crucial to confirm a thyroid nature of these
ectopic masses and their location
 Transdiscipline approach must be done
 Guerra Germsno, Cinelli Mariapia, Mesolelia Massimo, et al, Morphological,
diagnostic and surgical features of ectopic thyroid gland. International Journal of
Surgery, 2014, S3-S11.
 Noussios George, Anagnostis Panaglotis, Goulis D, et al. Ectopic thyroid tissue:
anatomical, clinical, and surgical implications of a rare entity. European Journal of
Endocrinology (2011) 188 375-382
 Santangelo Giuseppe, Pellino Gianluca, De Falco Nadia, et al. Prevalence, diagnosis
and management of ectopic thyroid glands. International Journal of Surgery.
 Stokic Edita, Kijajic Viadimir, Benc Damir, et al. A Thyroid Ectopic Case Repor. Srp
Arh Celok Lek (2014) 142 (11-12)
TERIMA KASIH