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Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2008-0909
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The Journal of Clinical Endocrinology & Metabolism Vol. 93, No. 11 4198-4199
Copyright © 2008 by The Endocrine Society

IMAGE IN ENDOCRINOLOGY

Iodine 131 and Lingual Thyroid

Pedro Iglesias, Roberto Olmos-García, Bernardo Riva and Juan J. Díez

Departments of Endocrinology (P.I.) and Otolaryngology (B.R.), Hospital General, 40002 Segovia, Spain; Department of Nuclear Medicine (R.O.-G.), Hospital Clínico Universitario, 47005 Valladolid, Spain; and Department of Endocrinology (J.J.D.), Hospital Ramón y Cajal, 28034 Madrid, Spain

Address all correspondence and requests for reprints to: Pedro Iglesias, Department of Endocrinology, Hospital General, 40002 Segovia, Spain. E-mail: piglesias{at}hgse.sacyl.es.

We report for the first time an achondroplastic patient with a compressive lingual thyroid adequately controlled with radioactive iodine therapy. A 71-yr-old woman with achondroplasia was referred to us to control and treat subclinical hypothyroidism and symptomatic lingual thyroid (dysphagia to solid food, dysphonia, and choking). Hormonal investigations were compatible with subclinical hypothyroidism (TSH 13.9 mU/liter, normal range N: 0.4–5.0, and free T4 17.4 pmol/liter, N: 11.0–23.0). Antithyroid antibodies (antiperoxidase and antithyroglobulin) were negative. Thyroid ultrasound confirmed the absence of orthotopic thyroid tissue. Cervical 99mTc- pertechnetate scan was consistent with the presence of functioning thyroid tissue located at the base of the tongue (Fig. 1Go). Cervical computed tomography scan performed with iv radiocontrast showed a solid mass (3.0 x 2.0 x 2.0 cm) in sublingual location (Fig. 2AGo).


Figure 1
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  		FIG. 1. Thyroid 99mTc pertechnetate scanning showing the presence of functioning thyroid tissue located at the base of the tongue (white arrow) and the absence of orthotopic thyroid gland.

 

Figure 2
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  		FIG. 2. Cervical computed tomography scanning performed with iv radiocontrast showing a solid mass (6.3 cm3) at the base of the tongue (white arrow) before (A) and 6 (2.6 cm3) (B), 12 (2.3 cm3) (C), and 24 (1.4 cm3) (D) months after the first dose of 131I.

 
Given the difficulties of surgical excision in this particular case along with the rejection of surgery by the patient, we considered other therapeutic alternatives. The patient started suppressive hormone therapy with levothyroxine (LT4) with the aim of avoiding ectopic thyroid tissue growth. Moreover, we decided to treat the patient with iodine 131 (131I) therapy for decreasing the size of the lingual thyroid (1, 2, 3). The patient was treated with 131I, 20 mCi, divided into two doses of 10 mCi, separated by 9 months. She began LT4 at diagnosis of lingual thyroid and was withdrawn 10 d before each dose of 131I. TSH and free T4 values at each time when 131I was given were 11.6 mU/liter and 16.5 pmol/liter and 19.1 mU/liter and 20.0 pmol/liter, respectively. LT4 was introduced again 5 d after each administered 131I dose. This therapeutic regimen achieved an appropriate reduction in ectopic thyroid tissue volume with improvement in local symptomatology (Fig. 2Go, B–D). 131I can be considered as a safe and effective therapeutic alternative in the long-term management in those patients with symptomatic lingual thyroid with special anatomical difficulties and in whom surgery is contraindicated or refused by the patient.


   Footnotes
 
Abbreviations: LT4, Levothyroxine.

Received April 28, 2008.

Accepted July 14, 2008.


   References
Top
 References
 

  1. Kalan A, Tariq M 1999 Lingual thyroid gland: clinical evaluation and comprehensive management. Ear Nose Throat J 78:340–349[Medline]
  2. Danner C, Bodenner D, Breau R 2001 Lingual thyroid: iodine 131: a viable treatment modality revisited. Am J Otolaryngol 22:276–281[CrossRef][Medline]
  3. Park HM, Gupta S, Skierczynski P 2003 Radioiodine-131 therapy for lingual thyroid. Thyroid 13:607




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