Male patient, 11 years old.
After one month of having had chickenpox, she began to have difficulty swallowing progressively, without evidence of symptoms of hypothyroidism or hyperthyroidism.
Their growth rate during the last year was normal (5 cm/year) and their bone age was 12 years.
Background.
A 33-week preterm newborn presented with respiratory distress and required mechanical ventilation for four days.
No relevant morbid history.
She is currently in sixth grade with good school performance.
Family history The child was born to healthy parents, with a history of grandparent thyroiditis and maternal aunt.
Their family size was l69±5 cm (percentile 13.7).
Location.
Stem: 146.4 cm (range: 54 cm), Body Mass Index: 18.2 kg/m2 (range: 62.5 cm); Non-development pubic percentile: 3 cener I, testicle.
In the pharynx, a reddish mass of approximately 2x2 cm is seen at the base of the tongue, with venous vessels on its surface, with no evidence of bleeding or ulceration.
No stridor or odynophagia
On examination of the neck, the thyroid gland was not palpable in the pre-tracheal position.
Laboratorio.
Thyroid function tests revealed elevated TSH 10.79 IU/mL (normal range = 5.721 dL) with normal thyroxine, but in its lowest quartile, 6.0 L-thyroxine normal (4.3 ng/dl negative range).
Imaging study.
The optic nasofibrolaryngoscopy showed a red, tense, rounded mass with blood vessels on the surface.
Computed tomography (CT) of the neck confirmed a well circumscribed mass at the base of the tongue, of 2.0 x 1.9 x 1.8 cm, hyperdense in the sections without intravenous contrast medium, without nodules.
The Tc-99 scintigraphy showed uptake at the base of the tongue, with no evidence of thyroid in its normal location, consistent with a lingual manifestation of the thyroid gland.
Follow up.
After diagnosis, the patient started L-Tiroxine at a dose of 75 \ig/day.
One month after treatment TSH was suppressed (0.11 IU/mL) with high normal free thyroxine 1.93 ng/dL (0.8-2.0).
Physical examination revealed a gradual decrease in size of the lingual thyroid and disappearance of dysphagia.
