A Rare Case of Bleeding Ectopic Lingual Thyroid Presenting as Hematemesis

• The authors have no financial conflicts of interest. which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. To the Editor: Lingual thyroid is a rare embryological anomaly caused by failure of the gland to descend from the foramen cecum to its normal site in the pre-laryngeal area. Its precise pathogenesis is unknown, and has been found to be more prevalent in females (female:male ratio, 7:1). 1 Although bleeding from an ectopic lingual thyroid is rare, life-threatening massive hemorrhage is possible, since the lingual thyroid may have prominent large blood vessels on its surface. 2-4 We present a rare case of bleeding from an ectopic lingual thyroid presenting as hematemesis. A 42-year-old woman visited the emergency room of our hospital complaining of hematemesis. Her blood pressure was 110/70 mm Hg and pulse rate was 80 beats per minute. Given a history of recent drinking and vomiting, the initial impression was Mallory-Weiss syndrome. Initial emergency gastroendoscopic examination revealed fresh blood in the stomach, without any evidence of mucosal abnormalities in the esophagus and stomach. Under supportive care, the hematemesis spontaneously stopped two days later, and a follow-up gastroendoscopic examination showed no blood in the stomach. Neck computed tomography (CT) examination revealed a 3-cm enhancing mass on the midline base of the tongue and no presence of thyroid tissue in the normal thyroid position. On laryngoscopic examination, the mass had a smooth surface with engorged vessels, and the lesion was more clearly visualized when the tongue was pulled forward, which are characteristic findings of an ectopic lingual thyroid (Fig. 1). Thyroid ultrasonography revealed absence of the thyroid gland. Technetium (Tc99m) thyroid scan was performed and demonstrated isotope uptake at the base of the tongue and no uptake in the normal thyroid location (not shown here). A thyroid function test showed subclinical hypo-thyroidism: free thyroxine (fT4), 1.52 ng/dL (normal range, 0.89‒1.78 ng/dL); T3, 95 ng/dL (normal range, 60‒180 ng/dL); and thyroid-stimulating hormone, 6.43 mIU/mL (normal range, 0.17‒4.78 mIU/mL). Although surgical removal was recommended due to the risk of re-bleeding, the patient refused surgery and opted for a wait and see approach. Ectopic thyroid is a rare developmental anomaly and is caused by aberrant em-bryogenesis during the descent of the thyroid gland to the neck. Thyroid tissue may be found anywhere along the course of the thyroglossal duct (i. Among these, lingual thyroid, complete arrest …