A 19-year female presented to the Johns Hopkins Endocrine Clinic to adjust her thyroid hormone replacement therapy. She had been diagnosed with a lingual thyroid at age 3 during a routine physical examination. At that time, she had multiple diagnostic tests, including imaging (likely including a radioactive iodine scan) that reportedly confirmed the lingual mass to be thyroid tissue. At the time of diagnosis, per her mother, thyroid function tests were normal. However, to prevent the lingual thyroid tissue from growing and causing compressive symptoms, the patient was placed on thyroid hormone replacement therapy. The dose was adjusted over the next 15 years, but the patient had stopped the medication about 1 month prior to the clinic visit. She had no symptoms of hypothyroidism or compressive or obstructive symptoms. At the time of the visit, serum TSH was elevated at 36.8 mU/L (0.5-4.5) with FT4 0.9 ng/dL (0.8-1.8) and total T3 of 107 ng/dL (76-181). Physical examination revealed an easily seen erythematous round mass at the base of her tongue (Fig 1). No palpable thyroid tissue was present in the pre-tracheal region. Imaging of the neck was not performed given the already established diagnosis.
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