Rediscovering the Physical Exam: Lingual Thyroid in Juvenile Hypothyroidism- A Case Report

Rediscovering the Physical Exam: Lingual Thyroid in Juvenile Hypothyroidism- A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Rediscovering the Physical Exam: Lingual Thyroid in Juvenile Hypothyroidism- A Case Report Syeda Humaida Hasan, Orindom Shing Pulock, Kamrun Nahar, Muhammad Jabed Bin Amin Chowdhury, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8045218/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Feb, 2026 Read the published version in BMC Pediatrics → Version 1 posted 12 You are reading this latest preprint version Abstract Background and Novelty: Lingual thyroid is a rare congenital malformation. The symptoms of lingual thyroid range from hypothyroidism to dysphagia and even sleep apnea. However, it can be difficult to diagnose in asymptomatic children. The novelty of this case stands from the early detection of lingual thyroid prior to the onset of local manifestation, emphasizing the value of meticulous physical examination. Case Report: We present a case of 5 years old girl who had growth failure and no local symptoms, Clinical examination revealed stunting along with a 2-cm size mass in the oral cavity. Her biochemical tests suggested hypothyroidism and ectopic location of thyroid at the base of the tongue was identified as the cause. She was managed with thyroid hormone replacement therapy and experienced a reduction in mass size. Conclusion: A careful clinical examination remains crucial for identifying diagnostic clues in resource-limited setting. We recommend routine oral cavity examination in all suspected cases of hypothyroidism specially in pediatric age group. Lingual Thyroid hypothyroidism ectopic thyroid careful physical examination case report Figures Figure 1 Figure 2 Background Lingual thyroid is a rare developmental defect caused by the thyroid gland’s failure to descend from the foramen cecum which usually located between the circumvallate papillae of the tongue and epiglottis. 1,2 This presents as a lobular mass at the base of the tongue producing low levels of thyroid hormones leading to hypothyroidism and can remain asymptomatic unless the gland enlarges 3 . Moreover, ectopic thyroid can have other possible locations such as, submandibular and lateral cervical regions, palatine tonsils, carotid bifurcation, pituitary gland, axilla, heart and ascending aorta, thymus and other part so the gastrointestinal and reproductive system 4 . Lingual thyroid is four to seven times more prevalent in female than male with overall prevalence of 1 in 100,00 to 1 in 300,000 individuals 5 . Studies have depicted that 33% of the paediatric patients with thyroid ectopy suffers from hypothyroidism and later develops clinical manifestations of hypothyroidism during the period of physiological stress such as puberty, pregnancy or menstruation. 1 , 6 , 7 Dysphagia, dysphonia, cough, throat pain, foreign body sensation, bleeding, sleep apnoea, dyspnoea are amongst the common symptoms 8 , 9 , 10 Apart from the clinical symptoms, Technetium (Tc-99) is the most commonly used confirmatory diagnostic technique for Lingual thyroid. Diagnosis of lingua thyroid often missed in asymptomatic patient even though there is biochemical evidence of hypothyroidism. 10 Case presentation This is a 5-year-old girl who presented with stunted growth and an unremarkable past medical history. She weighed 13.3 kilograms (kg), measured 96 centimeters in height (height-for-age was − 2.7 SD), and had a body mass index (BMI) of 14.5 kg/m². Despite this feature of growth failure, she didn’t have any other complaints. A thorough physical examination revealed a smooth, round, pink mass about 2 cm in size at the base of her tongue, although no foreign body sensation. Our differential diagnoses included lingual thyroid, lingual tonsil, and thyroglossal duct cyst. We aimed to exclude hypothyroidism as a cause for her growth failure and investigate any relationship between the mass and her primary diagnosis. Therefore, we recommended thyroid function tests, neck ultrasonography, a thyroid scan, x-ray of the left hand for bone age. Her serum thyroid-stimulating hormone (TSH) level was 84 µIU/ml (reference range: 0.5–5.5 µIU/ml) and Free Thyroxine (FT4) was 18.13 pmol/L (reference range: 8.56–25.60 pmol/L) displaying a subclinical hypothyroid state. An ultrasound revealed an empty thyroid bed and a 17x17 mm oval-shaped soft tissue lesion at the base of her tongue. Technetium (Tc99m) thyroid scan revealed no radiotracer concentration in the thyroid base, and intense radiotracer concentration at the nodular lesion in the base of the tongue. Her bone age was appropriate for her age. She was found to have borderline intellectual functioning through “Wechsler preschool and primary scale of intelligence” (WPPSI-IV) conducted by a trained psychologist. She was diagnosed as juvenile hypothyroidism with a lingual thyroid. Treatment with L-Thyroxine was initiated at 4 µg/kg/day. At the first follow-up, TSH level decreased to 12.28 µIU/ml, and free thyroxine was 18.13 pmol/L. L-Thyroxine was then gradually adjusted based on TSH levels. After three months, the size of the lingual thyroid had significantly decreased (Fig-1b), and she is now receiving regular follow-up care for hypothyroidism. Discussion Our index patient was pre-pubertal and her lingual thyroid was diagnosed through careful physical examination before symptom onset which were expected to occur during puberty. 3 Since there was no foreign body sensation, no dysphagia, no dysphonia or cough and no respiratory symptoms, diagnosis of lingual thyroid might be easily overlooked without a direct examination of the oral cavity. This would further delay her crucial diagnosis and jeopardize clinical management. Neck ultrasound is commonly the first-line imaging modality due to its non-invasive nature, cost-effectiveness, and availability, especially in resource-limited settings. A Tc-99 scan can serve as a confirmatory tool to identify ectopic thyroid tissue deposits 11 . However, fine needle aspiration cytology from the ectopic tissue can be considered in cases of suspicion of malignant transformation 12 . Though Lingual thyroid is often the only functional thyroid tissue in most of the cases, severity of symptom, complications and thyroid function status provide guidance for management. 10 Asymptomatic euthyroid cases require follow-up, while hypothyroid cases can be managed with levothyroxine, which also reduces gland size. 3,12,13 Lingual thyroids causing airway obstruction may require complete resection with subsequent levothyroxine supplementation. 10 Given our patient's age, lack of local symptoms, and hypothyroidism, we maintained thyroid hormone replacement therapy which led to the reduction of lingual thyroid size. Furthermore, based on available research, we recommended regular follow-up to detect any further progression or complication of the condition. 12 . Conclusion In paediatric patients with growth failure, detailed physical examination of oral cavity is crucial to explore the possibilities of lingual thyroid. Moreover, long term follow-up is required in children who received thyroid replacement therapy to monitor changes in size, complications and their overall growth and development. Abbreviations BMI Body Mass Index FT4 Free Thyroxine L thyroxine Levothyroxine kg/m 2 kilograms per square meter pmol/L picomoles per liter SD Standard Deviation Tc 99 Technetium-99m TSH Thyroid Stimulating Hormone µIU/ml micro-international units per milliliter WPPSI-IV Wechsler preschool and primary scale of intelligence Declarations Ethics and consent to participate: Written informed consent for participation was obtained from the patient’s parents/legal guardians, and the signed consent form has been uploaded. Consent for publication: Written informed consent for publication was obtained from the patient’s parents/legal guardians. Availability of data and materials: No separate dataset is available. Competing Interests: The authors declare that they have no conflict of interest. Clinical trial number : not applicable. Funding: The authors did not receive any funding for this work. Authors’ Contribution: SHH diagnosed the case, collected the images, initiated the idea of submission, obtained consent, performed the literature review and drafted the manuscript. KN and MJBAC collected patient’s medical data drafted and revised the manuscript. ED and OSP performed literature review, edited the images and revised the manuscript. All the authors revised and approved the final manuscript. Acknowledgement: The authors would like to thank the patient and the parents for their cooperation. ORCID IDs: SHH 0000-0003-3818-5963 OSP 0000-0002-0254-9406 References Ramanathan R, Veerapandian JP. Lingual thyroid with hypothyroidism in a child. Int J Contemp Pediatr. 2019;6(4):1747–9. 10.18203/2349-3291.ijcp20192787 . Amr B, Monib S. Lingual thyroid: A case report. Int J Surg Case Rep. 2011;2(8):313. 10.1016/j.ijscr.2011.10.004 . Fiaschetti V, Claroni G, Scarano AL, Schillaci O, Floris R. Diagnostic evaluation of a case of lingual thyroid ectopia. Radiol Case Rep. 2016;11(3):165–70. 10.1016/j.radcr.2016.04.004 . Alanazi SM, Limaiem F. Ectopic Thyroid. In: StatPearls . StatPearls Publishing; 2025. Accessed January 17, 2025. http://www.ncbi.nlm.nih.gov/books/NBK539892/ Yoon JS, Won KC, Cho IH, Lee JT, Lee HW. Clinical characteristics of ectopic thyroid in Korea. Thyroid Off J Am Thyroid Assoc. 2007;17(11):1117–21. 10.1089/thy.2007.0004 . Guerra G, Cinelli M, Mesolella M, et al. Morphological, diagnostic and surgical features of ectopic thyroid gland: A review of literature. Int J Surg. 2014;12:S3–11. 10.1016/j.ijsu.2014.05.076 . al-Jurayyan NA, el-Desouki MI. Transient iodine organification defect in infants with ectopic thyroid glands. Clin Nucl Med. 1997;22(1):13–6. 10.1097/00003072-199701000-00003 . Amr B, Monib S. Lingual thyroid: A case report. Int J Surg Case Rep. 2011;2(8):313–5. 10.1016/j.ijscr.2011.10.004 . Islam MN, Naznin A, Salekin MS, et al. Dual Ectopic Thyroid: A Case Report in a 12 years old girl. Bangladesh J Nucl Med. 2022;23(1–2):67–9. 10.3329/bjnm.v23i1-2.57713 . Al Driweesh TAK, Mokhatrish MM, Islam T, Al-Qahtani KH. Incidental lingual thyroid with subclinical hypothyroidism: case report. Egypt J Otolaryngol. 2020;36(1):13. 10.1186/s43163-020-00013-5 . Cruz-Dardíz N, Rivera-Santana N, Torres-Torres M, et al. Lingual thyroid gland: it’s time for awareness. Published online May. 2020;29. 10.1530/EDM-20-0026 . Noussios G, Anagnostis P, Goulis DG, Lappas D, Natsis K. Ectopic thyroid tissue: anatomical, clinical, and surgical implications of a rare entity. Eur J Endocrinol. 2011;165(3):375–82. 10.1530/EJE-11-0461 . Ramanathan R, Veerapandian JP. Lingual thyroid with hypothyroidism in a child. Int J Contemp Pediatr. 2019;6(4):1747. 10.18203/2349-3291.ijcp20192787 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 23 Feb, 2026 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 11 Dec, 2025 Reviews received at journal 09 Dec, 2025 Reviews received at journal 04 Dec, 2025 Reviewers agreed at journal 03 Dec, 2025 Reviewers agreed at journal 02 Dec, 2025 Reviews received at journal 02 Dec, 2025 Reviewers agreed at journal 02 Dec, 2025 Reviewers invited by journal 02 Dec, 2025 Editor assigned by journal 02 Dec, 2025 Editor invited by journal 01 Dec, 2025 Submission checks completed at journal 01 Dec, 2025 First submitted to journal 30 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8045218","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":554712338,"identity":"747e26eb-8f9a-4d6d-b7ca-d9de668be0c8","order_by":0,"name":"Syeda Humaida 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09:30:25","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":40711,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8045218/v1/b6351e8573919202a8f01de2.html"},{"id":97669978,"identity":"2cbce881-630c-47f2-8a0c-080f5623b9bc","added_by":"auto","created_at":"2025-12-08 09:29:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":892046,"visible":true,"origin":"","legend":"\u003cp\u003e(A) The clinical photograph showing the oral cavity and base of tongue (white dash circle) of the patient with a smooth, round and pink mass (white arrow), (B) remission of mass (diagnosed as lingual thyroid) following treatment with L-thyroxine.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8045218/v1/bda51d92f3d8b69bdae22138.png"},{"id":97488588,"identity":"601d7714-5a24-4d2c-a80c-67758012f33f","added_by":"auto","created_at":"2025-12-05 01:55:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":121693,"visible":true,"origin":"","legend":"\u003cp\u003eTechnetium (Tc99m) thyroid scan revealing no radiotracer concentration in the thyroid base but intense concentration at the base of the tongue (white arrow) suggesting ectopic thyroid tissue.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8045218/v1/085e344993d0730a94f15836.png"},{"id":103766158,"identity":"55bd7d34-ec76-4c2d-af2e-e61f3f00e7d3","added_by":"auto","created_at":"2026-03-02 16:12:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1359933,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8045218/v1/583f6828-c1e9-47f9-a284-52fec1dcf8df.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Rediscovering the Physical Exam: Lingual Thyroid in Juvenile Hypothyroidism- A Case Report","fulltext":[{"header":"Background","content":"\u003cp\u003eLingual thyroid is a rare developmental defect caused by the thyroid gland\u0026rsquo;s failure to descend from the foramen cecum which usually located between the circumvallate papillae of the tongue and epiglottis. \u003csup\u003e1,2\u003c/sup\u003e This presents as a lobular mass at the base of the tongue producing low levels of thyroid hormones leading to hypothyroidism and can remain asymptomatic unless the gland enlarges \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Moreover, ectopic thyroid can have other possible locations such as, submandibular and lateral cervical regions, palatine tonsils, carotid bifurcation, pituitary gland, axilla, heart and ascending aorta, thymus and other part so the gastrointestinal and reproductive system \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Lingual thyroid is four to seven times more prevalent in female than male with overall prevalence of 1 in 100,00 to 1 in 300,000 individuals \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eStudies have depicted that 33% of the paediatric patients with thyroid ectopy suffers from hypothyroidism and later develops clinical manifestations of hypothyroidism during the period of physiological stress such as puberty, pregnancy or menstruation.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Dysphagia, dysphonia, cough, throat pain, foreign body sensation, bleeding, sleep apnoea, dyspnoea are amongst the common symptoms \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Apart from the clinical symptoms, Technetium (Tc-99) is the most commonly used confirmatory diagnostic technique for Lingual thyroid. Diagnosis of lingua thyroid often missed in asymptomatic patient even though there is biochemical evidence of hypothyroidism.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eThis is a 5-year-old girl who presented with stunted growth and an unremarkable past medical history. She weighed 13.3 kilograms (kg), measured 96 centimeters in height (height-for-age was \u0026minus;\u0026thinsp;2.7 SD), and had a body mass index (BMI) of 14.5 kg/m\u0026sup2;. Despite this feature of growth failure, she didn\u0026rsquo;t have any other complaints. A thorough physical examination revealed a smooth, round, pink mass about 2 cm in size at the base of her tongue, although no foreign body sensation. Our differential diagnoses included lingual thyroid, lingual tonsil, and thyroglossal duct cyst.\u003c/p\u003e\u003cp\u003eWe aimed to exclude hypothyroidism as a cause for her growth failure and investigate any relationship between the mass and her primary diagnosis. Therefore, we recommended thyroid function tests, neck ultrasonography, a thyroid scan, x-ray of the left hand for bone age. Her serum thyroid-stimulating hormone (TSH) level was 84 \u0026micro;IU/ml (reference range: 0.5\u0026ndash;5.5 \u0026micro;IU/ml) and Free Thyroxine (FT4) was 18.13 pmol/L (reference range: 8.56\u0026ndash;25.60 pmol/L) displaying a subclinical hypothyroid state. An ultrasound revealed an empty thyroid bed and a 17x17 mm oval-shaped soft tissue lesion at the base of her tongue. Technetium (Tc99m) thyroid scan revealed no radiotracer concentration in the thyroid base, and intense radiotracer concentration at the nodular lesion in the base of the tongue. Her bone age was appropriate for her age. She was found to have borderline intellectual functioning through \u0026ldquo;Wechsler preschool and primary scale of intelligence\u0026rdquo; (WPPSI-IV) conducted by a trained psychologist. She was diagnosed as juvenile hypothyroidism with a lingual thyroid.\u003c/p\u003e\u003cp\u003eTreatment with L-Thyroxine was initiated at 4 \u0026micro;g/kg/day. At the first follow-up, TSH level decreased to 12.28 \u0026micro;IU/ml, and free thyroxine was 18.13 pmol/L. L-Thyroxine was then gradually adjusted based on TSH levels. After three months, the size of the lingual thyroid had significantly decreased (Fig-1b), and she is now receiving regular follow-up care for hypothyroidism.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur index patient was pre-pubertal and her lingual thyroid was diagnosed through careful physical examination before symptom onset which were expected to occur during puberty.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Since there was no foreign body sensation, no dysphagia, no dysphonia or cough and no respiratory symptoms, diagnosis of lingual thyroid might be easily overlooked without a direct examination of the oral cavity. This would further delay her crucial diagnosis and jeopardize clinical management.\u003c/p\u003e\u003cp\u003eNeck ultrasound is commonly the first-line imaging modality due to its non-invasive nature, cost-effectiveness, and availability, especially in resource-limited settings. A Tc-99 scan can serve as a confirmatory tool to identify ectopic thyroid tissue deposits \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. However, fine needle aspiration cytology from the ectopic tissue can be considered in cases of suspicion of malignant transformation \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Though Lingual thyroid is often the only functional thyroid tissue in most of the cases, severity of symptom, complications and thyroid function status provide guidance for management.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Asymptomatic euthyroid cases require follow-up, while hypothyroid cases can be managed with levothyroxine, which also reduces gland size. \u003csup\u003e3,12,13\u003c/sup\u003e Lingual thyroids causing airway obstruction may require complete resection with subsequent levothyroxine supplementation.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eGiven our patient's age, lack of local symptoms, and hypothyroidism, we maintained thyroid hormone replacement therapy which led to the reduction of lingual thyroid size. Furthermore, based on available research, we recommended regular follow-up to detect any further progression or complication of the condition. \u003csup\u003e12\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn paediatric patients with growth failure, detailed physical examination of oral cavity is crucial to explore the possibilities of lingual thyroid. Moreover, long term follow-up is required in children who received thyroid replacement therapy to monitor changes in size, complications and their overall growth and development.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBody Mass Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFT4\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFree Thyroxine\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eL thyroxine\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLevothyroxine\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ekg/m\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ekilograms per square meter\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003epmol/L\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epicomoles per liter\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard Deviation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTc 99\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTechnetium-99m\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTSH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eThyroid Stimulating Hormone\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026micro;IU/ml\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003emicro-international units per milliliter\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWPPSI-IV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWechsler preschool and primary scale of intelligence\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics and consent to participate:\u003c/strong\u003e Written informed consent for participation was obtained from the patient’s parents/legal guardians, and the signed consent form has been uploaded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eWritten informed consent for publication was obtained from the patient’s parents/legal guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eNo separate dataset is available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors did not receive any funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ Contribution:\u003c/strong\u003e SHH diagnosed the case, collected the images, initiated the idea of submission, obtained consent, performed the literature review and drafted the manuscript. KN and MJBAC collected patient’s medical data drafted and revised the manuscript. ED and OSP performed literature review, edited the images and revised the manuscript. All the authors revised and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u0026nbsp;\u003c/strong\u003eThe authors would like to thank the patient and the parents for their cooperation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eORCID IDs:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSHH 0000-0003-3818-5963\u003c/p\u003e\n\u003cp\u003eOSP 0000-0002-0254-9406\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRamanathan R, Veerapandian JP. Lingual thyroid with hypothyroidism in a child. 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Published online May. 2020;29. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1530/EDM-20-0026\u003c/span\u003e\u003cspan address=\"10.1530/EDM-20-0026\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNoussios G, Anagnostis P, Goulis DG, Lappas D, Natsis K. Ectopic thyroid tissue: anatomical, clinical, and surgical implications of a rare entity. Eur J Endocrinol. 2011;165(3):375\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1530/EJE-11-0461\u003c/span\u003e\u003cspan address=\"10.1530/EJE-11-0461\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRamanathan R, Veerapandian JP. Lingual thyroid with hypothyroidism in a child. Int J Contemp Pediatr. 2019;6(4):1747. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18203/2349-3291.ijcp20192787\u003c/span\u003e\u003cspan address=\"10.18203/2349-3291.ijcp20192787\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Lingual Thyroid, hypothyroidism, ectopic thyroid, careful physical examination, case report","lastPublishedDoi":"10.21203/rs.3.rs-8045218/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8045218/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and Novelty:\u003c/h2\u003e\u003cp\u003eLingual thyroid is a rare congenital malformation. The symptoms of lingual thyroid range from hypothyroidism to dysphagia and even sleep apnea. However, it can be difficult to diagnose in asymptomatic children. The novelty of this case stands from the early detection of lingual thyroid prior to the onset of local manifestation, emphasizing the value of meticulous physical examination.\u003c/p\u003e\u003ch2\u003eCase Report:\u003c/h2\u003e\u003cp\u003eWe present a case of 5 years old girl who had growth failure and no local symptoms, Clinical examination revealed stunting along with a 2-cm size mass in the oral cavity. Her biochemical tests suggested hypothyroidism and ectopic location of thyroid at the base of the tongue was identified as the cause. She was managed with thyroid hormone replacement therapy and experienced a reduction in mass size.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e\u003cp\u003eA careful clinical examination remains crucial for identifying diagnostic clues in resource-limited setting. We recommend routine oral cavity examination in all suspected cases of hypothyroidism specially in pediatric age group.\u003c/p\u003e","manuscriptTitle":"Rediscovering the Physical Exam: Lingual Thyroid in Juvenile Hypothyroidism- A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-05 01:55:06","doi":"10.21203/rs.3.rs-8045218/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-11T07:58:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-09T16:04:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-04T15:48:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20625743423122480399608783575040232037","date":"2025-12-03T13:34:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224277822196437887224228614086294841006","date":"2025-12-03T04:20:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-02T17:44:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"197291509378803756338676209632309120304","date":"2025-12-02T17:27:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-02T10:23:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-02T08:44:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-01T07:46:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-01T06:52:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-11-30T05:22:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8f81f6bc-2ab1-4f1c-9996-67260b2b2e9d","owner":[],"postedDate":"December 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T16:09:43+00:00","versionOfRecord":{"articleIdentity":"rs-8045218","link":"https://doi.org/10.1186/s12887-026-06623-x","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2026-02-23 15:58:40","publishedOnDateReadable":"February 23rd, 2026"},"versionCreatedAt":"2025-12-05 01:55:06","video":"","vorDoi":"10.1186/s12887-026-06623-x","vorDoiUrl":"https://doi.org/10.1186/s12887-026-06623-x","workflowStages":[]},"version":"v1","identity":"rs-8045218","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8045218","identity":"rs-8045218","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}