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Not all sore throats are strep throat
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A young man was traveling when he came down with a bloody sore throat. He was seen at an urgent care facility, diagnosed with strep throat and prescribed antibiotics. He proceeded on his trip, but the pain and bleeding became worse. He was evaluated at another health care facility where a mass was noted in his throat. A CT was done:
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As you can see, he has a lingual thyroid. No thyroid tissue was seen in the usual location. Radioiodine imaging can be helpful in confirming if such a mass is thyroid, but often the CT appearance is classic, as it is in this patient.
Lingual thyroids are uncommon and occur 80% of the time in females. Lingual thyroid is a developmental anomaly which results when there is incomplete migration of the thyroid.
Most of the time lingual thyroid is asymptomatic. Many patients with a lingual thyroid are hypothyroid. Thyroid carcinoma appears to be rare with only about 30 cases reported in the literature. No specific treatment is necessary other than thyroid hormone replacement therapy in those who are hypothyroid.
In some patients, the aberrant tissue can cause symptoms of dysphagia, bleeding or obstruction. Radioiodine has been used by some to shrink the thyroid and ameliorate symptoms. If bleeding, obstruction or other symptoms are severe, however, surgery may be necessary.