Skip to content
How It Works
Explore
Ask a Question Resources Pricing
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Sign Up
PubMed This is a summary of 22 peer-reviewed journal articles Updated
Endocrinology · Lingual Thyroid

Understanding Lingual Goiter and Ectopic Thyroid

At a Glance

A lingual goiter, or ectopic lingual thyroid, is thyroid tissue at the base of the tongue that did not move to the neck during development. It may be the only thyroid tissue, so scans and hormone tests guide safe monitoring and treatment.

Learning that you have a lingual goiter (more precisely called an ectopic lingual thyroid) can be a confusing experience, largely because it is such a rare condition. It is estimated to occur in only about 1 in every 100,000 to 300,000 people, though rates vary depending on how the condition is defined [1][2]. Because it is so uncommon, it is very normal for the diagnostic journey to have taken some time or for you to have seen several specialists before getting a clear answer [3].

A lingual goiter is essentially thyroid tissue that is located at the back of the tongue rather than in its usual spot at the base of the neck [4]. This page will help you understand how this happened, what it means for your body, and why it is usually a manageable condition.

How Your Thyroid Developed

To understand a lingual goiter, it helps to look back at how your body formed before you were born. During fetal development, the thyroid gland actually begins its life at the very back of the tongue, at a spot called the foramen cecum [5].

Between the 3rd and 7th weeks of pregnancy, the thyroid is supposed to “descend” or travel down the neck to its final home in front of the windpipe (trachea) [6]. It follows a specific path called the thyroglossal duct [7].

In your case, this migration was interrupted. The thyroid tissue got “stuck” at the starting point—the base of the tongue [8][9]. While researchers are studying specific signals and genes that guide this movement, we don’t yet have a single known reason why this happens to some people and not others [10][11].

Your Only Thyroid Tissue

One of the most important facts to understand about a lingual goiter is that for many patients, this mass is not an “extra” piece of tissue. In approximately 70% of people who have clinically significant symptoms from a lingual thyroid, this is the only functioning thyroid tissue in their entire body [3].

Because this tissue is often the sole source of the thyroid hormones your body needs for energy and metabolism, doctors are very careful about how they treat it. If the tissue is removed or damaged without other thyroid tissue present, patients will need to take thyroid hormone replacement medication for the rest of their lives [12].

To confirm whether you have any other thyroid tissue, doctors often use a thyroid scintigraphy (a scan that uses a tiny amount of a radioactive marker to show where functioning thyroid cells are located) [13][14]. This is more accurate than a standard ultrasound for finding tissue that isn’t in the normal spot [15].

Understanding the Risks

While the idea of a growth at the base of the tongue can be frightening, there are two reassuring facts to keep in mind:

  • Malignancy is very rare: The reported risk of cancer developing in a lingual thyroid is exceptionally low, estimated at less than 1%, though the exact risk is uncertain [16][17]. Most of these masses are entirely benign (non-cancerous). However, rapid growth, bleeding, ulceration, or pain should prompt immediate medical evaluation [3].
  • Thyroid function can be managed: Many people with this condition have a thyroid that doesn’t produce quite enough hormone, a condition called hypothyroidism [18]. This is common and can usually be managed effectively with a daily pill that replaces the missing hormone, which may also help shrink the mass in some cases [12].

Confirming the Diagnosis

Because this condition is rare, your medical team may use several different tools to “map” the tissue and check its function:

  1. Thyroid Function Tests: Blood tests to measure your levels of TSH and T4 [19].
  2. Imaging: Ultrasound of the neck to see if a thyroid gland exists in the “normal” spot, and potentially a CT or MRI to see exactly how the lingual mass relates to your airway [20][21].
  3. Visual Exam: A specialist may use a flexible nasopharyngoscopy (a thin, flexible tube with a camera) to look at the mass directly through the nose or throat [22].

The goal of these tests is to determine if the tissue is working correctly and whether its size is likely to cause you any physical discomfort.

Common questions in this guide

What is a lingual goiter, and why is the thyroid at the base of the tongue?
A lingual goiter, more precisely called an ectopic lingual thyroid, is thyroid tissue at the back of the tongue instead of the lower neck. Before birth, the thyroid normally moves from the tongue area down the neck; in this condition, that movement stops before it reaches its usual location.
Could the ectopic thyroid be my only functioning thyroid tissue?
Yes. In about 70% of people who have clinically significant symptoms from a lingual thyroid, it is the only functioning thyroid tissue. Doctors often use a thyroid scan to look for functioning thyroid tissue in the neck before considering a procedure that could remove or damage it.
What tests are used to confirm a lingual thyroid?
Doctors may check TSH and T4 blood levels, use an ultrasound to look for a normal thyroid in the neck, and perform a thyroid scan to locate functioning tissue. CT or MRI can show how the mass relates to the airway, and a flexible camera examination can view it directly.
Does a lingual thyroid cause low thyroid hormone, and will I need medication?
Many people with a lingual thyroid do not make enough thyroid hormone, which is called hypothyroidism. Daily thyroid hormone replacement can restore the missing hormone and may reduce the size of the mass in some cases; whether you need it depends on your test results and your doctor’s assessment.
Can a lingual goiter affect swallowing, breathing, or speech?
It can, especially if the tissue is large enough to affect nearby spaces. A clinician can assess symptoms such as a lump in the throat, trouble swallowing, breathing problems, or changes in clear speech with an examination and imaging.
Is an ectopic lingual thyroid cancerous?
Most lingual thyroid masses are benign, and the reported cancer risk is less than 1%, although the exact risk is uncertain. Rapid growth, bleeding, ulceration, or pain should be assessed promptly by a medical professional.
How is a lingual thyroid monitored over time?
Monitoring may include changes in symptoms, thyroid hormone blood tests, and imaging to check the tissue’s size and location. Ask your care team how often you need follow-up, especially if swallowing, breathing, or other symptoms change.

Get notified when new evidence is published on lingual goiter.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.

References

References (22)
  1. 1

    Navig ati ng o bs tructive lingual thyro i d coexist i ng with sub - clin i cal hyp othyro i dism: A c as e r epor t.

    Ishaq M, Hayat M, Fakhar U, et al.

    JPMA. The Journal of the Pakistan Medical Association 2025; (75(11)):1843-1845 doi:10.47391/JPMA.22581.

    PMID: 41418145
  2. 2

    Ectopic lingual thyroid.

    Benhammou A, Bencheikh R, Benbouzid MA, et al.

    B-ENT 2006; (2(3)):121-2.

    PMID: 17067081
  3. 3

    TORS excision of lingual thyroid carcinoma: Technique and systematic review.

    Vincent A, Jategaonkar A, Kadakia S, Ducic Y

    American journal of otolaryngology 2019; (40(3)):435-439 doi:10.1016/j.amjoto.2019.02.013.

    PMID: 30833008
  4. 4

    Incidental Finding of Dual Ectopic Thyroid on Computed Tomography Angiography.

    Pierro A, Cilla S, Modugno P, Sallustio G

    Journal of clinical imaging science 2017; (7()):30 doi:10.4103/jcis.JCIS_21_17.

    PMID: 28852580
  5. 5

    Shaping the thyroid: From peninsula to de novo lumen formation.

    Pierreux CE

    Molecular and cellular endocrinology 2021; (531()):111313 doi:10.1016/j.mce.2021.111313.

    PMID: 33961919
  6. 6

    Arrested Descent of the Thyroid: A New Manifestation of Abnormal Thyroid Embryology.

    Branstetter BF, Fernandez A

    The Laryngoscope 2024; (134(2)):995-997 doi:10.1002/lary.30831.

    PMID: 37338100
  7. 7

    Thyroglossal duct surgery. Sistrunk procedure.

    Righini CA, Hitter A, Reyt E, Atallah I

    European annals of otorhinolaryngology, head and neck diseases 2016; (133(2)):133-6.

    PMID: 26725753
  8. 8

    [Ectopic tissue of the thyroid gland and the parathyroid glands].

    Theurer S, Siebolts U, Lorenz K, et al.

    Der Pathologe 2018; (39(5)):379-389 doi:10.1007/s00292-018-0467-1.

    PMID: 30105609
  9. 9

    Diagnostic evaluation of a case of lingual thyroid ectopia.

    Fiaschetti V, Claroni G, Scarano AL, et al.

    Radiology case reports 2016; (11(3)):165-70 doi:10.1016/j.radcr.2016.04.004.

    PMID: 27594942
  10. 10

    Glis3 as a Critical Regulator of Thyroid Primordium Specification.

    Rurale G, Marelli F, Duminuco P, Persani L

    Thyroid : official journal of the American Thyroid Association 2020; (30(2)):277-289 doi:10.1089/thy.2019.0196.

    PMID: 31797737
  11. 11

    Regeneration of Thyroid Function by Transplantation of Differentiated Pluripotent Stem Cells.

    Kurmann AA, Serra M, Hawkins F, et al.

    Cell stem cell 2015; (17(5)):527-42.

    PMID: 26593959
  12. 12

    LINGUAL THYROID: 35-YEAR EXPERIENCE AT A TERTIARY CARE REFERRAL CENTER.

    Carranza Leon BG, Turcu A, Bahn R, Dean DS

    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2016; (22(3)):343-9 doi:10.4158/EP15973.OR.

    PMID: 26789339
  13. 13

    Thyroid ultrasonography versus scintigraphy for establishing a stepwise imaging approach in pediatric patients with thyroid dysgenesis in resource-limited settings.

    Arafa N, Atef S, Elshwimy NKH, et al.

    Pediatric endocrinology, diabetes, and metabolism 2026; (32(3)):172-180 doi:10.5114/pedm.2026.163205.

    PMID: 42902700
  14. 14

    Thyroid imaging study in children with suspected thyroid dysgenesis.

    Chun S, Lee YS, Yu J

    Annals of pediatric endocrinology & metabolism 2021; (26(1)):53-59 doi:10.6065/apem.2040120.060.

    PMID: 33819958
  15. 15

    Pediatric thyroid ultrasound: a radiologist's checklist.

    Tritou I, Vakaki M, Sfakiotaki R, et al.

    Pediatric radiology 2020; (50(4)):563-574 doi:10.1007/s00247-019-04602-2.

    PMID: 32166365
  16. 16

    Differentiated thyroid carcinoma in lingual thyroid.

    Sturniolo G, Violi MA, Galletti B, et al.

    Endocrine 2016; (51(1)):189-98 doi:10.1007/s12020-015-0593-y.

    PMID: 25987346
  17. 17

    Thyroid cancer in lingual thyroid and thyroglossal duct cyst.

    Sturniolo G, Vermiglio F, Moleti M

    Endocrinologia, diabetes y nutricion 2017; (64(1)):40-43 doi:10.1016/j.endonu.2016.07.010.

    PMID: 27825535
  18. 18

    Does surgical management still play a role in the management of ectopic lingual thyroid: Institutional experience and systematic review of the literature.

    Sauer AB, Dowling EM, Bauman MMJ, et al.

    American journal of otolaryngology 2022; (43(3)):103461 doi:10.1016/j.amjoto.2022.103461.

    PMID: 35427937
  19. 19

    Delayed Diagnosis of Ectopic Thyroid Due to Ignored Borderline Result of Newborn Screening for Congenital Hypothyroidism.

    Al Alwan I, Alhawsawi KI

    The American journal of case reports 2026; (27()):e948708 doi:10.12659/AJCR.948708.

    PMID: 41553978
  20. 20

    Pediatric lingual ectopic thyroid: two contrasting cases and a narrative literature review.

    Shi Z, Tao C

    Frontiers in pediatrics 2026; (14()):1866654 doi:10.3389/fped.2026.1866654.

    PMID: 42694171
  21. 21

    Airway management in patients with lingual thyroid: a case report and review of the literature.

    Nisa L, Morrison S, Levi E

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2022; (279(7)):3289-3295 doi:10.1007/s00405-022-07310-0.

    PMID: 35201391
  22. 22

    Management of Lingual Thyroid with Second Thyroid Anomaly: An Institutional Experience.

    Parida PK, Herkel K, Preetam C, et al.

    Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India 2022; (74(Suppl 3)):5329-5337 doi:10.1007/s12070-021-02493-0.

    PMID: 36742580

This page is for informational purposes only and does not constitute medical advice about your lingual thyroid. Your endocrinologist or ENT specialist can interpret your tests and recommend care for your situation.

Guide contents lingual goiter
Research & Literature
02 Symptoms and Emergency Signs to Watch For