Endocrinology · Lingual Thyroid

Symptoms and Emergency Signs to Watch For

At a Glance

A lingual goiter at the base of the tongue can cause difficulty swallowing, voice changes, snoring, sleep apnea, or low thyroid hormone. High-pitched noisy breathing, severe shortness of breath, inability to swallow saliva, or bleeding require immediate emergency care.

Because a lingual goiter is located at the very base of your tongue, it can cause both physical symptoms in your throat and systemic symptoms throughout your body if your thyroid hormone levels are affected ^[1]^[2].

While many lingual thyroids are discovered incidentally without symptoms, those that do cause issues usually present with symptoms related to the physical presence of the mass or to hypothyroidism (an underactive thyroid) ^[1]^[3].

Symptoms Caused by the Mass

As the thyroid tissue at the base of the tongue grows, it can begin to take up space in the throat. This often leads to several common experiences:

Dysphagia (Difficulty Swallowing): You may feel like food is catching in your throat or that you have to swallow multiple times to clear a bite ^[1]^[4].
Globus Sensation: This is the persistent feeling of a “lump” or foreign object in your throat, even when you aren’t eating ^[1]^[5].
Dysphonia (Voice Changes): Your voice may sound muffled, hoarse, or “thick,” as if you are speaking with a mouthful of food ^[1]^[6].
Sleep Apnea and Snoring: If the mass is large enough, it can partially block your airway when your muscles relax during sleep. This can lead to loud snoring, gasping for air at night, or obstructive sleep apnea, where you briefly stop breathing during sleep ^[7]^[8].

Thyroid Hormone Symptoms

Hypothyroidism is frequently seen in patients with a symptomatic lingual thyroid because the ectopic tissue cannot produce enough hormone for the body’s needs ^[6].

Subclinical Hypothyroidism: This occurs when your body is working harder to get the thyroid to function (marked by an elevated TSH level), but your hormone levels (Free T4) are still in the normal range. You may have mild symptoms or none at all, and it does not inevitably progress to overt disease ^[9]^[10].
Overt Hypothyroidism: This occurs when hormone levels actually drop below normal. Common symptoms include persistent fatigue, feeling unusually cold (cold intolerance), constipation, unexplained weight gain, and feeling “foggy” or depressed ^[3]^[11].

Emergency “Red Flag” Symptoms

While many symptoms of a lingual goiter develop slowly, certain signs indicate a medical emergency. If you experience any of the following, you should seek immediate emergency care (911 or your local emergency room), as these can indicate your airway is becoming blocked or the tissue is bleeding ^[12]^[13].

Red Flag Symptom	What It Means
Stridor	A high-pitched, whistling, or noisy sound coming from the upper airway when you breathe in ^[12]^[14].
Severe Dyspnea	Extreme shortness of breath or feeling like you are struggling or working hard to pull in air ^[12]^[15].
Acute Bleeding	Coughing up blood (hemoptysis) or vomiting blood (hematemesis) coming from the back of the tongue ^[13]^[16].
Inability to Swallow	Being unable to swallow your own saliva or sudden, severe choking episodes ^[12].

In an emergency situation, doctors focus first on protecting your airway. Because the mass is at the base of the tongue, standard intubation (placing a breathing tube) can be difficult, and specialists like Ear, Nose, and Throat (ENT) surgeons are often called in to assist ^[17]^[15]. Always inform emergency responders that you have a mass at the base of your tongue to help them plan the safest way to support your breathing, and consider carrying a printable emergency medical card with this information.

Common questions in this guide

What symptoms can a lingual goiter cause?

Many lingual thyroids cause no symptoms. When the tissue enlarges, it can make food feel stuck, cause a persistent lump sensation, change the voice, produce snoring, or lead to pauses in breathing during sleep. It may also be associated with low thyroid hormone, causing fatigue, feeling unusually cold, constipation, weight gain, or low mood.

Which lingual thyroid symptoms require emergency help?

Call 911 or your local emergency number for high-pitched noisy breathing, severe trouble breathing, inability to swallow saliva, sudden choking, or coughing or vomiting blood. These signs can signal that the airway is narrowing or that the tissue is bleeding, so do not wait for symptoms to improve.

Can a lingual thyroid cause low thyroid hormone?

Yes. Lingual thyroid tissue may not make enough thyroid hormone; blood tests can show an early form with an elevated thyroid-stimulating hormone level and normal thyroid hormone, or overt hypothyroidism when hormone levels are low. Symptoms may include fatigue, feeling cold, constipation, unexplained weight gain, or trouble thinking clearly.

Could a lingual goiter be causing my snoring or poor sleep?

Yes. A larger mass at the base of the tongue can narrow the airway, especially when throat muscles relax during sleep. Loud snoring, waking up gasping, pauses in breathing, or feeling unrefreshed in the morning should be discussed with a healthcare professional.

What should I tell emergency responders about a lingual goiter?

Tell emergency responders that you have lingual thyroid tissue or a mass at the base of your tongue. Placing a breathing tube can be difficult when a mass is in this location, so emergency teams may involve an ear, nose, and throat surgeon while protecting your breathing.

What should I do if I see blood from the back of my tongue?

Blood in saliva, coughing up blood, or vomiting blood from the back of the tongue needs immediate emergency evaluation. Call 911 or your local emergency number, especially if the bleeding occurs with breathing or swallowing problems.

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 (17)

1
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
2
Lingual Thyroid with Subclinical Hypothyroidism in a Young Female.
Thapa S, Khanal P
Case reports in endocrinology 2021; (2021()):6693477 doi:10.1155/2021/6693477.
PMID: 33564479
3
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
4
The gland that never descended: Preoperative transarterial embolization of a symptomatic lingual thyroid.
Díaz O, García H
Radiology case reports 2026; (21(12)):6306-6313 doi:10.1016/j.radcr.2026.09.014.
PMID: 42840549
5
Lingual thyroid: can we 'wait and see'?
Magalhães C, Azevedo P, Nakamura R, Duarte D
BMJ case reports 2015; (2015()).
PMID: 26240100
6
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
7
Transoral robotic resection of a lingual thyroid: a novel treatment for obstructive sleep apnoea.
Curtis J, Walford S, Howe D
BMJ case reports 2021; (14(9)) doi:10.1136/bcr-2020-241412.
PMID: 34531229
8
A large lingual thyroid extending to the epiglottis.
Eryilmaz A, Basal Y
BMJ case reports 2015; (2015()).
PMID: 26563340
9
[Autoimmune thyroid disease].
Koehler VF, Bojunga J
Deutsche medizinische Wochenschrift (1946) 2021; (146(20)):1329-1336 doi:10.1055/a-1258-5674.
PMID: 34644793
10
An uncommon cause of dysphagia.
Senthilraja M, Rajan R, Kapoor N, et al.
Journal of family medicine and primary care 2019; (8(3)):1282-1283 doi:10.4103/jfmpc.jfmpc_2_19.
PMID: 31041293
11
Lingual thyroid with severe hypothyroidism: A case report.
Huang H, Lin YH
Medicine 2021; (100(43)):e27612 doi:10.1097/MD.0000000000027612.
PMID: 34713843
12
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
13
Enlarged hemorrhagic lingual thyroid managed with transoral robotic surgery.
Filarski CF, Levine B, Buttan A, et al.
Endocrine 2021; (72(3)):923-927 doi:10.1007/s12020-020-02586-w.
PMID: 33420947
14
Acute neonatal respiratory distress caused by a lingual thyroid: the role of nasendoscopy and medical treatment.
Lane L, Prudon S, Cheetham T, Powell S
The Journal of laryngology and otology 2015; (129(4)):403-5 doi:10.1017/S002221511500002X.
PMID: 25720918
15
Lingual Thyroid Unmasked by Acute Stroke: A Hidden Airway Emergency.
Yoneoka Y, Tange A, Honda K, Ohara N
Cureus 2025; (17(12)):e99162 doi:10.7759/cureus.99162.
PMID: 41536379
16
Lingual ectopic papillary thyroid carcinoma: Two case reports and review of the literature.
Huang NS, Wei WJ, Qu N, et al.
Oral oncology 2019; (88()):186-189 doi:10.1016/j.oraloncology.2018.11.019.
PMID: 30473413
17
Lump at the back of my tongue. The lingual thyroid-A case report and narrative review of literature.
Jabbour J, Agostinho N, Bains HK, et al.
Clinical case reports 2021; (9(6)):e04160 doi:10.1002/ccr3.4160.
PMID: 34194759

This page is for informational purposes only and does not constitute medical advice. A clinician should assess your breathing, swallowing, thyroid levels, and sleep symptoms; call emergency services immediately for severe breathing trouble, bleeding, or inability to swallow saliva.