From benign lymphoid hyperplasia of the tongue base to iatrogenic hypothyroidism and severe menopausal osteoporosis

C. Vasiliu, M. Cârșote, A. Valea, S.E. Albu, C. Grigoriu, A. Ghemigian

Rezumat: Introduction. The histological aspects described in benign lymphoid hyperplasia (BLH) are rarely found at the level of head and neck. The prognosis is usually good but, for oncologic safety, the differential diagnosis with a lymphoma needs to be established. For the cases with lingual sites, the breathing or eating difficulties may be similar with those from thyroid conditions. Aim. We introduce a clinical case with symptoms potentially caused by a polinodular goiter but who was also diagnosed with a lingual tumor and other multiple comorbidities which are potentially pathogenic correlated. Material and methods. The gynecological and endocrine assessments are described. Results. A 69-yearold female accused dysphagia and dyspneea at thr age of 53. The endocrine assays revealed at that moment an enlargement of thyroid volume which was partially consistent with the symptoms. These investigations were fulfilled with otolaryngology evaluation which pointed a tumor of the tongue base.The biopsy confirmed BLH. The goiter was periodically checked-up and 8 years later she developed hyperthyroidism. Initially, she was treated with thiamazole followed by total thyroidectomy and later on thyroid substitution with levothyroxine which was offered to her. Four years later, she suffered a low-trauma fracture at the level of left distal radius caused by osteoporosis, as confirmed by central DXA. In order to treat this, intravenous therapy with antiresorbtive (ibandronate) was started once every 3 months (in association with vitamin D and calcium supplements). The therapy was continued for four more years without new fractures and with an improvement at DXA scores. Conclusion. BLH of the tongue is exceptional and needs to be differentiated from thyroid pathology due to accuses. The menopausal context may associate osteoporosis which is potentially related to BLH or to the therapy of iatrogenic hypothyroidism.
Cuvinte cheie: benign lymphoid hyperplasia, goiter, hypothyroidism, menopausal osteoporosis.