Endocrinology & Metabolic Syndrome
Open Access

Uncommon Presentation of A Common Disease

Ashok Venkatanarasu^{* *}Correspondence: Ashok Venkatanarasu, Department of Endocrinology, Sanjeevani Clinic, Hyderabad, Telangana, India, Tel: +919989025000, Email:

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35 years man presented with foreign body sensation in mouth, difficulty in breathing and swallowing. He had noticed enlargement of his tongue, which filled the whole of his mouth. On further enquiry, he admitted of general weakness, associated with body aches, fatigue, swelling of face and constipation.

He was clinically suspected to have hypothyroidism and subjected the relevant thyroid hormone assays which confirmed primary hypothyroidism with elevated level of thyroid stimulating hormone (TSH) at 114 micro IU/mL (0.4-4.2)^* combined with low levels of thyroid hormones (T3-48.6ng/dL (60-180)^*, T4- 2.1mcg/dL (4.6-10.5)^*. He was initiated on the standard replacement doses of levothyroxine.

At follow up, three and a half months later there was resolution of macroglossia and all the other symptoms with restoration of euthyroid state (T3-103ng/dL, t4- 10.7mcg/dL and TSH- 0.30 micro IU/mL). We report the rare presentation of primary hypothyroidism as macroglossia. Other causes of macroglossia include amyloidosis, acromegaly, Downs' syndrome and Beckwith-Wiedemann syndrome (Figure 1 & 2).

Figure 1: Macroglossia with teeth indentation on the lateral margins of the tongue.

Figure 2: Resolution of macroglossia.