Multidisciplinary diagnosis and treatment of lingual thyroid presenting as hematemesis

RATIONALE: Hematemesis is a common symptom of gastrointestinal disorders and is often associated with upper gastrointestinal issues. However, lingual thyroid, a rare ectopic thyroid condition, can also present with hematemesis, complicating diagnosis and increasing the risk of misdiagnosis. This paper reports a case of lingual thyroid in which the primary symptom was hematemesis. PATIENT CONCERNS: A 59-year-old male patient with dwarfism and congenital hypothyroidism underwent irregular thyroid hormone therapy. He was admitted to the hospital after experiencing hemoptysis and a sensation of a foreign body in the throat. DIAGNOSES: Ectopic lingual thyroid with nodular goiter and hemorrhage. INTERVENTIONS: The patient received medical management to control bleeding and was administered a daily regimen of levothyroxine sodium (100 µg). OUTCOMES: During the follow-up period, the patient did not vomit blood. LESSONS: In this case, the patient's initial presentation of hematemesis prompted clinicians to expand the diagnostic approaches after excluding common gastrointestinal etiologies, including rare conditions such as ectopic thyroid hemorrhage. Nodular lesions in ectopic thyroid tissue, characterized by abundant blood supply and superficial location, suggest that bleeding mechanisms may involve internal vascular rupture or ulcer formation. Endoscopic observation of an active hemorrhage strongly supports this pathological mechanism. The successful management of this case highlights the critical value of multidisciplinary collaboration for challenging rare diseases. Through the multidisciplinary team, we effectively integrated initial screening via endoscopic examination, precise localization through imaging modalities, and specialized decision-making from endocrinology and surgery departments. This comprehensive approach enables rapid diagnosis, formulates personalized conservative treatment plans, minimizes therapeutic risks, and ultimately achieves favorable patient outcomes.