Key Clinical Message
We are reporting a case of hypothyroidism presenting as fissured tongue, demonstrating significant resolution of fissure tongue upon thyroid hormone replacement therapy.
Keywords: fissure tongue, hypothyroidism, levothyroxine, macroglossia
1. CASE PRESENTATION
A 53‐year‐old male presented to the internal medicine department with a complaint of progressive worsening of cracks on the tongue for 2 years (Figure 1). He had a normal tongue 2 years ago and subsequently noticed cracks on the tongue. He denied experiencing tongue pain, halitosis, cold intolerance, constipation, or weight gain.
FIGURE 1.
Fissure tongue before treatment.
On reviewing his past medical history, he had bronchial asthma under control on regular inhalational steroids. He had no history of skin diseases, neck surgery, or irradiation. He was a teetotaler and never smoked.
He appeared well‐built and nourished, with a BMI of 24.31 kg/m2. Oral cavity examination revealed a thick tongue with diffuse fissures on the anterior surface and the sides of the tongue with scalloping. A Grade 1 goiter was detected during the neck examination. Skin, joint, and systemic examinations were normal.
2. WHAT IS THE DIAGNOSIS?
A fissure tongue in hypothyroidism due to macroglossia.
The presence of macroglossia and goiter raised the suspicion of hypothyroidism. Biochemical analysis revealed TSH of more than 100 mIU/L (0.27–4.2 mIU/L), free T4–0.2 ng/dL (0.93–1.7 ng/dL), and free T3–0.1 ng/dL (0.2–0.44 ng/dL), anti‐TPO antibodies 600 IU (0–34 IU). Ultrasound of the thyroid showed micronodules.
The patient was initiated on levothyroxine 100 μg once daily, and the dose was titrated. During follow‐up a year later, he was on levothyroxine 175 μg once daily. His TSH was 7.1 mIU/L, and the fissures on the tongue had significantly improved (Figure 2).
FIGURE 2.
Partial resolution of fissure tongue after treatment with levothyroxine in hypothyroidism.
3. DISCUSSION
Fissure tongue is often considered a normal variant of the tongue and is sometimes associated with geographic tongue, macroglossia, pernicious anemia, Sjögren syndrome, psoriasis, acromegaly, Pierre Robin syndrome, Down syndrome, and Melkersson–Rosenthal syndrome.
Oral manifestations of hypothyroidism are more commonly observed in children than in adults. These manifestations include macroglossia, thick lips, malocclusion, delayed teeth eruption, enamel hypoplasia, dysgeusia, and glossitis. Macroglossia in hypothyroidism may result in fissuring of the tongue. 1
The occurrence of fissured tongue in relation to hypothyroidism is not common. A study conducted by Jacob et al. found thyroid diseases in 2% of patients with fissured tongue. 2 Another study by Mathew et al. revealed an association with hypothyroidism in 1.5% of fissured tongue patients. 3
There is no specific treatment for a fissured tongue except for maintaining good oral hygiene. However, our patient showed significant improvement in the fissure tongue on levothyroxine supplement.
It is unlikely that the fissured tongue observed in our patient with hypothyroidism is a mere coincidence. The patient had a normal tongue before noticing the fissures 2 years ago, which suggests that macroglossia caused by hypothyroidism might have contributed to the development of the fissures.
4. CONCLUSION
Macroglossia in hypothyroidism can give rise to a fissured tongue. Correcting hypothyroidism may lead to the resolution of fissured tongue.
AUTHOR CONTRIBUTIONS
Ravishankar Mylaraiah: Conceptualization; resources; software; writing – original draft; writing – review and editing. Sangeeta Sharma: Investigation. Tamer Shalaby: Resources.
FUNDING INFORMATION
None.
CONFLICT OF INTEREST STATEMENT
The authors have no multiplicity of interest to disclose.
CONSENT
Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.
ACKNOWLEDGMENTS
None.
Mylaraiah R, Sharma S, Shalaby T. Hypothyroidism presenting as a fissure tongue. Clin Case Rep. 2024;12:e8640. doi: 10.1002/ccr3.8640
DATA AVAILABILITY STATEMENT
Data openly available in a public repository that issues datasets with DOIs.
REFERENCES
- 1. Hartsfield JK Jr, Cameron AC. Chapter 3 – Acquired and developmental disturbances of the teeth and associated Oral Structures. In: Dean JA, ed. McDonald and Avery's Dentistry for the Child and Adolescent. 10th ed. Mosby; 2016:39‐79. doi: 10.1016/B978-0-323-28745-6.00003-X [DOI] [Google Scholar]
- 2. Jacob LE, Varghese S, Thomas J, Mathew A, Omal PM, John S. Prevalence of lingua plicata: a cross sectional study. J Oral Diagn. 2019;4(1):1‐5. [Google Scholar]
- 3. Mathew A, Cherian S, Daniel M, Abraham T, Mathew R. Prevalence of fissured tongue in a south Indian population‐a cross‐sectional study. J Oral Med. 2017;1(1):9. [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data openly available in a public repository that issues datasets with DOIs.