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“Stick out your tongue and say ‘ahhhh!’” You’ve probably had a doctor say that to you at least once. But what if that tongue has wavy edges that look like the edges of a pie crust? You could have a condition known as scalloped tongue. It’s a known sign of hypothyroidism and other underlying health conditions. Ahead, we’ll look at the ins and outs of scalloped tongue and the connection to hypothyroidism.
Scalloped tongue is a condition that results after the tongue becomes swollen – known as macroglossia or glossitis. An enlarged tongue that consistently pushes up against the teeth can create tooth-shaped indentations that give the tongue’s edges a distinctive scalloped appearance. In some cases, a scalloped tongue may appear redder than usual.
While “scalloped tongue” is the best-known name, the condition is also known as lingua indentata, pie crust tongue, wavy tongue, or crenated tongue.
Scalloped tongue is rarely painful, but some patients report tenderness in the tongue, a mild sore throat, or a dry mouth.
Scalloped tongue is not considered a disease on its own. Instead, it may indicate other underlying health conditions that should be investigated and treated.
An enlarged, swollen tongue – and the scalloped tongue that can result – has multiple causes, including:
- Genetic and congenital conditions, including Down syndrome, Apert syndrome, and congenital hypothyroidism
- Untreated hypothyroidism and thyroiditis
- Conditions such as sarcoidosis, amyloidosis, and neurofibromatosis that cause inflammation and tissue infiltration that can cause the tongue to become enlarged
- Temporomandibular joint (TMJ) disorders, jaw misalignment, and poor tooth alignment
- Dehydration, leading to swelling in the body and tongue
- Stress and anxiety-related habits, including grinding your teeth
- Sleep apnea and sleep disorders
- Infection of the tongue
- Injury to the tongue
- Deficiencies in critical nutrients, especially vitamin B-12, riboflavin, niacin, and iron
- Smoking, which can irritate mucosal tissue in the mouth and tongue and cause inflammation
Scalloped tongue is diagnosed primarily by a visual examination from your health care provider. Your provide will focus, however, on determining the underlying medical condition causing your tongue to be enlarged, swollen, and scalloped. As part of this diagnostic process, your doctor will likely evaluate your thyroid and may also order additional blood tests for inflammation, protein levels, and vitamin and nutritional deficiencies.
To evaluate other possible underlying conditions, your doctor will review your medical history and lifestyle information such as hydration, smoking habits, and stress level.
You may also be referred for a dental examination for a more in-depth examination of your teeth.
Healing a scalloped tongue primarily involves optimally treating the underlying disease that is causing tongue swelling and enlargement.
Apart from comprehensive treatment programs for the causal genetic, congenital, neurological, and autoimmune conditions, other treatment approaches depend on the cause of the scalloped tongue, including:
- Infection: Antibiotics and/or anti-inflammatory prescription medications may be prescribed to treat any underlying infections or inflammatory reactions.
- Sleep apnea: Your doctor may recommend using a continuous positive airway pressure (CPAP) machine or nasal dilator to help treat sleep apnea.
- Dehydration: If you’re dehydrated, your doctor will recommend increasing your fluid levels to a sufficient level to reduce your tongue swelling.
- Anxiety: If you have anxiety contributing to your scalloped tongue, your doctor may prescribe anti-anxiety drugs or recommend cognitive therapy, active stress management practice, and mindfulness techniques to help reduce your stress-related teeth grinding.
- Grinding your teeth, TMJ: Dental devices like a mouth guard and positioners are sometimes recommended when tongue scalloping is caused by teeth grinding or aggravated by TMJ, especially during sleep.
- Problematic oral habits: In some cases, breaking bad oral health habits may require sessions with an occupational therapist.
- Orthodontic treatment: You may require orthodontic treatment to correct problems with the alignment of your jaw or teeth.
While less common, your doctor may recommend oral surgery to reduce the tongue size and eliminate excess tissue, blocking the tongue from pushing against the teeth and causing a scalloped tongue.
As mentioned, an enlarged and swollen tongue is a symptom of congenital hypothyroidism – hypothyroidism that is present at birth. While congenital hypothyroidism is rare – occurring in 1 in 2000 to 4000 newborns -- an enlarged tongue is a common sign. Scalloped tongue won’t manifest unless the hypothyroidism remains untreated or poorly treated after the baby develops teeth. (The good news is that within 48 hours of birth, almost all newborns in the U.S. have the standard “heel stick” test – which looks for 50 congenital conditions, including hypothyroidism.)
Because untreated congenital hypothyroidism puts newborns at risk of developmental disabilities and mental retardation, infants diagnosed with congenital hypothyroidism are immediately started on thyroid hormone replacement treatment to support more normal physical, cognitive, and neurological development. The enlarged tongue also tends to resolve with adequate thyroid hormone treatment.
In children and adults, untreated hypothyroidism and thyroiditis (inflammation of the thyroid gland) can lead to swelling of the tongue and scalloped tongue. (Note that hypothyroidism also increases your risk of sleep apnea, a condition known to be one of the causes of scalloped tongue.)
Suppose you have scalloped tongue and have not been diagnosed with a thyroid condition. In that case, a complete thyroid exam should be part of your initial evaluation. Visit your doctor for a thyroid examination and thyroid test panel. You can also start by ordering a Paloma Health Complete Thyroid Blood Test kit. Paloma’s at-home thyroid test kit makes it easy to collect your blood sample at home with a painless finger prick.
The Paloma kit tests Thyroid Stimulating Hormone (TSH), Free Triiodothyronine (Free T3), Free Thyroxine (Free T4), and Thyroid Peroxidase (TPO) antibodies, and you have the option to add on a Reverse T3 (RT3) and vitamin D tests. You mail your results to the certified lab with pre-paid shipping, and your thyroid lab results are released to a secure online dashboard within days.
Treatment for hypothyroidism requires a prescription thyroid hormone replacement drug, including:
- Levothyroxine (synthetic T4) drugs like Synthroid, Levoxyl, Unithroid, Euthyrox, Tirosint, and Tirosint-SOL
- Liothyronine (synthetic T3) drugs like Cytomel
- Natural desiccated thyroid (NDT) drugs like Armour, NP Thyroid, or compounded NDT
Suppose you’re already hypothyroid, and you develop scalloped tongue. In that case, your goal should be to work with your health care practitioner to determine the cause, starting with evaluating whether your thyroid levels and hypothyroidism treatment are optimal. Your thyroid hormone replacement treatment may need to be adjusted to help resolve your tongue swelling and enlargement.
When you need a diagnosis, treatment, or adjustments to your ongoing hypothyroidism care, remember that Paloma Health offers convenient and affordable virtual visits with top thyroid doctors across the country.
A note from Paloma Health
Scalloped tongue is not considered an emergency medical condition. Still, it is a sign that you may have an underlying health condition that warrants a consultation with your health care provider. With proper evaluation, diagnosis, and treatment of the underlying cause of tongue swelling and enlargement, most patients have complete resolution of their scalloped tongue.