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The lingual thyroid occurring in the midline of the tongue base is an uncommon congenital anomaly. We report the case of a 43-year-old female who presented with a long-term lumping sensation. Head and neck ultrasonography revealed a solid tumor located in the tongue base without any thyroid tissue identified in the orthotopic position of the thyroid gland. With normal thyroid function and the cytological reports of ultrasound-guided fine needle aspiration (FNA), the diagnosis of an ectopic thyroid gland was confirmed. The utility of head and neck ultrasound in diagnosing ectopic thyroid glands is emphasized in this report.