Lingual thyroid in children: a rare clinical entity

Objectives/Hypothesis: To study the presentation, management, and long-time outcome of children presenting with lingual thymid. Study design: Institutional review board approved, retrospective study (1993-2004) Methods: The study was conducted at a tertiary care pediatric medical center. The main outcomes measured were initial presentation, radiographic finding, endocrine evaluation, surgical outcome, pathologic features, complications, need for hormonal replacement. Resuts: Four patients presented to the Department of Otolaryngology and Communications Enhance. ment. Children's Hospital Boston with liognal thyroid between 1993 and 2004. All patients were female, with an age range of 2 to 12 years (x=6). All patients presented with a mass (1.4-3.5 cm) and most with respiratory or feeding difficulty. Magnetic resonance imaging was obtained in three patients and revealed a mass unsistant with lingual thydoir. Thyroid seen confirmed the lingual thyroid as the only fonctioning thyroid in all four patients. None of the patients responded to hormonal replacemement, and all underwent surgical excision of the mass, Surgical approach included midline glossotomy (n = 2) and CO 2 laser excision (n = 3). Pathologie evaluation confirmed lingual thyroid in all four patients. No evidence of machignancy was sen in any patient. All four patients require lifelong hormonal replacement. Conclusions: Lingual thyroid is a race condition. with an incidence of 1.100.000. This infrequent congenital anormally is often asymptomatic until a pathologic stress such as systemic disease or physiologie stress such as puberty causes enlargement of the ecloptic tissue, leading to dysphagia, dysphonia, and dyspnea. The work-up should include routine blood wr*ork including thyroid function tests thyrotropin, thyroxine, and thyroid hormone binding ratio; iodine thyroid scintigraphy; and computerized tomography of magnetic resonance imaging. The majority of patients require surgical excision of the symptomatic mass and, in case of absence of arthotopic thyroid atic mass and, in case of absence of arthotopic thyroid tissue, long-term thyroid hormone replacement.