From the Guidelines
The recommended management for a child with an enlarged lingual thyroid and no thyroid tissue in the neck is not directly addressed by the provided evidence, but considering the potential for airway obstruction, surgical excision (option B) may be necessary to relieve symptoms, as seen in cases of lingual tonsillar hypertrophy causing obstructive sleep apnea, as discussed in the American Thoracic Society clinical practice guideline 1.
Given the context of the question, it's crucial to prioritize the management of potential airway obstruction, especially if the enlarged lingual thyroid is causing significant symptoms. The provided evidence, although focused on lingual tonsillar hypertrophy, highlights the importance of addressing airway obstruction in children, which can be applied to the scenario of an enlarged lingual thyroid.
Key considerations in managing a child with an enlarged lingual thyroid include:
- Assessing the degree of airway obstruction and its impact on the child's quality of life and sleep
- Evaluating the child for any signs of hyperthyroidism or hypothyroidism, as the lingual thyroid is functioning thyroid tissue
- Considering the potential benefits and risks of surgical excision versus medical management or ablation
While antithyroid drugs (option A) might be considered for managing hyperthyroidism, and ablation (option C) could be an option for managing the thyroid tissue, surgical excision (option B) is likely the most appropriate choice for relieving airway obstruction caused by an enlarged lingual thyroid, especially if the child is experiencing significant symptoms. This approach must be balanced with the potential need for lifelong thyroid hormone replacement therapy, emphasizing the importance of a multidisciplinary approach to management, including endocrinology and surgery, as informed by the most recent clinical guidelines and evidence, such as those from the American Thoracic Society 1.
From the Research
Management of Lingual Thyroid
The management of lingual thyroid can be approached in several ways, including:
- Surgical excision: This is a common approach, especially in cases where the lingual thyroid is causing symptoms such as dysphagia or dysphonia 2, 3, 4.
- Hormone replacement therapy: This can be used to reduce the size of the ectopic tissue and improve symptoms, avoiding the need for surgical intervention 5, 6.
- Ablation: This is another potential management option, although it is not as commonly discussed in the literature as surgical excision or hormone replacement therapy 4.
- Antithyroid drugs: There is limited discussion of antithyroid drugs as a management option for lingual thyroid in the provided literature.
Considerations for Management
When considering management options for lingual thyroid, it is important to take into account the individual patient's circumstances, including:
- The presence or absence of orthotopic thyroid tissue: If the patient has no orthotopic thyroid tissue, they may require lifelong hormone replacement therapy after surgical excision of the lingual thyroid 3.
- The size and location of the lingual thyroid: Larger lingual thyroids or those that are causing symptoms may require surgical excision, while smaller ones may be managed with hormone replacement therapy or observation.
- The patient's overall health and medical history: This can influence the choice of management option and the need for ongoing monitoring and follow-up.
Treatment Options
Treatment options for lingual thyroid include: