Zulfiqar Ali, Muhamad Farooq.
A case of Lingual thyroid, the suprahyoid approach.
J Pak Inst Med Sci Jan ;6(1,2):376-9.

The lingual thyroid is an uncommon entity. It may be managed medically but failure of medical management may necessitate surgical removal. Different approaches described are: Transhyoid, lateral cervical, trans-oral, midline mandibulo-labial-glossotomy. We report our experience with the management of a case of lingual thyroid which was operated via a suprahyoid approach. It is felt that it is, a convenient and better approach.

Case Report: A 30 years old female presented in April 1994 with progressive dysphagia for solids and feeling of a lump in the throat for 10 years, dysarthria and nocturnal dysponea for 2 years. There were no other symptoms. On clinical examination a large rounded, reddish smooth, firm, nontender and mobile mass was preseent on the tongue base. Other E.N.T. and systemic examination was un-remarkable. She was diagnosed as a case of lingual thyroid. Thyroid scan showed an area of isotope uptake at the base of the tongue only. No thyroid tissue was visualized in the neck. T3, T4, & TSH levels were within normal limits. Other investigations (like Blood complete picture, ESR, Urine test, X-Ray chest, ECG, Blood urea and serum electrolytes) were also within normal limits. She was given a trial of thyroxine replacement therapy for four months but the lingual thyroid did not regress in size. Therefore she was evaluated and prepared for surgery. On 5th Sept. 1994, the mass was excised via a suprahyoid approach under general anaesthesia. A skin crease incision was given at the level of hyoid bone extending from one greater cornu to the other. After elevating the subplatysmal flap, suprahyoid muscles were separated from the body of the hyoid bone and after entering into the vallecula, the lingual thyroid was excised under direct vision and wound was closed in layers. A Haemovac drain was put in. The whole specimen measuring 6 x 7 x 0.5 cm and weighing 30 grams was submitted for histopathology which showed normal thyroid tissue. There was no evidence of malignancy. The drain was removed on 3rd and skin stitches on 7th postoperative day. The post operative recovery was good and she is doing well after 8 months of follow-up.

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