Coblation assisted excision of lingual thyroid

Advances in Lingual Thyroid Management Using Coblation Technology: A Case Series Study

Lingual thyroid is a rare, abnormal ectopic thyroid tissue seen at the base of the tongue. It is a rare embryological anomaly caused by the failure of the descendence of the thyroid gland from the foramen caecum to its normal prelaryngeal area. The main aim of our study is to discuss recent advancements in the management of lingual thyroid using coblation technology. We are discussing the prospective study of 12 lingual thyroid cases that came to the government ENT hospital, Koti, in Hyderabad, from July 2016 to July 2023. All patients were assessed by a detailed history, blood investigations, fine needle aspiration cytology, radiological investigations, technetium-99 scintigraphy, and an endocrinologist opinion. In our study, all cases were hypothyroid and showed difficulty in swallowing and a few cases showed bleeding from the mouth, and difficulty in breathing, hence all 12 cases underwent coblation-assisted excision of swelling and with lifelong thyroxine supplementation. For all 12 cases, demographic, clinicopathological data and radiological data were recorded. Treatment depends on the age of the patient, the severity of symptoms, precipitating factors like puberty or pregnancy, or any other comorbidities with the disease. In our study, all cases were symptomatic and hypothyroid status, hence all 12 cases underwent coblation-assisted excision of swelling and lifelong thyroxine supplementation. All cases were followed up for 2 years with good recovery, minimal patient discomfort after surgery, and lifelong levothyroxine supplementation. Lingual thyroids have a female preponderance. In our study, all were female. Thyroid scintigraphy plays an important role in diagnosis, along with ultrasonography. In all symptomatic cases, surgery with Coblation-assisted excision of swelling is the treatment of choice, with good recovery, minimal patient discomfort after surgery and with lifelong levothyroxine supplementation.

Management of Lingual Thyroid with Second Thyroid Anomaly: An Institutional Experience

Patients diagnosed with Lingual thyroid (LT) may have second thyroid anomaly (STA).Given rarity of dual ectopics/anomalies, standardized management recommendations are lacking. We aimed to describe our experience in management of LT with STA and suggest a management algorithm. We conducted a retrospectivechart review of patients diagnosed with LT between Jul-2013 and Dec-2019. Data regarding demographics, clinical presentation, endocrine-profile, associated STA treatment received, and outcomes were collected and analyzed. Eight patients (female-7 cases, male-1 case, adult-4 cases, children-4 cases, mean age-18.1 years, range 6-43 years) with LT were identified. Four(50%) cases had STA in addition to LT (thyroglossal cyst in two-cases, sublingual thyroid in one-case and sub-mental thyroid in one-case) and presented as neck mass. Diagnosis was confirmed with flexible-nasopharyngoscopy,ultrasonography,thyroid-scintigraphy and computed-tomography. Ectopic thyroid(s) was/were only functional thyroid gland with absence of normal thyroid in all cases. Two- cases had symptomatic for LT and were managed by coblation assisted excision of LT in one and I131 ablation in one-case.All adult patients were hypothyroidand received thyroxin.All pediatric cases were euthyroidand received no surgical intervention for LT.Three patients required surgery for STA; Sistrunk surgery in two and excision of submental thyroid in one. All cases were asymptomatic. These results were utilized to suggest a management algorithm for LT with STA. LT patients with STA are more symptomatic and required more surgical interventions in compare to isolated LT. When appropriate, excision of STA with/without intervention for LT and thyroxin is advocated as the treatment modality of choice in LT patients with STA.

Is Transoral Robotic Surgery the Best Surgical Treatment for Lingual Thyroid?: A Case-Report and Literature Review

OBJECTIVES

To highlight the specific outcomes of the current surgical procedures for lingual thyroid excision, for benign and malignant lesions.

METHODS

We carried out a systematic review of surgical treatments of lingual thyroid, according to the PRISMA method. We conducted our literature search in PubMed and Ovid. Data was collected concerning patient demographics, tumor characteristics, types of surgery performed, and specific intra- and postoperative outcomes of each procedure. Surgical procedures were classified in 4 categories: transcervical approaches, "invasive" transoral approaches (transmandibular and/or tongue splitting), "non-invasive" transoral approaches, and transoral robotic surgery. We detailed the transoral robotic surgical technique through a case report, along with a surgical video.

RESULTS

Of 373 peer-reviewed articles found, 40 provided adequate information on surgical management and outcomes for patients with lingual thyroid. "Non-invasive" transoral approaches and transoral robotic surgeries required significantly fewer tracheostomies than "invasive" transoral and transcervical approaches (P < .001), while there was no statistical difference in the rate of surgical complications between each procedure.

CONCLUSIONS

Transoral robotic surgery appears to be a feasible, effective, and fast solution for lingual thyroid excision, with excellent short- and long-term surgical outcomes.

Lingual Thyroid Excision with Transoral Robotic Surgery

Ectopic thyroid gland may be detected at any place between foramen caecaum and normal thyroid localization due to inadequacy of the embryological migration of the thyroid gland. It has a prevalence varying between 1/10.000 and 1/100000 in the community. Usually follow-up without treatment is preferred except for obstructive symptoms, bleeding, and suspicion of malignity. Main symptoms are dysphagia, dysphonia, bleeding, dyspnea, and obstructive sleep apnea. In symptomatic cases, the first described method in surgical treatment is open approach since it is a region difficult to have access to. However, this approach has an increased risk of morbidity and postoperative complications. Transoral robotic surgery, which is a minimally invasive surgical procedure, has advantages such as larger three-dimensional point of view and ease of manipulation due to robotic instruments. In this report, a case at the age of 49 who presented to our clinic with obstructive symptoms increasing within the last year and was found to have lingual thyroid and underwent excision of ectopic thyroid tissue by da Vinci surgical system is presented.

Ectopic lingual thyroid

Ectopy of the thyroid gland is an abnormal embryological development. Its occurrence in children is rare. In this study, we report the case of a 12-year-old girl that presented with dysphagia and nocturnal dyspnea. Magnetic resonance imaging confirmed the presence of a lingual thyroid. Thyroid scintigraphy showed intense and elective uptake of radiotracer at the base of the tongue. Hormonal tests revealed hypothyroidism. Treatment consisted of opotherapy based on levothyroxine. Evolution has been favourable and the patient showed significant improvement with reduction of the dyspnea and the dysphagia and normalization of thyroid hormone tests.