Thyroid & Adrenal
A 6 year old child complains of difficulty in swallowing and on examination there is a sublingual swelling, which is suspected to be Lingual thyroid. The 1st step in the management of this child would be:
|A||Tracheostomy and airway maintenance|
|D||Explain to child that he may require immediate surgery|
a. When the median thyroid anlage does not descend in normal fashion, a lingual thyroid can result.
b. In most of these cases this may be the only thyroid tissue that remains.
c. Enlargement of a lingual thyroid can cause airway obstruction, dysphagia, or bleeding.
d. Most lingual thyroid glands can be suppressed with thyroid hormone administration.
e. In particularly resistant lingual thyroids, radioactive iodine treatment may represent another alternative.
f. Technetium pertechnetate (99mTc) is taken up rapidly by the normal activity of follicular cells. It is trapped by follicular cells, but not organified.
g. 99mTc has a short half-life and low radiation dose. Its rapid absorption allows quick evaluation of increased uptake (so-called hot) or hypofunctioning (so-called cold) areas of the thyroid.
h. Because screening with 99mTc shows uptake in the salivary glands and major vascular structures, interpretation of thyroid pathology requires a higher level of expertise.
i. 123I and 131I iodine scintigraphy is also used to evaluate the functional status of the gland . Both are trapped by active follicular cells and organified. 123I has a shorter half-life (12-13 hours) and allows a quicker image.
j. Advantages of scanning with 123I include a low dose of radiation (30 mrad) and short half-life. 123I is a good choice for evaluating suspected lingual thyroids or substernal goiters.