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

Abstract

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.

Keywords: Coblation; Levothyroxine; Lingual thyroid; Technetium-99 scintigraphy.

Fig. 1

shows a lingual thyroid swelling on the tongue

Fig. 2

Ultrasonography shows the absence of the thyroid gland in the neck

Fig. 3

a–d shows thyroid scintigraphy fused with SPECT-CT (single photon emission computed tomography) image

Fig. 4

shows coblation-assisted excision of lingual thyroid swelling using a coblation wand

Fig. 5

shows the histopathological examination of the specimen at a 4× magnification b 10× magnification c 40× magnification using hematoxylin and eosin stain