A 22-year-old woman presents with a firm midline base-of-tongue mass causing dysphagia and a foreign body sensation. Biopsy shows benign thyroid follicles. Total body scan shows no other functioning thyroid tissue and she is euthyroid on a small dose of levothyroxine. What is the correct statement about management?
- A Excise the mass completely to exclude malignancy in all cases
- B It should be removed only if symptomatic, and excision requires lifelong levothyroxine replacement ✓
- C Radioactive iodine ablation is the first-line treatment for all lingual thyroid tissue
- D Suppression doses of levothyroxine will reliably shrink it and avoid any intervention
Correct answer: B. It should be removed only if symptomatic, and excision requires lifelong levothyroxine replacement
Explanation
Lingual thyroid is the commonest ectopic thyroid location and may be the ONLY functioning thyroid tissue in up to 70 percent of cases, so complete excision commits the patient to lifelong levothyroxine. Asymptomatic lesions are observed; symptomatic ones are treated with suppression, radioactive iodine, or excision depending on size and response. Routine excision of every lesion is wrong precisely because of the risk of removing the patient's sole thyroid tissue, which kills option A.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.