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Dr. P. Jyoti
Dr. P. Jyoti, Consultant MD
Category: Medical
Satisfied Customers: 9126
Experience:  17 yrs experience in treating OPD & Emergency patients.
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Dear Sirs, I need an answer from a child endocrinologist with

Resolved Question:

Dear Sirs,
I need an answer from a child endocrinologist with experience in Ectopic Thyroid.
My grand daughter of for and a half years (born on September 28th, 2009) has Ectopic Thyroid, situated at the bottom of her tongue (now visible from the mouth), not detectable by ultra-sound but confirmed by a (nuclear/radiology - not sure what you all it) thyroid scan.
This was just discovered after a recent inflammation of the throat and her TSH value shot up from 7 to 17.
We were advised to start a 25 mg thyroxine treatment, but the problem is that the little girl seems to have difficulty in swallowing and continuously coughs to clear her throat.
What should be done about it, what could be the short/long term consequences and whether an operation is necessary and how safe is such an operation.
Thank you in anticipation of your reply,
Regards,
Phivos Kyriakides
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. P. Jyoti replied 3 years ago.

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I am not a pediatric endocrinologist but have a lot of experience in ectopic thyroid because it is in my line of specialty as an ENT surgeon

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Expert:  Dr. P. Jyoti replied 3 years ago.
Hello Phivos,

There are two problems here.

One is that she is having hypothyroidism, ie,low thyroid hormone, and secondly is the physical presence of the ectopic thyroid.

For her hypothyroidism she will need thyroxine.

The constant coughing and clearing of throat shows that her ectopic thyroid is causing her problems. In this situation it is best to remove this. The gland will get bigger as she approaches puberty and it will cause a lot of problems. It is best to get this removed when her doctors advise for the surgery.

You have not mentioned whether she has otherwise normal thyroid gland. Sometimes there will be pieces of ectopic thyroid in the neck upto the base of the tongue while the main thyroid gland will be there in the normal anatomical position. SOmetimes though the whole of the gland can be in an ectopic position.

If she has the normal gland also then there is no problem in removing the ectopic. But if she does not have a normal gland then she will need thyroxine for her entire life. This is not such a problem, she will just need to take a tablet everyday.

But since the ectopic gland is causing her problems it is best to remove it. THe operation is quite safe and will not cause her much problems.


Hope this shows you the way forward - wish you good health and a quick recovery.

I trust my answer has helped you gain more knowledge and confidence about your problem and in knowing what to discuss with your doctor.

Please remember to rate my service once you have all the information you need. If you have any other questions, please ask me – I’ll be happy to respond. Bonus is always welcome - Thank you!

Dr.P.Jyoti, MD.
Customer: replied 3 years ago.
Thank you for your reply. The thyroid scan indicated that the entire thyroid gland is located at the base of the tongue. She has not had any problems until earlier this year (January 2014) when she had some sort of infection and fever. This must have caused thyroid to enlarge and was given antibiotics. Her TSH Level was borderline hypo and in a matter of 2 weeks shot up to 17 (hypothyroid). Can this be merely due to infection? Previously the thyroid was not visible from her mouth.
Can thyroxine reduce to size of the gland to pose no problems? This avoid removal of the gland? Or perhaps can the thyroid reduce its size on its own? In case of removal, can this wait until she is older? Thank u
Expert:  Dr. P. Jyoti replied 3 years ago.
Hello Phivos,

Yes infection can cause thyroid function to detoriate.

But in any case, lingual thyroids are generally not sufficient to meet the requirements of the body and hence ectopic thyroid patients usually have hypothyroidism.

Thyroxine may be able to reduce the size on its own. But this depends, only time will tell whether it will reduce sufficiently or not.

Whether surgery will be needed or not will depend on her symptoms. If she is asymptomatic then there is no need for surgery. But if she continues to have symptoms then surgery would be needed.

Removal can wait till she is older, it is not an emergency. But again this depends on her symptoms.

Another safe way to get rid of this tissue is Radioiodine ablation. Discuss this with your endocrinologist.

Hope this shows you the way forward - wish you good health and a quick recovery.

I trust my answer has helped you gain more knowledge and confidence about your problem and in knowing what to discuss with your doctor.

Please remember to rate my service once you have all the information you need. If you have any other questions, please ask me – I’ll be happy to respond. Bonus is always welcome - Thank you!

Dr.P.Jyoti, MD.
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