Lingual thyroid as an anesthetic challenge

Lingual thyroid (LT) gland is a rare clinical entity which occurs due to failure of thyroid gland to descend to its normal cervical location during embryogenesis. Maternal antithyroid immunoglobulins may impair gland descent during early fetal life and cause lingual thyroid. This condition is associated with increase in levels of thyroid stimulating harmone (TSH). As the ectopic thyroid grows, requirement of thyroid harmone increases thus many patients with ectopic thyroid are associated with hypothyroid and require treatment. Ectopic thyroid gland is located at base of tongue and can present with dysphagia, dysphonia, upper airway obstruction and hemorrhage. Oropharyngeal mass can lead to difficult intubation and failure of ventilation. Evaluation of airway and indirect laryngoscopy may hint towards need of fiberoptic intubation. We present a case of 11 years old child of LT for appendectomy under general anesthesia. Key words: Lingual thyroid; Congenital Abnormalities; Thyroid Dysgenesis; Airway Management; Intubation; Difficult airway; Appendecetomy; Ectopic thyroid; Levothyroxin sodium