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Pediatric upper airway obstruction due to ectopic thyroid: classification and case reports
1Department of Otolaryngology, Children's Hospital of Michigan, Detroit 48201.
Insights
Ectopic thyroid tissue, though uncommon, can cause pediatric upper airway obstruction. This review covers four types, including the first reported pediatric intratracheal thyroid case, highlighting diagnostic and anatomical considerations.
Area of Science:
- Pediatric Otolaryngology
- Endocrinology
- Developmental Anatomy
Background:
- Pediatric upper airway obstruction (UAO) is a critical clinical challenge.
- Common causes of UAO are well-documented, but rare etiologies require further recognition.
- Ectopic thyroid tissue presents an unusual cause of UAO.
Observation:
- Two cases of pediatric ectopic thyroid causing airway obstruction are presented.
- One case represents the first reported instance of pediatric intratracheal thyroid.
- The spectrum of ectopic thyroid presentation and its airway impact are illustrated.
Findings:
- Ectopic thyroid can manifest as lingual, sublingual, thyroglossal, or intralaryngotracheal.
- Intralaryngotracheal thyroid development theories are discussed.
- Ectopic thyroid's variable relationship to the airway can lead to diverse obstruction patterns.
Implications:
- Increased awareness of ectopic thyroid as a cause of pediatric UAO is crucial for timely diagnosis.
- Understanding the developmental anatomy aids in explaining ectopic thyroid formation.
- This review provides a comprehensive resource for clinicians managing pediatric airway emergencies.
Abstract:
Few clinical situations can be as frightening, challenging, and as rewarding as stabilizing the airway of a child. Most causes of pediatric upper airway obstruction are well recognized, often discussed in the literature, and commonly encountered in practice. However, ectopic thyroid (i.e., thyroid tissue found in places other than its normal location) may be an unusual cause of pediatric upper airway obstruction with which the clinician may not be familiar. The resulting airway obstruction may be slow or rapid in onset, total or partial, and the relationship of the thyroid to the airway may be clear or obscure. Two cases of obstructing ectopic thyroid are presented which demonstrate the spectrum within which this form of airway obstruction may occur. One case is the first reported example in the English literature of pediatric intratracheal thyroid. A review of the literature is also presented. Four types of ectopic thyroid (lingual, sublingual, thyroglossal, and intralaryngotracheal) are illustrated and discussed in relation to their effect upon the pediatric upper airway. The authors also review the developmental anatomy of the thyroid and present two major theories regarding the development of intralaryngotracheal thyroid. The possible etiologies of the other ectopic forms are also discussed.