<prompt> A 6-yrs-old child complains of difficulty in swallowing and on examination there is a sublingual swelling, which is suspected to be Lingual thyroid. The 1st step in management of this child would be:Tracheostomy and airway maintenanceThyroid scanIntubationExplain to childs parents that he may require immediate surgery  <response>: Lingual Thyroid It represents failure of median thyroid tissue to descend normally. Presentation Asymptomatic Choking, dysphagia Airway obstruction, hemorrhage Hypothyroidism occasionally Investigation. Thyroid scan- always performed before radioablative therapy or surgery as it may be the only thyroid tissue present. Treatment Replacement thyroxine - decrease the size Radioactive iodine - decrease the size Surgery- excision rarely required. 