thyroglossal duct cyst

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What Is A Thyroglossal Duct Cyst?
Freepik A thyroglossal duct cyst is a
congenital anomaly that forms in the neck. It
results from the incomplete closure of the
thyroglossal duct, a structure that is present
during fetal development. This duct (tube-like
structure) serves as a pathway for the thyroid
gland as it descends from the base of the tongue
to its final position in the neck. Normally, the
thyroglossal duct disappears after birth.
However, in some cases, remnants of the duct
persist and can lead to the formation of a cyst,
typically located near the midline of the
neck. In the rest of this blog article, we will
learn more about thyroglossal duct cysts as we
answer the following questions
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• What are the causes of thyroglossal duct cysts?
• How prevalent is this condition?
• What are the signs and symptoms of a thyroglossal
  duct cyst?
• How is a thyroglossal duct cyst diagnosed and
  differentiated from other neck masses?
• How is a thyroglossal duct cyst treated?
• What is the Sistrunk procedure?
• What are some postoperative care and recovery
  tips for this condition?
• Can thyroglossal duct cysts become cancerous?
• What are common myths about thyroglossal duct
  cysts?
• Causes of Thyroglossal Duct Cysts
• As we have just learned, the primary cause of
  this condition is the incomplete closure which
  leaves behind a small portion of the thyroglossal
  duct, which can later develop into a cyst. While
  thyroglossal duct cysts are typically congenital
  (present at birth) and sporadic (infrequent and
  not directly inherited), there have been rare
  instances
• of familial clustering, suggesting a possible
  genetic factor in some cases. Published in
• the Indian Journal of Surgery in 2017 is an
  article that reports one of such rare cases,
  involving a family with 5 people affected with
  thyroglossal duct cysts. The authors suggest
  that doctors always take into consideration the
  family history of patients with thyroglossal
  duct cysts, as this might help identify other
  family members who may have the same condition.
• Prevalence of Thyroglossal Duct Cysts
• Thyroglossal duct cysts are the most common
  congenital neck masses, representing about 70
  of such anomalies, and they can affect people of
  all ages. However, they are most frequently
  diagnosed in children and young adults, typically
  before the age of 30.
• Estimates suggest that about 7 of the population
  may develop a thyroglossal duct cyst. Unlike
  some congenital conditions such as congenital
  hypothyroidism, thyroglossal duct cysts do not
  show a significant gender predominance.

Signs and Symptoms of a Thyroglossal Duct Cyst
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The most common symptom of a thyroglossal duct
cyst is a small, painless lump in the middle of
the neck. This lump is typically located just
below the chin and may move slightly when the
person swallows or sticks out their
tongue. While the cyst is typically present at
birth, it may not be immediately visible and
often remains asymptomatic for years. However,
it can become noticeable later in life,
particularly when it becomes enlarged due to an
infection. If the cyst does become infected, it
may cause pain, redness, tenderness, and swelling
in the neck. An infected cyst can also lead to
the formation of an abscess, which may rupture
and drain through the skin. Some individuals may
also notice that the size of the cyst increases
or decreases during episodes of upper respiratory
infections. A large cyst can press on
surrounding structures, making it hard to swallow
or breathe. Diagnostic procedures Diagnosing a
thyroglossal duct cyst typically begins with a
physical examination, followed by imaging
procedures and sometimes a biopsy to rule out
other conditions. 1. Physical Examination A
healthcare provider will assess the location,
size, and mobility of the neck lump. Because
thyroglossal duct cysts are characteristically
found in the midline of the neck and move when
swallowing or sticking out the tongue, this helps
distinguish them from other types of neck
masses. Its important to distinguish a
thyroglossal duct cyst from other neck masses,
such as branchial cleft cysts, lymphadenopathy,
or thyroid nodules, because an accurate
diagnosis ensures that the correct treatment
approach is followed.

• Imaging Procedures
• Ultrasound This is the most common imaging
  technique used to evaluate thyroglossal duct
  cysts. An ultrasound can help determine the size
  and internal characteristics of the cyst and
  whether it contains any solid components.
• CT Scan or MRI In some cases, a CT scan or MRI
  may be recommended,
• particularly if the cyst is large or there is
  suspicion of malignancy (cancer). These imaging
  tests provide detailed information about the
  relationship between the cyst and surrounding
  structures in the neck.

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• 3. Fine-Needle Aspiration (FNA) Biopsy
• If there is concern that the cyst could be
  malignant, an FNA biopsy may be performed.
  During this procedure, a small sample of fluid or
  tissue is extracted from the cyst to be analyzed
  under a microscope.
• Treatment options
• The primary treatment for a thyroglossal duct
  cyst is surgical removal, although antibiotics
  may be prescribed for cases where bacterial
  infection is present. Here are the most common
  treatment approaches
• Antibiotic Therapy
• If the cyst becomes infected, a course of
  antibiotics is the first line of treatment. This
  helps manage the infection, reduce inflammation,
  and prevent further complications like abscess
  formation. However, antibiotics alone will not
  eliminate the cyst, as the underlying tissue
  remains intact.
• Drainage of Abscess
• In the case of an infected cyst that has
  progressed to form an abscess, drainage may be
  necessary before surgery. Once the infection has
  subsided, the cyst can then be removed
  surgically to prevent future infections.
• Surgical Removal
• Surgery is the definitive treatment for
  thyroglossal duct cysts. The most common
  procedure is known as the Sistrunk procedure,
  which involves removing the cyst along with a
  portion of the thyroglossal duct and some tissue
  from the hyoid bone (a small horseshoe-shaped
  bone located above the Adams apple). This
  approach, which is capable of reducing the risk
  of recurrence and is considered the gold
  standard, will be explained in more detail in
  the next section.
• What is the Sistrunk procedure?
• The Sistrunk procedure is the most effective and
  widely accepted surgical approach for treating
  thyroglossal duct cysts. Developed by Dr. Walter
  Ellis Sistrunk in 1920, this technique ensures
  the complete removal of both the cyst and the
  surrounding tissue to minimize the chance of
  recurrence.

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• During the procedure
• The surgeon removes the cyst along with a portion
  of the thyroglossal duct, which may extend to
  the hyoid bone in the neck.
• A small section of the hyoid bone, which lies in
  front of the neck, is also removed. This is
  important because the thyroglossal duct is often
  attached to the hyoid bone. Removing part of the
  bone ensures no remnants of the duct are left
• behind.
• Surrounding tissues may also be excised to lower
  the risk of recurrence.
• The Sistrunk procedure has a high success rate,
  and most patients experience complete resolution
  of symptoms after surgery. Recurrence rates are
  very low, particularly when compared to simple
  excision techniques that dont include the
  removal of the hyoid bone.
• Postoperative Care and Recovery
• Recovery from the Sistrunk procedure is generally
  smooth, but post-operative care is essential to
  prevent complications and ensure proper healing.
  Heres what patients can expect after surgery
• Wound Care Proper wound management is absolutely
  necessary. Patients are typically advised to
  keep the surgical area clean and dry. Any signs
  of infection, such as redness, swelling, or
  discharge, should be reported to the healthcare
  provider immediately.
• Pain Management Mild pain, discomfort, or
  stiffness in the neck area is normal
• following surgery. Pain medications may be
  prescribed for the first few days after the
  procedure to alleviate discomfort.
• Follow-up Appointments Patients will need to
  attend follow-up appointments to ensure the
  wound is healing properly and to check for any
  signs of recurrence.
• Monitoring is important in the early weeks
  post-surgery.
• Most patients can return to normal activities
  within one to two weeks after surgery. Full
  recovery typically occurs within a month, though
  strenuous activities should be avoided until the
  doctor gives clearance.

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Can Thyroglossal Duct Cysts Become Cancerous?

• Though thyroglossal duct cysts are generally
  benign, there is a rare but real possibility of
  cancer developing within the cyst. The most
  common type of malignancy associated with
  thyroglossal duct cysts is papillary thyroid
  carcinoma, which arises from thyroid tissue
  present within the cyst.
• Cancerous transformation occurs in less than 1
  of cases, making it an uncommon complication.
  However, when it does happen, it is usually
  diagnosed during or after surgery, either
  through the discovery of suspicious features in
  the cyst or through routine pathological
  examination of the removed tissue.
• Key diagnostic steps if malignancy is suspected
  include
• An FNA biopsy to extract cells from the cyst to
  check for cancer.
• Imaging scans like ultrasound or CT may be
  ordered to assess the structure of the cyst and
  any irregularities.
• Surgical removal of the cyst along with
  surrounding tissues. If the suspected
• cancer is confirmed, further treatment options
  like thyroidectomy or radioactive iodine therapy
  may be considered depending on the spread of the
  cancer.
• Common Myths About Thyroglossal Duct Cysts
• There are several misconceptions surrounding
  thyroglossal duct cysts, often due to how rare
  they are and their association with childhood
  development. Lets debunk a few of these myths
• Myth Thyroglossal duct cysts only occur in
  children
• Fact While most cases are diagnosed in childhood
  or adolescence, adults can
• also develop symptoms or have the condition
  diagnosed for the first time. In some cases, a
  cyst may remain undetected until adulthood,
  especially if it remains small or asymptomatic.

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• Myth The cyst will go away on its own
• Fact Thyroglossal duct cysts do not resolve
  spontaneously. Once they form, they
• typically persist and may enlarge over time.
  Surgical removal is the only definitive
  treatment, especially if the cyst becomes
  infected or causes discomfort.
• Myth Surgery for a thyroglossal duct cyst is a
  risky procedure for children Fact The Sistrunk
  procedure is commonly performed in children and
  is a well-
• established, highly effective surgery with a very
  low risk of complications. Most patients recover
  fully with minimal risk of recurrence.
• Myth Thyroglossal duct cysts always affect
  thyroid function
• Fact Thyroglossal duct cysts are usually
  separate from the thyroid gland and do
• not typically affect thyroid function. Only in
  rare cases where malignancy develops or if the
  thyroid tissue is involved would thyroid function
  be impacted.

Key takeaways

• In most cases, a thyroglossal duct cyst is
  congenital, meaning it is present from birth,
  although symptoms may not emerge until during
  childhood or adulthood.
• Despite the relative frequency of thyroglossal
  duct cysts, familial cases are uncommon, with
  only a few reported worldwide.
• The long-term prognosis for individuals diagnosed
  with a thyroglossal duct cyst is generally very
  positive. Most patients, especially those who
  undergo the Sistrunk procedure, recover fully
  without any long-term complications.
• The Sistrunk procedure, which involves surgical
  removal of the cyst and
• surrounding tissue, is the gold standard for
  treatment, with low recurrence rates and a high
  success rate.
• If left untreated, the cyst can become infected,
  leading to abscess formation, pain, and
  potential airway obstruction in severe cases. In
  very rare instances, cancer may develop.

Disclaimer
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At ThyForLife, we do our utmost to provide
accurate information. For detailed medical
information regarding diagnosis, treatment, and
general practices please consult your healthcare
professional. Always listen to the advice of your
healthcare provider.