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  • • Thyroid develops from an evagination of the floor of the primitive pharynx (during fourth week of gestation)

    • Abnormal movement of the thyroid anlage can lead to a lingual thyroid or appear as a mass anywhere in the neck midline

    • Persistence of the thyroglossal duct leaves an epithelial lined tract that forms a cyst that communicates with the foramen cecum at the base of the tongue

    • Tract of a persistent thyroglossal duct extends through the hyoid bone

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Symptoms and Signs

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  • • Lingual thyroid (dysphagia, dysphonia, dyspnea, hemorrhage, pain)

    • Rounded, cystic mass in the midline of the neck (just below hyoid bone)

    • Cephalad-caudad movement of mass with deglutition and protrusion of tongue

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Imaging Findings

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  • • Lingual thyroid imaged by technetium pertechnetate or radioiodine scintigraphy

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Rule Out

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  • • Dermoid cyst

    • Enlarged lymph nodes (especially Delphian)

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  • • Physical exam

    • Cervical ultrasound

    • Thyroid scintigraphy

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Surgery

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  • • Lingual or ectopic thyroid should be excised

    • Acute thyroglossal tract infections should be treated with heat, antibiotics, and incision and drainage (if indicated)

    • -Complete tract excision (en bloc with middle of hyoid bone—Sistrunk procedure) once inflammation has subsided

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Complications

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  • • Thyroglossal cysts are prone to infection

    • Excision of lingual or ectopic thyroid can lead to permanent hypothyroidism

    • Carcinoma develops more frequently in ectopic thyroid tissue than normal thyroid tissue

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Prognosis

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  • • Recurrence of thyroglossal cyst is 6-9% and is more common following infection

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References

De Felice M, Di Lauro R: Thyroid development and its disorders: genetics and molecular mechanisms. Endocr Rev 2004;25:722.

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