Thyroglossal Cyst

• • 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

Symptoms and Signs

• • 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

Imaging Findings

• • Lingual thyroid imaged by technetium pertechnetate or radioiodine scintigraphy

Rule Out

• • Dermoid cyst

  • Enlarged lymph nodes (especially Delphian)

• • Physical exam

  • Cervical ultrasound

  • Thyroid scintigraphy

Surgery

• • 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

Complications

• • 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

Prognosis

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

References