Condition Overview
Thyroglossal duct cyst (TGDC) is a congenital anomaly that arises from remnants of the thyroglossal duct, a temporary structure present during the early development of the thyroid gland. Normally, this duct disappears once the thyroid gland reaches its final position in the neck, but in some cases, remnants persist and form a cyst. TGDCs are the most common congenital neck cysts, typically presenting in children or young adults.
A TGDC usually manifests as a midline neck mass that moves upward when the tongue is protruded or during swallowing. This movement is a key clinical sign differentiating TGDC from other neck masses. The cyst can vary in size and may become infected, causing redness, swelling, pain, and sometimes draining pus. Infected TGDCs may require immediate medical attention. The structure can also have solid components (residual thyroid tissue), which can develop thyroid cancer as with any other thyroid tissue. When present, fine needle aspiration (FNA) should be considered. Finally, while it is rare, a thyroglossal duct cyst may be the only thyroid tissue that a patient has. Patients should be warned about this before any treatment is considered.
Diagnosis of TGDC is often clinical, supported by imaging studies such as ultrasound, CT scan, or MRI to confirm the cyst's location and exclude other pathologies. FNA may be needed as well, as above.
Treatment Options
- Sistrunk Procedure (Excision of TGDC)
- Description: The Sistrunk procedure is the standard treatment for TGDC. It involves the surgical removal of the cyst along with a portion of the hyoid bone and a tract of tissue to reduce the risk of recurrence. This comprehensive approach addresses potential remnants of the thyroglossal duct and is usually definitive. It is rare for an experienced surgeon to offer anything othe than a Sistrunk procedure for this condition.
- Indications: Confirmed TGDC, recurrent infections, cosmetic concerns, suspicion of malignancy.
- Radiofrequency Ablation (RFA)
- Description: While not a common treatment for TGDC, RFA may be considered in select cases where surgery is not feasible or as an adjunct treatment for recurrent cysts with a solid component. RFA uses heat generated by radiofrequency energy to reduce the cyst size.
- Indications: Patients unsuitable for surgery, palliative treatment.
- Thyroid Lobectomy or Total Thyroidectomy
- Description: This surgical procedure involves the removal of one or both lobes of the thyroid gland. It is not typically indicated for TGDC but may be considered if there is concurrent thyroid pathology that warrants surgical intervention, or if a patient is thought to need radioactive iodine after a procedure.
- Indications: Coexisting thyroid nodules or tumors, suspicion of malignancy in the thyroid.
- Transoral or Scarless Excision of a Thyroglossal Duct Cyst (Scarless Sistrunk)
- Description: As with any thyroid surgery, a normal Sistrunk procedure leaves a scar. The Russell Center is one of very few centers in the entire world to offer excision of a TGDC with no visible scar by using the "scarless" transoral technique. Dr Russell has been offering this procedure for nearly a decade. It is quite challenging for most surgeons to master. This procedure can also be done on children (pediatric patients) when needed.
- Indications: TGDC and a desire to minimize the visible scar
Management of TGDC requires a thorough evaluation by a multidisciplinary team and may include pediatricians, surgeons, and radiologists to ensure accurate diagnosis and effective treatment. Early intervention, particularly with the Sistrunk procedure, is essential to prevent complications and recurrence. Having an experienced team such as that at the Russell Center ensures that you will have access to the widest range of options for your thyroglossal duct cyst.
