The clinical features of thyroglossal duct remnant cysts (TGDC) have been well described, however the histopathologic aspects of these lesions have not been addressed in a detailed manner. In particular, there has been no large community practice based series evaluating TGDC histologically compared with management outcomes. A retrospective review of all TGDC diagnosed between 2005 and 2015 was performed. Six hundred eighty-five patients were identified (344 males; 341 females). Age at presentation was bimodal (first and fifth decades) and ranged from 0.8 to 87years (mean 31.3years). Males predominate in children (150:111); females in adults (230:194). Patients presented most frequently with a mobile midline neck mass in an infrahyoid location. An associated skin fistula (n=67) was twice as common in pediatric as adult patients. The average cyst size was 2.4cm (range 0.4-9.9cm) by imaging studies and 2.6cm (range 0.2-8.5cm) by pathologic examination; pediatric patients had smaller cysts (mean2.1cm) than adults (mean2.8cm). Histologically, 257 (38%) TGDC were lined by respiratory epitheliumalone, 68 (10%) squamous epithelium alone, 347 (51%) exhibited both respiratory and squamous epithelium, and 13 (1%) had no identifiable epithelial lining. Four hundred eighty-four (71%) TGDC had associated thyroid gland tissue present within the cyst wall (n=282), skeletal muscle (n=71), adipose tissue (n=34), or a combination of these sites (n=97). The hyoid bone was identified in 647 (grossly and/or histologically), and absent in 38. Surgical management consisted of Sistrunk procedure (n=647), cystectomy (n=31), or thyroidectomy/thyroid lobectomy (n=7). Treatment related complications were observed in 6 patients, which included vocal cord damage, seroma, and hematoma. Recurrences developed in 20 (3%) patients, 14 of whom were managed initially by cystectomy. Papillary thyroid carcinoma was identified in 22 (3.2%) TGDC. In summary,TGDC show a bimodal peak in the 1st and 5th decades, commonly presenting as a midline cervical lesion below the hyoid bone, associated with a skin fistula in 10%. Histologically TGDC are most commonly lined by a combination of respiratory and squamous epithelium. Thyroid gland tissue is identified in 71% of cases (0.45cm mean size), although not limited to the cyst wall, but present in the surrounding soft tissues. Rare TGDC may harbor malignancy (3.2%). TGDC are most effectively managed by Sistrunk procedure rather than excision, which carries low rates of complications(1%) and recurrence(3%).