Thyroglossal Duct Research Articles

Thyroglossal cyst – A retrospective analysis in a tertiary care center

Background: Thyroglossal duct cyst (TGDC), one of the most common congenital neck lesions, is due to the persistence and dilatation of remnants of an epithelial tract, formed during migration of the thyroid in embryogenesis. Aims and Objectives: The objective was to study the location of TGDC in different age and sex groups and variations in presentation. Materials and Methods: A retrospective study was carried out in the Department of ENT at Assam Medical College and Hospital, Dibrugarh from July 2018 to June 2023. The diagnosis was made on the basis of fine-needle aspiration cytology and ultrasonography. Results: A total of 25 cases were analyzed. Majority of them belonged to the age group of 11–20 years. Male: female ratio was 2:3. Nearly 100% of cases had a chief complaint of midline neck swelling that moves with protrusion of the tongue. Most common site of occurrence is the infrahyoid region. Nearly 80% of cases underwent Sistrunk operation. Conclusion: Thyroglossal cyst with its varied presentation is notorious for recurrence. Proper evaluation and excision are the keys toward successful outcomes.

Midline Branchial Cleft Cyst Initially Misdiagnosed as a Thyroglossal Duct Cyst: A Rare Case Study and Literature Review

Midline Branchial Cleft Cyst Initially Misdiagnosed as a Thyroglossal Duct Cyst: A Rare Case Study and Literature Review

Thyroid Cancer in Thyroglossal Duct Remnants: Case Series and Extensive Review of the Literature

Thyroid Cancer in Thyroglossal Duct Remnants: Case Series and Extensive Review of the Literature

What is the annual risk of infection in congenital midline neck cysts in children? Thyroglossal duct cysts versus dermoid cysts

IntroductionMidline neck lumps in children are mostly found to be thyroglossal duct cysts or dermoid cysts. Thyroglossal duct cysts often have an associated sinus tract which may connect all the way to the foramen caecum on the tongue, while dermoids have no such connection. This study aims to estimate the annual infection risk for midline neck cysts based on our patient series, and to see if this differs between thyroglossal duct cysts and dermoid cysts. MethodsAll children seen at the Royal Hospital for Children, Glasgow who underwent surgical excision of a midline neck cyst between 1st January 2017 and 31st December 2021 were identified. In those whose cyst had been infected prior to surgical excision, the age at which the first episode of infection occurred was recorded and used to calculate a survival curve. ResultsWe identified 53 children (29 male, 24 female) aged 1–16 years (median 4) at the time of surgical excision. There were 26 thyroglossal and 24 dermoid cysts, plus 2 with indeterminate histology and 1 lymph node. Of the 24 dermoids, 4 suffered infection prior to surgery (17%), and 2 of these recurred after surgery (8%). Of the 26 thyroglossal cysts, 16 suffered infection prior to surgery (62%) and 5 of these recurred (19%). 78% of thyroglossal and dermoid cysts had at least 1 episode of infection by age 10 years. DiscussionIn a child with a congenital midline neck cyst that has never been infected, deferring surgery for a year comes with a 7.8% risk that the cyst will get infected.

A Case Report Highlighting Uncommon Histopathological Finding of Papillary Thyroid Cancer within a Thyroglossal Duct Cyst

This study discusses a case involving a 30-year-old male presented in ENT OPD with complaints of painless swelling in front of his neck. Papillary thyroid carcinoma originating from a thyroglossal duct cyst is an infrequent and atypical form of cancer. Typically, it remains undetected until surgical intervention and the optimal approach to its management is a subject of ongoing debate. Here, we present the case of a 30-year-old male who initially presented with a thyroglossal duct cyst but was subsequently diagnosed with papillary thyroid carcinoma. This case report focuses on suspecting having a Thyroglossal duct cyst, presented with painless swelling in front of the neck at the level of the hyoid bone. The mass moved when the tongue protruded but did not move when the patient swallowed. It exhibited a soft consistency during palpation, was not tender, movable, non-compressible, non-reducible, lacked fluctuation, and did not expand on the valsula while showing no changes in overlying skin temperature. TGD carcinoma can sometimes go undetected because it is a rare condition. When dealing with rapidly expanding neck masses in the midline, it's essential to conduct appropriate examinations, including neck imaging and fine-needle aspiration cytology. While the Sistrunk procedure is adequate for squamous carcinoma, differentiated thyroid carcinoma typically necessitates total thyroidectomy as the recommended course of action.

Indocyanine Green (ICG) Fluorescence-Assisted Open Surgery Using the Rubina® Lens System in the Pediatric Population: A Single-Center Prospective Case Series.

There are scarce papers about the use of fluorescence-guided surgery (FGS) in the open surgical field. This study aimed to assess the usefulness of FGS in an open setting in the pediatric population and to report our preliminary experience using the Rubina® Lens system. All patients undergoing ICG fluorescence-assisted open surgery over the period September 2022-September 2023 were enrolled. Each surgical procedure was performed using the Rubina® Lens for ICG fluorescence visualization. A total of 25 patients, 14 boys and 11 girls with a median age at surgery of 5.8 years-old (range 0-15), were enrolled. Surgical indications were dermoid/epidermoid cysts of the head (n = 7), lymphangiomas of the head/neck (n = 2), thyroglossal duct cysts (n = 7), gynecomastia (n = 3), preauricular fistula (n = 2), second branchial cleft fistula (n = 1), fibrolipoma of the shoulder (n = 1) and myofibroma of the gluteal/perineal region (n = 2). In all procedures, an intralesional injection of 2.5 mg/mL ICG solution using a 30-gauge needle was administered. No adverse reactions to ICG occurred. Median operative time was 68.6 min (range 35-189). The visualization of ICG-NIRF with the Rubina® Lens was achieved in all cases. No intraoperative complications were reported. Postoperative complications occurred in 3/25 patients (12%), with gynecomastia (n = 1), thyroglossal duct cyst (n = 1) and neck lymphangioma (n = 1), who developed a fluid collection in the surgical site, requiring needle aspiration in outpatient care (Clavien-Dindo 2). Complete mass excision was confirmed with pathology reports. Based on this initial experience, FGS using the Rubina® Lens was very helpful in open surgery, providing enhanced visualization of anatomy and identification of margins, real-time reliability and low complication rate. It was easy to use, time saving, feasible and clinically safe. Previous experience in MIS is necessary to adopt this technology. The accuracy of the injection phase is important to avoid diffusion of the ICG into the perilesional tissue.

Management of Thyroglossal Duct Cysts in Children: Retrospective Analysis of a Series of 32 Patients

Background: Thyroglossal duct cysts (TGDC) are one of the most common congenital anomalies found in the anterior neck region of children. Sistrunk’s procedure, described in 1920, is still considered the gold standard. Cyst recurrence is the most feared complication. Our study aims to describe the epidemiological, clinical, and therapeutic features of our patients, as well as reviewing the literature to identify factors that may explain the occurrence of complications and recurrences. Methods: The data of 32 patients aged 0 to 16 years who underwent TGDC surgery at Rabat's University Children's Hospital Infant Surgery Department "A", between 2015 and 2020 were retrospectively analyzed. We focused on aspects of clinical presentation, intra- and postoperative treatment, and long-term follow-up. Results: This study included 32 cases, out of which five (15,6%) had in their history postoperative recurrences of TGDC (without excising the central part of the hyoid bone), 09 patients had per-operative symptoms of infection, and 4 out of them had intraoperative cyst rupture. Only one out of these four patients had recurrence (3.1%); the only significant risk factor of TGDC recurrence was the non-adherence to the Sistrunk technique. Conclusion: TGDC is the most common neck anomaly in children. This condition can be managed successfully without complications and with a low recurrence rate. Preoperative infection and cyst rupture did not influence the recurrence rates.

Thyroglossal duct cyst papillary carcinoma with lymphatic infiltration: A case report

Thyroglossal duct cyst papillary carcinoma with lymphatic infiltration: A case report

Cytodiagnosis of a Thyroglossal Duct Cyst in a Tertiary Facility: A Case Report of a 27-Year-Old Female

Cytodiagnosis of a Thyroglossal Duct Cyst in a Tertiary Facility: A Case Report of a 27-Year-Old Female

Papillary Thyroid Cancer in Thyroglossal Duct Cysts: A Pictorial Review and Case Series.

Thyroglossal duct cyst is the most common congenital neck mass, but the incidence of malignancy within a thyroglossal duct cyst is rare, estimated at 1%. Most cancers arising within thyroglossal duct cysts are incidentally detected after surgical excision. We present the preoperative radiologic findings of 8 patients with papillary thyroid cancer arising within a thyroglossal duct cyst, as evaluated on ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography scan.

Role of imaging in the management of thyroglossal duct cyst carcinomas (TGC-TIRADS): a single centre retrospective study over 16 years

Role of imaging in the management of thyroglossal duct cyst carcinomas (TGC-TIRADS): a single centre retrospective study over 16 years

Risk-adjusted analysis of perioperative outcomes after the Sistrunk procedure.

Thyroglossal duct cyst (TGDC) is the most common pediatric congenital neck mass. The Sistrunk procedure is the standard method of excision and is associated with low rates of recurrence. This study aimed to review our institution's outcomes following the Sistrunk procedure, specifically the rates of wound complications and cyst recurrence. This was a retrospective case series of pediatric patients undergoing the Sistrunk procedure from June 2009 to April 2021. A total of 273 patients were included. Of these, 139 (53%) patients were male and 181 (66%) were white. The average age at the time of surgery was 7.1 years. The overall cyst recurrence rate was 11%. The most common wound complications were seroma (14%) and surgical site infections (SSIs) (12%). Wound complications were associated with prior history of cyst infection (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.07-3.60, z-test 2.2, p = .03). Pediatric surgery was associated with fewer wound complications (OR 0.18; 95% CI 0.05-0.6, z-test -2.78, p = .005). However, pediatric surgery operated on fewer patients with a history of cyst infection (36% vs. 55%, p = .012). Drain placement and postoperative antibiotics did not affect rates of wound complications. Prior cyst infection is associated with increased rates of postoperative wound complications. Postoperative antibiotics and drain placement did not significantly affect complication rates. 4.

Papillary thyroid carcinoma in thyroglossal duct cyst: a review article

Papillary thyroid carcinoma in thyroglossal duct cyst: a review article

Papillary thyroid cancer occuring in thyroglossal duct cyst- a rare presentation

Papillary thyroid cancer occuring in thyroglossal duct cyst- a rare presentation

Sistrunk technique as a surgical approach in thyroglossal duct cyst of His or Bockdalek

Thyroglossal duct cyst is one of the most common lesions in the midline of the neck and is found in around 7% of the population. It occurs equally in both genders and is detected in the first five years in 25 to 35%, between six to 10 years in 40 to 50% and in adolescence between 75 and 90% of cases and in some cases it preserves tissue. functional thyroid and in 0.17 to 1% it is the absolute ectopic thyroid. The diagnosis is fundamentally clinical, although an ultrasound may be useful. A thyroid scintigraphy is recommended not for a positive diagnosis of a thyroglossal duct cyst, but to demonstrate the existence of a normal thyroid gland and rule out the rare thyroid ectopias, whose inadvertent removal would cause permanent hypothyroidism. Diagnostic errors are the most frequent cause of inadequate surgical technique, which produces a high recurrence rate. Since its introduction in 1920, sistrunk surgery is the ideal treatment with the best results, with recurrence limits of 0.5 to 3%, this technique considerably reduces the risk of cyst recurrence to <3%, and one of the key points for the success of the surgery is the need to resect the medial third of the hyoid bone by approximately 1.5 cm. We present the case of a female patient who underwent resection of a thyroglossal cyst with the sistrunk technique to confirm the effectiveness of the technique in reducing the percentage of recurrences.

Simultaneous thyroglossal duct cyst with parathyroid cyst: A case report

Time series analysis is a valuable tool in epidemiology that complements the classical epidemiological models in two different ways: Prediction and forecast. Prediction is related to explaining past and current data based on various internal and external influences that may or may not have a causative role. Forecasting is an exploration of the possible future values based on the predictive ability of the model and hypothesized future values of the external and/or internal influences. The time series analysis approach has the advantage of being easier to use (in the cases of more straightforward and linear models such as Auto-Regressive Integrated Moving Average). Still, it is limited in forecasting time, unlike the classical models such as Susceptible-Exposed-Infectious-Removed. Its applicability in forecasting comes from its better accuracy for short-term prediction. In its basic form, it does not assume much theoretical knowledge of the mechanisms of spreading and mutating pathogens or the reaction of people and regulatory structures (governments, companies, etc. ). Instead, it estimates from the data directly. Its predictive ability allows testing hypotheses for different factors that positively or negatively contribute to the pandemic spread; be it school closures, emerging variants, etc. It can be used in mortality or hospital risk estimation from new cases, seroprevalence studies, assessing properties of emerging variants, and estimating excess mortality and its relationship with a pandemic.

SAT542 TDC or Not TDC: Isolated Ectopic Papillary Carcinoma in the Midline Neck with a Benign Native Thyroid

Abstract Disclosure: M. Fasen: None. L. Kosmiski: None. Background: Thyroglossal duct carcinoma is a rare entity, occurring in about 1% of all thyroglossal duct cysts (TDC). Several cases have reported PTC within a thyroglossal duct cyst. Initially thought to be a TDC, we present an unusual case of a midline ectopic papillary thyroid carcinoma with absence of features characteristic of a TDC in the context of benign native thyroid tissue. Clinical Case: A 19 year old female presents to the clinic with a progressively growing midline neck mass over the past five years associated with mild dysphagia. Physical exam was notable for 2 x 2 cm mobile nontender midline mass. Neck ultrasound demonstrated a complex cystic lesion measuring 3.8 x 3.4 x 2.5 cm with partial calcification and mildly vascular. The thyroid itself had no nodules. She underwent a Sistrunk procedure with follow-up pathology revealing 1.6 cm classical PTC that extended into surrounding soft tissue and focal invasion into skeletal muscle without a definitive remnant thyroglossal duct lining despite cystic architecture. The differential included PTC completely replacing the thyroglossal duct cyst, PTC arising from ectopic thyroid tissue or metastatic PTC. Due to the unclear origin of the PTC, decision was made to perform total thyroidectomy. Pathology of the thyroid and four lymph nodes were negative for malignancy confirming a PTC origin from an extra-thyroidal remnant. The patient’s course was complicated by post-operative hypocalcemia resolved with calcitriol and calcium carbonate. She is pending discussion with endocrinology regarding adjuvant radioactive iodine. Conclusion: Thyroglossal duct carcinoma, most commonly papillary carcinoma, is a rare condition that should be considered in patients presenting with cystic midline neck masses. Sistrunk surgery should be performed in all cases for tumor removal. Thyroidectomy in individuals with normal thyroid can be considered due to the probability of concomitant intraglandular thyroid cancer and enables management with adjuvant radio-iodine if needed. In this particular case, PTC was found without evidence of a TDC and suggests PTC arose from ectopic thyroid tissue. Ectopic thyroid tissue can undergo malignant transformation along with the native thyroid gland. There are only a few other reports of isolated ectopic thyroid tissue malignancy with a benign thyroid gland. Presentation Date: Saturday, June 17, 2023

SAT574 Thyroglossal Duct Papillary Thyroid Cancer With Normal Eutopic Thyroid Gland: A Management Dilemma

Abstract Disclosure: H. Belal: None. J.T. Batch: None. G.Y. Gandhi: None. Background: The incidence of thyroglossal duct cyst carcinomas is less than 1%, the majority being papillary thyroid cancer. One-third arise de novo from the thyroglossal duct. The rest are direct metastasis of eutopic papillary thyroid cancer. Management in the setting of a normal eutopic thyroid gland is challenging. Clinical Case: A 35-year-old female presented with transient right facial paresthesia. CT angiogram revealed an incidental 2.3 cm thyroglossal duct cyst with internal ectopic thyroidal tissue and micro-calcifications. She denied any compressive symptoms, radiation exposure, or family history of thyroid cancer and was euthyroid. Ultrasound noted a normal thyroid gland and complex solid-cystic mass measuring 2.3 x 2.0 x 1.5 cm superior to the isthmus. Satisfactory fine needle aspiration of the mass revealed benign-appearing epithelial cells, macrophage, and colloid-like material. Due to new anterior neck pain, a Sistrunk Procedure (SP) was performed. Pathology revealed a 1.2 cm papillary thyroid carcinoma, conventional type (confirmed by TTF-1 and thyroglobulin stains), arising within the thyroglossal duct cyst. Surgical margins were free of cancer, and there was no lymphovascular invasion. A thyroid ultrasound seven months after the procedure revealed heterogenous thyroid tissue, no thyroid nodules, and several small benign-appearing reniform-shaped cervical lymph nodes in zones 1 and 2. The patient was offered yearly thyroid ultrasound surveillance versus prophylactic thyroidectomy. She elected to proceed with thyroidectomy due to concerns about disease recurrence. Final pathology results revealed right lobe 2 mm papillary microcarcinoma limited to the thyroid. Conclusion: Fine needle aspiration of thyroglossal duct cysts can have a high false negative rate, as in our patient. There is currently no consensus on treatment of thyroid carcinomas arising from thyroglossal duct cysts. There are four possible surgical strategies: 1) SP alone 2) SP with concurrent thyroid lobectomy or pyramidal lobe resection 3) SP with total or near total thyroidectomy in all patients and 4) SP and selective addition of total or near total thyroidectomy in high-risk patients. The role of radio-iodine ablation and levothyroxine suppression after SP is also unclear. Management recommendations are Grade C, relying on case reports, case series, and expert opinion. Whether or not to proceed with total thyroidectomy, especially in the setting of a normal thyroid gland, remains highly controversial. Some experts even argue for an early aggressive surgical approach with SP, total thyroidectomy, and level I lymph node sampling in all patients to provide accurate staging and allow for the use of thyroglobulin and whole-body scintigraphy in surveillance. Multisite comparative data on the long-term outcomes of patients who receive early aggressive versus conservative management is needed. Presentation: Saturday, June 17, 2023

SAT500 Thyroglossal Duct Cyst Cancer: Diagnosis And Management

Abstract Disclosure: A.P. Solis Pazmiño: None. C. Rocha: None. L. Figueroa: None. C. Garcia: None. Background: Thyroglossal duct remnants form during the embryologic development of the thyroid gland. In rare cases, with an incidence of about 1%, carcinoma is present within these cysts, most commonly papillary thyroid carcinoma. Sistrunk procedure (SP) is the main treatment and optimal patient management includes multidisciplinary consultation in order to improve survival. However, there is a debate about whether SP is enough if there is a malignancy in the thyroid or if total thyroidectomy should be done on patients 45 years of age and individuals with aggressive disease [1]. TGDCC harbors an excellent prognosis and low recurrence rate. Clinical Case: We present a case of an elderly woman with a large submental mass that had been gradually enlarging for about 2 years. She had symptoms of dysphagia but denied odynophagia, hoarseness, or shortness of breath. Our patient had high blood pressure and a penicillin allergy but was otherwise healthy without a family history of carcinoma. Physical examination revealed a large submental mass (4.5x4x3.5 cm) that was hard and with smooth edges and did not move with deglutition. There was no extension into the oral cavity on bimanual palpation or palpable masses/nodules in the cervical region. There was a thyroid gland enlargement (right lobe 5x3x1.5, left lobe 4.5x2x1.2 cm). The ultrasound showed enlarged cervical lymph nodes. Fine needle aspiration (PAAF) suggested metastasis of thyroid cancer. Clinical lesson: Although Sistrunk surgery is accepted, performing a total thyroidectomy for TGDCC is controversial. Evidence suggests that it should be reserved for patients older than 45 years, like the patient described in this case. Total thyroidectomy is preferably performed based on the FNAB result (high-risk malignant) or if both thyroid lobes do not consist of healthy tissue anymore, regarding postoperative complication. Since TGDCC is a rare malignancy, a broad differential diagnosis should be considered: metastasis from an unknown primary, paraganglioma, hyalinizing trabecular tumor, and thyroglossal duct cyst, among others. The clinicopathological correlation, as well as the use of the FNA and the immunohistochemical markers, improve the diagnosis accuracy and help to decide the best treatment for the patient. Presentation Date: Saturday, June 17, 2023

SAT517 Papillary Thyroid Cancer in Thyroglossal Duct Cyst.

Abstract Disclosure: P.L. castellanos: None. S.E. Meek: None. A.M. Chindris: None. V.J. Bernet: None. Approximately 250 cases of papillary thyroid cancer (PTC) within a thyroglossal duct cyst (TGDC) have been reported worldwide. The presence of PTC within a TGDC is rare representing less than 1 % of all TGDC cases. This report describes the case of a young male with PTC in a TGDC suspicious nodules. We present this case along with a review of the literature related to this very uncommon finding. Papillary thyroid carcinoma is a very rare disease but always should be considered when speaking of a mass at the level of the central neck. There is a considerable controversy regarding the role of thyroidectomy to treat thyroglossal duct cyst carcinoma since the treatment of choice is Sistrunk procedure and the only indications to make a thyroidectomy will be aggressive disease and more than 45 years old according to some articles but without any consensus now. With a cure rate of 95 % and recurrence rate of 3 -10 % when this cancer is treated by Sistrunk operation, it doesn’t seem necessary to do an extent surgery if there is not enough thyroid compromised. Long term follow up is necessary to exclude the development of thyroid cancer. Presentation Date: Saturday, June 17, 2023