Thyroglossal cyst

Classification and external resources

A thyroglossal cyst is a fibrous cyst that forms from a persistent thyroglossal

duct. Thyroglossal cysts can be defined as an irregular neck mass or a lump
which had developed from cells and tissues left over after the formation of the
thyroid gland during developmental stages.[1]

Thyroglossal cysts are the most common cause of midline neck masses and are
generally located substandard to the hyoid bone, yet these neck masses can
occur anywhere along the path of the thyroid gland from the base of the tongue
to the suprasternal notch.[2]

Other common causes of midline neck masses include lymphadenopathy,

dermoid cysts, and various odontogenic anomalies.[2]

Thryoglossal cyst are developed at birth and can have many diagnosis
procedures to establish the degree of the cyst. Also complications can come
along with the before and after masses of the Thyroglossal Cysts, treatments are
available to help with pain and reduction of the cyst

Presentation[edit]

It usually presents as a midline neck lump (in the region of the hyoid bone) that
is usually painless, smooth and cystic, though if infected, pain can occur. There
may be difficulty breathing, dysphagia (difficulty swallowing), or dyspepsia
(discomfort in the upper abdomen), especially if the lump becomes large.

The most common location for a thyroglossal cyst is midline or slightly off
midline, between the isthmus of the thyroid and the hyoid bone or just above the
hyoid bone. A thyroglossal cyst can develop anywhere along a thyroglossal duct,
though cysts within the tongue or in the floor of the mouth are rare.

A thyroglossal cyst will move upwards with protrusion of the tongue.

Thyroglossal cysts are associated with an increased incidence of ectopic thyroid

tissue. Occasionally, a lingual thyroid can be seen as a flattened strawberry-like
lump at the base of the tongue.[3]

Causes[edit]

Thyroglossal Duct Cysts are developed as a birth defect. During the embryonic
development the thyroid gland is being formed beginning at the base of the
tongue moving towards the neck canal, known as the thyroglossal duct. Once the
thyroid reaches its final position in the neck the duct normally disappears. Yet, in
some cases portions of the duct remain behind leaving small pockets, known as
cysts. During a person's life these cyst pockets can fill with fluids and mucus,
enlarging when infected, presenting the thyroglossal cyst.[1]
Embryology
The thyroglossal tract arises from the foramen cecum at the junction of the
anterior two-thirds and posterior one-third of the tongue. Any part of the tract
can persist causing a sinus, fistula or cyst. Most fistulae are acquired following
rupture or incision of the infected thyroglossal cyst. A thyroglossal cyst is lined
by pseudostratified, ciliated columnar epithelium while a thyroglossal fistula is
lined by columnar epithelium.

Diagnosis[edit]

The diagnosis of a thyroglossal duct cyst needs to be examined by medical

professions and is usually done by a physical exam. It is important to identify
whether or not the thyroglossal cyst contains any thyroid tissue as it can define
the degree of cyst that is being dealt with.[1]

Diagnosis procedures for a thyroglossal cyst include:[1]

Type

Definition

Blood Tests Blood tests generally aim to test the thyroid function.
Ultrasounds Ultrasounds use high frequency sound waves to create images of
blood vessels, tissues and orangs through a computer to examine the degree of
mass and its surrounding tissues.
Thyroid Scans Radioactive iodine or technetium (a radioactive metallic element)
is used in this procedure to show any abnormalities of the thyroid.
Fine Needle Aspiration The removal of cells from the cyst using a needle to
diagnose correctly.
Symptoms
Thyroglossal duct cysts most often present with a palpable asymptomatic
midline neck mass below the level of the hyoid bone. The mass on the neck
moves during swallowing or on protrusion of the tongue because of its
attachment to the tongue via the tract of thyroid descent. Some patients will
have neck or throat pain, or dysphagia.
The persistent duct or sinus can promote oral secretions, which may cause cysts
to become infected. Up to half of thyroglossal cysts are not diagnosed until adult
life. The tract can lie dormant for years or even decades until some kind of
stimulus leads to cystic dilation. Infection can sometimes cause the transient
appearance of a mass or enlargement of the cyst, at times with periodic
recurrences. Spontaneous drainage may also occur. Differential diagnosis are
ectopic thyroid, enlarged lymph nodes, dermoid cysts and goiter.
Clinical features
Clinical features can be found in the subhyoid portion of the tract and 75%
present as midline swellings. The remainder can be found as far lateral as lateral
tip of the hyoid bone.

Typically, the cyst will move upwards on protrusion of the tongue, given its
attachment to the embryonic duct, as well as on swallowing because of
attachment of the tract to the foramen caecum.
Post surgery infection on a Thyroglossal Cyst, reaction from stitches.
Post removal of stitches from surgery on a Thyroglossal Cyst infection
An infected thyroglossal duct cyst can occur when it is left untreated for a certain
amount of time or simply when a thyroglossal duct cyst hasn't been suspected
by a person. The degree of infection can be examined as major rim enhancement
has occurred, located inferior to the hyoid bone. Also soft tissue swelling occurs

along with airway obstruction and trouble swallowing due to the rapid
enlargement of the cyst.
With infections there can be rare cases where an expression of fluid is projected
into the pharynx causing other problems within the neck. Infections can occur
before and after the removal of the thyrglossal duct cyst. The infections that
occur after the removal of the cyst include skin reactions, including shiny skin,
redness and dryness from stitching and the healing process of the skin being
exposed to other bacterias.
Thyroglossal Fistula
With a Thyroglossal duct cysts ruptures can occur unexpectedly, resulting
draining sinuses known as thyroglossal fistula. Thyroglossal fistula can develop
when the removal of the cyst has not been fully completed. This is usually
noticed when bleeding in the neck occurs causing swelling and fluid ejection
around the original wound of removal. Breathing and swallowing problems can
also be of occurrence due to pressure within the neck.
Thyroglossal duct cyst carcinoma
In rare cases of thyroglossal cysts cancer can be presented. It is a very
uncommon and the management for it can be seen as controversial. When
thyroglossal carcinoma occurs they are presented with a tumor, which usually
arise's from the ectopic thyroid tissue within the cyst.[6] This can result in the
surgical removal of the lymph nodes and thyroid gland to stop any spreading of
cancer to the rest of the body.

Treatment

Treatment for a thyroglossal cyst is called the Sistrunk procedure: surgical

resection of the duct to the base of the tongue and removal of the central portion
of the hyoid bone.

Although generally benign the cyst will be removed if the patient exhibits
difficulty in breathing or swallowing, or if the cyst is infected. Even if these
symptoms are not present the cyst may be removed to eliminate the chance of
infection or development of a carcinoma,[8] or for cosmetic reasons if there is
unsightly protrusion from the neck.

The Sistrunk procedure involves excision not only of the cyst but also of the
path's tract and branches. A removal of the central portion of the hyoid bone is
indicated to ensure complete removal of the tract. It is unlikely that there will be

a recurrence after such an operation. The original Sistrunk paper is available online with a modern commentary.[9] At times antibiotics can be indicated if there
is sign of infection.

Thyroid scans and thyroid function studies are ordered preoperatively; this is
important to demonstrate that normally functioning thyroid tissue is in its usual
area.