Thyroglossal cyst is a fluid-filled swelling in the midline of the neck usually found at the level of the hyoid bone or inferior to it. It represents the remnant of the thyroglossal duct which develops during embryogenesis in the fetal foramen cecum (tongue base) and then migrates to its final destination in the middle to lower anterior cervical region. The duct is normally obliterated in the first trimester while a persistence of the duct is associated with the formation of the cyst.
Thyroglossal cyst (TGC) is a fluid-filled remnant of the thyroglossal duct which runs from the foramen cecum at the fetal base of the tongue to the lower anterior cervical region   . TGC develops due to the anomalous formation and migration of the thyroid gland during embryogenesis. TGC is the commonest midline cervical mass found in clinical practice . It is usually located at the level of the hyoid bone or inferior to it near the thyrohyoid membrane but can also be found in the lingual or submental region  .
TGC can present as an asymptomatic mass in children, frequently around the age of 6 years. Approximately 7% of TGCs have been reported to occur in adults and the most common presentation in adults is an underlying infection of the cyst  . Clinical features of TGC include a midline cervical mass which moves with swallowing or protrusion of the tongue, sometimes accompanied by symptoms of a sore throat, odynophagia, dysphagia, and hoarseness. Sudden enlargement of the cyst, especially if it is located in the lingual or submental region can lead to airway obstruction. Occasionally TGC may present as an infected cyst or as a malignancy within the cyst   . Cases of papillary thyroid carcinoma, as well as, squamous carcinoma have been reported in older adults   .
Entire Body System
- Thyroid Nodule
The ultrasound scan is very useful for evaluating thyroid nodules and to look for features that may indicate that the thyroid nodule is suspicious for cancer. It is also useful for looking for any enlarged lymph nodes in the neck. [singhealth.com.sg]
Solitary thyroid nodules affect 1–2% of children, but the risk of malignancy is greater in children than in adults, especially for cysts larger than 1 cm. [analesdepediatria.org]
At first evaluation in our clinic, a neck ultrasound confirmed the presence of an 11 mm thyroid nodule and additionally identified a 12 mm TGDC remnant. [hormones.gr]
Differential Diagnosis Dermoid cyst Lymph node Cystic hygroma Branchial cyst Lipoma Laryngocele Thyroid nodule Treatment Infected cyst treated with antibiotic to cover oropharyngeal flora (aerobes and anaerobes) and warm compresses. [pedclerk.bsd.uchicago.edu]
nodules, lymphatic malformations, hemangioma, midline lymphadenopathy, and salivary gland tumors. [consultant360.com]
The patient had a 10-year history of multinodular goiter, which had recently been complicated by hyperthyroidism. [hormones.gr]
Differential diagnosis are ectopic thyroid, enlarged lymph nodes, dermoid cysts and goiter. [en.wikipedia.org]
2016 2017 2018 2019 Billable/Specific Code Applicable To Congenital parenchymatous goiter (nontoxic) Congenital goiter (nontoxic) NOS Type 1 Excludes transitory congenital goiter with normal function ( P72.0 ) E03.0 ) congenital hypothyroidism ( ICD- [icd10data.com]
[…] malformation of posterior pituitary Congenital malposition of the thyroid gland Congenital malposition of thymus Ectopic pituitary tissue Ectopic thymic tissue Ectopic thyroid tissue Female Kallman's syndrome General loss of peroxisomal function Lingual goiter [icd9data.com]
Other diagnoses include: Lymph nodes Goiter Dermoid cyst Lipomas Branchial cleft cyst Enlarged lymph node Ectopic thyroid anomalies which are odontogenic in origin. [lecturio.com]
- Soft Tissue Swelling
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 [en.wikipedia.org]
There may be difficulty breathing, dysphagia (difficulty swallowing), or dyspepsia (discomfort in the upper abdomen), especially if the cyst becomes large. [en.wikipedia.org]
- Failure to Thrive
These patients commonly present with stridor, feeding difficulties, coughing, cyanotic episodes, failure to thrive, and breath-holding spells. 6 Diagnosis can be made at the bedside with direct laryngoscopy. [consultant360.com]
Jaw & Teeth
Face, Head & Neck
- Neck Mass
Cervical bronchogenic cyst is a rare congenital malformation that usually appears as a painless neck mass. [ncbi.nlm.nih.gov]
Thyroglossal cysts can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during developmental stages.Thyroglossal cysts are the most common cause of midline neck masses [en.wikipedia.org]
Symptoms Thyroglossal duct cysts most often present with a palpable (able to be felt) asymptomatic midline neck mass at or below the level of the hyoid bone. The neck mass moves with swallowing. [healthcentral.com]
- Neck Swelling
A benign thyroglossal cyst is a common clinical condition and is second only to a cervical lymph node as the most common cause of a solitary neck swelling. [ncbi.nlm.nih.gov]
Associations: Ectopic thyroid (40%) Differential diagnoses: The differentials for Thyroglossal cyst includes other causes of midline neck swelling. [epomedicine.com]
Lumps within the thyroid gland They present as neck swellings and include thyroid cysts, adenomas and malignancy, all of which commonly present as a single thyroid nodule. [lecturio.com]
Case 3 The third case is a case of 85-year-old woman who presented with an anterior neck swelling for the past 10 years and difficulty in breathing for the past 1 month which was gradually worsening. [saudisurgj.org]
Keywords: Cystic neck swelling, Sistrunk′s operation, thyroglossal duct cyst How to cite this article: Ramalingam W, Chugh R. Thyroglossal duct cyst: Unusual presentation in an adult. [laryngologyandvoice.org]
TGCs are diagnosed clinically but radiological testing is required to confirm the diagnosis and to detect the presence of the thyroid gland in children. Physical examination finding of a midline cervical mass which moves with swallowing or protrusion of the tongue is the classical presentation of TGC.
A majority of clinicians prefer ultrasound for initial diagnosis, especially in children, as it is non-invasive, easily available, is not associated with exposure to radiation, and does not require sedation. Ultrasound reveals fluctuant, cystic mass which occasionally spread cervical strap muscles. The fluid within the cyst appears anechoic although in some cases the fluid may contain debris. The walls of the cyst are thin and avascular. Rarely, in a presence of an infection, there may be evidence of inflammatory changes.
Computed tomography (CT) and magnetic resonance imaging (MRI) are useful to delineate the extent of the mass and its anatomic relationship to neighboring structures    . CT findings include a well circumscribed cystic lesion with rim enhancement . The cysts have a thin wall and appear smooth, well defined, homogeneously attenuated, and located usually within 2 cm of the midline. There may be displacement of the sternocleidomastoid either posteriorly or posterolaterally and in certain cases, TGCs may be embedded in the infrahyoid (strap) muscles. CT scan is preferred in adults as TGCs are rare in adults and therefore have a broader differential diagnosis and also because the incidence of malignancies associated with TGCs in adults is higher which CT scans are able to detect better than the ultrasound.
MRI is preferred when TGCs are located near the base of the tongue. TGC features on MRI are a low, variable T1 signal in uncomplicated cysts and a high signal if there is previous hemorrhage or infection . T2 image shows a high signal.
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