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Thyroglossal Duct Cyst

Thyroglossal Cyst's 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.

Causes

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]

Diagnosis

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	Defintion
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.

Complications

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.^[2]

With infections there can be rare cases where an expression of fluid is projected into the pharynx causing other problems within the neck ^[3]. 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 heeling process of the skin being exposed to other bacteria’s.

Thyroglossal Fistula

With a Thyroglossal duct cysts ruptures can occur unexpectedly, resulting draining sinuses known as thyroglossal fistula.^[2] 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 occurance due to pressure within the neck. ^[4]

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. ^[5]. 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. ^[6]

Statisitics

90% of children before the age of 10 are presented with Thyroglossal Duct Cysts ^[7]
70% of neck anomalies are from Thyroglossal cysts ^[7]
Thyroglossal Duct Cysts are the second most common neck abnormalities after lymphadenopathy^[7]
A person can live with a Thyroglossal Duct Cyst without any problems, until an infection is presented^[7]
Approximately 7% of the population has thyroglossal duct remnants ^[8]
Thyroglossal duct carcinoma occurs in approximately 1 to 2 % of Thyroglossal cyst cases.^[9]

References

^ ^a ^b ^c ^d University of Rochester Medical Center. (2015). Thyroglossal duct cyst. Retrieved from http://www.urmc.rochester.edu
^ ^a ^b ^c ^d Deaver, M. J., Silman, E. F., & Lotfipour, S. (2009). Infected thyroglossal duct cyst. Western Journal of Emergency Medicine. 10(3), 205. Retrieved from http://www.ncbi.nlm.nih.gov
^ Stahl, W.M., & Lyall, D. (1954). Cervical cysts and fistulae of thyroglossal Tract Origin. Annals of Surgery. 139(1), 123-128. Retrieved from http://www.ncbi.nlm.nih.gov
^ The State of Queensland. (2011) Thyroglossal cysts/fistuka. Retrieved from http://www.health.qld.gov.au
^ Ali, M., Abussa, A., & Hashmi, H. (2007). Papillary thyrpid carcinoma formation in a thyroglossal cyst. A case report. Libyan Journal of Medicine. 2(3), 148-149, doi:10.4176/070611
^ Sabra, M. (2009). Clinical thyroidology for patients. American Thyroid Assoication. 3(2), 12. Retrieved from http://www.thyroid.org
^ ^a ^b ^c ^d Weerakkody, Y., & Gaillard F. (2015). Thyroglossal duct cyst. UBM Medica Network. Retrieved from http://radiopaedia.org
^ Karmakar, S., Saha, A., & Mukherjee, D. (2012). Thyroglossal cyst: An unusual presentation. US National Library of Medicine. 65(1), 185-187, doi:10.1007/s12070-011-0458-5
^ Forest, V., Murali, R., & Clark JR. (2011). Thyroglossal duct cyst carcinoma: Case series. National Library of Medicine. 40(2), 151-156. Retrieved from http://www.ncbi.nlm.nih.gov

[uni2015-1] University of Rochester Medical Center. (2015). Thyroglossal duct cyst. Retrieved from http://www.urmc.rochester.edu

[deav2009-2] Deaver, M. J., Silman, E. F., & Lotfipour, S. (2009). Infected thyroglossal duct cyst. Western Journal of Emergency Medicine. 10(3), 205. Retrieved from http://www.ncbi.nlm.nih.gov

[stahl1954-3] Stahl, W.M., & Lyall, D. (1954). Cervical cysts and fistulae of thyroglossal Tract Origin. Annals of Surgery. 139(1), 123-128. Retrieved from http://www.ncbi.nlm.nih.gov

[qld2011-4] The State of Queensland. (2011) Thyroglossal cysts/fistuka. Retrieved from http://www.health.qld.gov.au

[5] Ali, M., Abussa, A., & Hashmi, H. (2007). Papillary thyrpid carcinoma formation in a thyroglossal cyst. A case report. Libyan Journal of Medicine. 2(3), 148-149, doi:10.4176/070611

[6] Sabra, M. (2009). Clinical thyroidology for patients. American Thyroid Assoication. 3(2), 12. Retrieved from http://www.thyroid.org

[weer2015-7] Weerakkody, Y., & Gaillard F. (2015). Thyroglossal duct cyst. UBM Medica Network. Retrieved from http://radiopaedia.org

[karm2012-8] Karmakar, S., Saha, A., & Mukherjee, D. (2012). Thyroglossal cyst: An unusual presentation. US National Library of Medicine. 65(1), 185-187, doi:10.1007/s12070-011-0458-5

[9] Forest, V., Murali, R., & Clark JR. (2011). Thyroglossal duct cyst carcinoma: Case series. National Library of Medicine. 40(2), 151-156. Retrieved from http://www.ncbi.nlm.nih.gov

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