Child with a thyroglossal duct cyst.

What is a thyroglossal duct cyst?

A thyroglossal duct cyst is a fluid-filled sac located at the midline of the neck. These cysts most commonly occur in children before the age of 5. A small, round mass in the front of the neck is the classic presentation. These cysts are usually filled with mucous. Occasionally, they appear after an upper respiratory infection when they become enlarged and painful. If infected, redness and sometimes drainage of mucous from the cyst may occur through the skin.

What causes a thyroglossal duct cyst?

A thyroglossal duct cyst is a congenital defect, which means that it was present from birth. When the thyroid gland forms during fetal development, it begins at the base of the tongue and moves down the neck through a canal called the thyroglossal duct. As the thyroid gland and thyroglossal duct develop, they travel through a bone in the neck, called the hyoid bone. After the thyroid gland reaches its final location in the neck, the thyroglossal duct usually disappears. Occasionally, if portions of the thyroglossal duct remain along any point of the migration, a cyst may form.

How is the thyroglossal duct cyst diagnosed?

Diagnosis is made by physical examination. An ultrasound examination will help to confirm the presence of the cyst and normal thyroid in the neck. It is important to determine if the thyroid gland is located in its normal position because rarely the thyroid gland may have arrested migration in the neck and be located in the upper neck, alone or in conjunction with the thyroglossal duct cyst.

How are the thyroglossal duct cyst managed?

If the cyst is infected, an antibiotic may be given to treat the infection. Occasionally, surgical drainage of the infected cyst is required if the infection is severe. Following resolution of infection and confirmation by diagnostic studies, the definitive treatment for the thyroglossal duct cyst is surgical removal. This surgery is called the Sistrunk procedure and includes removal of the cyst and the mid-portion of the hyoid bone. The hyoid bone, because of its intimate association with the thyroglossal duct, may contain remnants of the duct. If the hyoid bone is not surgically removed, there is a greater chance for recurrence of the thyroglossal duct cyst.

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