Thyroglossal duct diseases: presentation and outcomes

Thyroglossal Duct Cysts (TGDC) in the Elderly Population: The Role of Conservative Management

Sistrunk procedure is the treatment for thyroglossal duct cysts (TGDC), the majority of which occur in children. TGDC are very rare in the elderly and account for under 2% of cases. Management in this population, where risks of surgery may outweigh benefits, is unclear. Here we present two cases of elderly patients with asymptomatic to mildly symptomatic TGDC. Both patients were 87-year-old women who were found to have neck swelling on exam. They both underwent computed tomography (CT) scans and ultrasound-guided fine needle aspiration (FNA). Both had histology consistent with a thyroglossal duct cyst. The patients were managed conservatively without evidence of recurrence. We conclude that in elderly patients with FNA demonstrating TGDC and minimal to no symptoms, conservative management is reasonable.

Research progress of ectopic thyroid cancer in thyroglossal duct cyst: A case report and literature review

RATIONALE

Thyroglossal duct carcinoma, a rare clinical condition characterized by ectopic thyroid adenocarcinoma within thyroglossal duct cysts (TGDCs), typically confirmed through intraoperative rapid pathology, this condition generally has a favorable prognosis. Nevertheless, comprehensive treatment guidelines across all disease stages are lacking, the purpose of this study is to report 1 case of the disease and propose the treatment plan for each stage of the disease.

PATIENT CONCERNS

A patient presented with thyroid swelling, classified as C-TIRADS 4A following a physical examination. Preoperative thyroid puncture identified papillary thyroid carcinoma, and genetic testing revealed a BRAF gene exon 15-point mutation. Ancillary tests showed a slightly decreased thyroid stimulating hormone (TSH) level (0.172) with no other significant abnormalities.

DIAGNOSES

Preoperative fine-needle aspiration cytology (FNAC) confirmed right-side thyroid cancer. Intraoperative exploration uncovered a TGDC and intraoperative rapid pathology confirmed thyroglossal duct carcinoma.

INTERVENTIONS

A Sistrunk operation and ipsilateral thyroidectomy were performed.

OUTCOMES

Postoperative recovery was satisfactory.

LESSONS

Thyroglossal duct carcinoma is a rare disease affecting the neck. Due to limited clinical cases and the favorable prognosis associated with this condition, there is currently no established set of diagnostic and treatment guidelines. According to tumor size, lymph node metastasis, thyroid status and other factors, the corresponding treatment methods were established for each stage of thyroglossal duct cancer, which laid the foundation for the subsequent treatment development of this disease.

Carcinoma arising from thyroglossal duct remnants

Thyroglossal duct cysts (TGDCs) are unusual remnants of the thyroid gland that are rarely observed in association with carcinoma. The present study aimed to showcase the clinical characteristics, diagnosis and management of patients with TGDC carcinoma. It was a single-center study conducted from February 2016 to February 2020. The study involved the retrospective analysis of a series of cases with TGDC carcinoma. A total of 10 patients were included in the study, of whom eight (80%) were females. Their age ranged from 25 to 48 years with a mean age of 39.1 years. A total of five cases (50%) underwent only Sistrunk's procedure, four patients (40%) underwent total thyroidectomy along with Sistrunk's procedure and one patient (10%) was treated by Sistrunk operation and lobectomy. In all of the cases (100%), histopathological examination confirmed papillary thyroid carcinoma in TGDCs. In addition, in the thyroid tissue, 2 cases (20%) also had papillary thyroid carcinoma and 3 cases (30%) had papillary thyroid microcarcinoma. Radioiodine was administered in one patient (10%) with suppressive thyroxine. A three-year follow-up with ultrasound revealed no suspicious lesions in any of the cases. Although rare, carcinoma may develop in the thyroglossal cysts. In this situation, both the thyroid gland and different lymph node compartments should be evaluated for malignancy. Surgical intervention is the cornerstone of management.