Thyroglossal duct cysts and ectopic thyroid
- Gregory W Randolph, MD, FACS
Gregory W Randolph, MD, FACS
- Associate Professor in Otology & Laryngology
- Harvard Medical School
- Dipti V Kamani, MD
Dipti V Kamani, MD
- Clinical Research Specialist
- Massachusetts Eye and Ear Infirmary
- Section Editors
- Sally E Carty, MD, FACS
Sally E Carty, MD, FACS
- Section Editor — Endocrine Surgery
- Professor, Chief, Division of Endocrine Surgery
- University of Pittsburgh School of Medicine
- Douglas S Ross, MD
Douglas S Ross, MD
- Section Editor — Thyroid Disease
- Professor of Medicine
- Harvard Medical School
Thyroglossal duct cysts (TGDCs) are the most common form of congenital cyst in the neck. They are cysts of epithelial remnants of the thyroglossal tract and present characteristically as a midline neck mass at the level of the thyrohyoid membrane, closely associated with the hyoid bone. Although most patients with TGDCs are children or adolescents, up to one-third are aged 20 years or older [1,2]. Males and females are equally affected.
Patients with a TGDC often have ectopic thyroid glands. (See 'Thyroid ectopia' below.)
The anlage of the thyroid gland forms at the foramen cecum of the tongue, which is located on the dorsum of the tongue posteriorly at the apex of the V-shaped sulcus formed by the circumvallate papillae . During the fourth week of gestation, a ventral diverticulum of the foramen cecum is formed from the first and second pharyngeal pouches (the medial thyroid anlage). This diverticulum, with its narrow neck connected to the tongue, descends in the midline of the neck as the thyroglossal tract to the position of the normal thyroid in the base of the neck, where the thyroid lobes separate, by the seventh week. The path of descent is usually anterior to the hyoid bone but may be posterior to or through the bone and ends on the anterior surface of the first few tracheal rings.
The tract usually atrophies and disappears by the tenth week of gestation. Portions of the tract and remnants of thyroid tissue associated with it may persist at any point between the tongue and the thyroid (figure 1).
The pyramidal lobe can be thought of as the most caudal remnant of this tract and is present in approximately one-third of normal subjects. The lateral thyroid anlage, consisting of the C-cell precursors, which arises from the neural crest portion of the fourth pharyngeal pouch, ultimately fuses with the descended medial anlage . The pyramidal lobe usually arises from the isthmus of the thyroid but may arise from the medial aspect of one of the thyroid lobes or both lobes.
- Brown RL, Azizkhan RG. Pediatric head and neck lesions. Pediatr Clin North Am 1998; 45:889.
- Allard RH. The thyroglossal cyst. Head Neck Surg 1982; 5:134.
- Livolsi, V. Surgical Pathology of the Thyroid Gland, WB Saunders, Philadelphia 1990.
- Noyek AM, Friedberg J. Thyroglossal duct and ectopic thyroid disorders. Otolaryngol Clin North Am 1981; 14:187.
- Ellis PD, van Nostrand AW. The applied anatomy of thyroglossal tract remnants. Laryngoscope 1977; 87:765.
- Chon SH, Shinn SH, Lee CB, et al. Thyroglossal duct cyst within the mediastinum: an extremely unusual location. J Thorac Cardiovasc Surg 2007; 133:1671.
- Congenital lesions: Thyroglossal duct cysts and branchial cleft anomalies. In: Masters of Surgery, 3, Little Brown, Boston 1997. p.383.
- Slotnick D, Som PM, Giebfried J, Biller HF. Thyroglossal duct cysts that mimic laryngeal masses. Laryngoscope 1987; 97:742.
- Shaari CM, Ho BT, Som PM, Urken ML. Large thyroglossal duct cyst with laryngeal extension. Head Neck 1994; 16:586.
- Greinwald JH Jr, Leichtman LG, Simko EJ. Hereditary thyroglossal duct cysts. Arch Otolaryngol Head Neck Surg 1996; 122:1094.
- Schader I, Robertson S, Maoate K, Beasley S. Hereditary thyroglossal duct cysts. Pediatr Surg Int 2005; 21:593.
- Chou J, Walters A, Hage R, et al. Thyroglossal duct cysts: anatomy, embryology and treatment. Surg Radiol Anat 2013; 35:875.
- Loh WS, Chong SM, Loh KS. Intralaryngeal thyroglossal duct cyst: implications for the migratory pathway of the thyroglossal duct. Ann Otol Rhinol Laryngol 2006; 115:114.
- Pérez-Martínez A, Bento-Bravo L, Martínez-Bermejo MA, et al. An intra-thyroid thyroglossal duct cyst. Eur J Pediatr Surg 2005; 15:428.
- Pediatric Otolaryngology, 4, Saunders, Philadelphia 2002. p.1738.
- Di Benedetto V. Ectopic thyroid gland in the submandibular region simulating a thyroglossal duct cyst: a case report. J Pediatr Surg 1997; 32:1745.
- Lilley JS, Lomenick JP. Delayed diagnosis of hypothyroidism following excision of a thyroglossal duct cyst. J Pediatr 2013; 162:427.
- LiVolsi VA, Perzin KH, Savetsky L. Carcinoma arising in median ectopic thyroid (including thyroglossal duct tissue). Cancer 1974; 34:1303.
- Radkowski D, Arnold J, Healy GB, et al. Thyroglossal duct remnants. Preoperative evaluation and management. Arch Otolaryngol Head Neck Surg 1991; 117:1378.
- Massine RE, Durning SJ, Koroscil TM. Lingual thyroid carcinoma: a case report and review of the literature. Thyroid 2001; 11:1191.
- Wildi-Runge S, Stoppa-Vaucher S, Lambert R, et al. A high prevalence of dual thyroid ectopy in congenital hypothyroidism: evidence for insufficient signaling gradients during embryonic thyroid migration or for the polyclonal nature of the thyroid gland? J Clin Endocrinol Metab 2012; 97:E978.
- Leung AK. Ectopic thyroid gland and thyroxine-binding globulin excess. Acta Paediatr Scand 1986; 75:872.
- Leung AK, Wong AL, Robson WL. Ectopic thyroid gland simulating a thyroglossal duct cyst: a case report. Can J Surg 1995; 38:87.
- Ling L, Zhou SH, Wang SQ, Wang LJ. Misdiagnosed ectopic thyroid carcinoma: report of two cases. Chin Med J (Engl) 2004; 117:1588.
- Mussak EN, Kacker A. Surgical and medical management of midline ectopic thyroid. Otolaryngol Head Neck Surg 2007; 136:870.
- WOOLNER LB, BEAHRS OH, BLACK BM, et al. Classification and prognosis of thyroid carcinoma. A study of 885 cases observed in a thirty year period. Am J Surg 1961; 102:354.
- WOOLNER LB, LEMMON ML, BEAHRS OH, et al. Occult papillary carcinoma of the thyroid gland: a study of 140 cases observed in a 30-year period. J Clin Endocrinol Metab 1960; 20:89.
- Crile, G. Papillary carcinoma of the thyroid and lateral cervical region. Surg Gyn Obstet 1947; 85:757.
- Henry JF. Surgical anatomy and embryology of the thyroid and parathyroid glands and recurrent laryngeal nerve. In: Textbook of Endocrine Surgery, WB Saunders, Philadelphia 1997.
- Meyer JS, Steinberg LS. Microscopically benign thyroid follicles in cervical lymph nodes. Serial section study of lymph node inclusions and entire thyroid gland in 5 cases. Cancer 1969; 24:302.
- Shahin A, Burroughs FH, Kirby JP, Ali SZ. Thyroglossal duct cyst: a cytopathologic study of 26 cases. Diagn Cytopathol 2005; 33:365.
- Pinczower E, Crockett DM, Atkinson JB, Kun S. Preoperative thyroid scanning in presumed thyroglossal duct cysts. Arch Otolaryngol Head Neck Surg 1992; 118:985.
- Tunkel DE, Domenech EE. Radioisotope scanning of the thyroid gland prior to thyroglossal duct cyst excision. Arch Otolaryngol Head Neck Surg 1998; 124:597.
- Gupta P, Maddalozzo J. Preoperative sonography in presumed thyroglossal duct cysts. Arch Otolaryngol Head Neck Surg 2001; 127:200.
- Reede DL, Bergeron RT, Som PM. CT of thyroglossal duct cysts. Radiology 1985; 157:121.
- Brown RE, Harave S. Diagnostic imaging of benign and malignant neck masses in children-a pictorial review. Quant Imaging Med Surg 2016; 6:591.
- Rosenberg TL, Brown JJ, Jefferson GD. Evaluating the adult patient with a neck mass. Med Clin North Am 2010; 94:1017.
- Rosenberg HK. Sonography of pediatric neck masses. Ultrasound Q 2009; 25:111.
- Yim MT, Tran HD, Chandy BM. Incidental radiographic findings of thyroglossal duct cysts: Prevalence and management. Int J Pediatr Otorhinolaryngol 2016; 89:13.
- Heshmati HM, Fatourechi V, van Heerden JA, et al. Thyroglossal duct carcinoma: report of 12 cases. Mayo Clin Proc 1997; 72:315.
- Peretz A, Leiberman E, Kapelushnik J, Hershkovitz E. Thyroglossal duct carcinoma in children: case presentation and review of the literature. Thyroid 2004; 14:777.
- NUTTALL FQ. CYSTIC METASTASES FROM PAPILLARY ADENOCARCINOMA OF THE THYROID WITH COMMENTS CONCERNING CARCINOMA ASSOCIATED WITH THYROGLOSSAL REMNANTS. Am J Surg 1965; 109:500.
- Zizic M, Faquin W, Stephen AE, et al. Upper neck papillary thyroid cancer (UPTC): A new proposed term for the composite of thyroglossal duct cyst-associated papillary thyroid cancer, pyramidal lobe papillary thyroid cancer, and Delphian node papillary thyroid cancer metastasis. Laryngoscope 2016; 126:1709.
- Joseph TJ, Komorowski RA. Thyroglossal duct carcinoma. Hum Pathol 1975; 6:717.
- Page CP, Kemmerer WT, Haff RC, Mazzaferri EL. Thyroid carcinomas arising in thyroglossal ducts. Ann Surg 1974; 180:799.
- Weiss SD, Orlich CC. Primary papillary carcinoma of a thyroglossal duct cyst: report of a case and literature review. Br J Surg 1991; 78:87.
- Plaza CP, López ME, Carrasco CE, et al. Management of well-differentiated thyroglossal remnant thyroid carcinoma: time to close the debate? Report of five new cases and proposal of a definitive algorithm for treatment. Ann Surg Oncol 2006; 13:745.
- Pellegriti G, Lumera G, Malandrino P, et al. Thyroid cancer in thyroglossal duct cysts requires a specific approach due to its unpredictable extension. J Clin Endocrinol Metab 2013; 98:458.
- Hans SS, Lee PT, Proctor B. Carcinoma arising in thyroglossal duct remnants. Am Surg 1976; 42:773.
- Hartl DM, Al Ghuzlan A, Chami L, et al. High rate of multifocality and occult lymph node metastases in papillary thyroid carcinoma arising in thyroglossal duct cysts. Ann Surg Oncol 2009; 16:2595.
- Mazzaferri EL. Thyroid cancer in thyroglossal duct remnants: a diagnostic and therapeutic dilemma. Thyroid 2004; 14:335.
- Thompson LD, Herrera HB, Lau SK. Thyroglossal Duct Cyst Carcinomas: A Clinicopathologic Series of 22 Cases with Staging Recommendations. Head Neck Pathol 2016.
- Brereton RJ, Symonds E. Thyroglossal cysts in children. Br J Surg 1978; 65:507.
- Ducic Y, Chou S, Drkulec J, et al. Recurrent thyroglossal duct cysts: a clinical and pathologic analysis. Int J Pediatr Otorhinolaryngol 1998; 44:47.
- Flageole H, Laberge JM, Nguyen LT, et al. Reoperation for cysts of the thyroglossal duct. Can J Surg 1995; 38:255.
- Kaselas Ch, Tsikopoulos G, Chortis Ch, Kaselas B. Thyroglossal duct cyst's inflammation. When do we operate? Pediatr Surg Int 2005; 21:991.
- Foley DS, Fallat ME. Thyroglossal duct and other congenital midline cervical anomalies. Semin Pediatr Surg 2006; 15:70.
- Pollock WF, Stevenson EO. Cysts and sinuses of the thyroglossal duct. Am J Surg 1966; 112:225.
- Al-Dajani N, Wootton SH. Cervical lymphadenitis, suppurative parotitis, thyroiditis, and infected cysts. Infect Dis Clin North Am 2007; 21:523.
- Shah R, Gow K, Sobol SE. Outcome of thyroglossal duct cyst excision is independent of presenting age or symptomatology. Int J Pediatr Otorhinolaryngol 2007; 71:1731.
- Sistrunk WE. THE SURGICAL TREATMENT OF CYSTS OF THE THYROGLOSSAL TRACT. Ann Surg 1920; 71:121.
- Patel NN, Hartley BE, Howard DJ. Management of thyroglossal tract disease after failed Sistrunk's procedure. J Laryngol Otol 2003; 117:710.
- Perkins JA, Inglis AF, Sie KC, Manning SC. Recurrent thyroglossal duct cysts: a 23-year experience and a new method for management. Ann Otol Rhinol Laryngol 2006; 115:850.
- Falvo L, Giacomelli L, Vanni B, et al. Papillary thyroid carcinoma in thyroglossal duct cyst: case reports and literature review. Int Surg 2006; 91:141.
- Chen KT. Cytology of thyroglossal cyst papillary carcinoma. Diagn Cytopathol 1993; 9:318.
- Baskin HJ. Percutaneous ethanol injection of thyroglossal duct cysts. Endocr Pract 2006; 12:355.
- Chow TL, Choi CY, Hui JY. Thyroglossal duct cysts in adults treated by ethanol sclerotherapy: a pilot study of a nonsurgical technique. Laryngoscope 2012; 122:1262.
- CLINICAL FEATURES
- THYROID ECTOPIA
- Association with hypothyroidism
- Lingual thyroid
- Lateral nonmalignant thyroid tissue
- Exophytic and paracytic nodules
- DIFFERENTIAL DIAGNOSIS
- Fine-needle aspiration
- Incidentally found TGDC
- INFECTED THYROGLOSSAL DUCT CYST
- Preoperative evaluation
- Sistrunk procedure
- SUMMARY AND RECOMMENDATIONS