Thyroglossal Cysts: Safety, Treatment, and Concerns

Thyroglossal duct cyst

I am 43 years old and recently discovered a thyroglossal cyst (size 5mm x 9mm) during an ultrasound examination of my lymph nodes, which my doctor found incidentally.
As I understand from what the doctor said, these thyroglossal cysts typically should disappear naturally after birth.
However, it was revealed by the ultrasound (though the doctor could not palpate it during the neck examination).
The doctor suggested that this thyroglossal cyst could be treated surgically.
I would like to ask the doctor:
1) Is it safe to leave the thyroglossal cyst in the body? Is it medically necessary to address it? If treatment is required, must it be done surgically?
2) Is there a chance that its size could increase, or could it disappear? Additionally, is there a significant risk of it becoming malignant?
3) If the thyroglossal cyst has not disappeared after 43 years since birth (and cannot be palpated in the neck), is treatment necessary?
4) If it cannot be palpated in the neck, could it be a lymph node rather than a thyroglossal cyst? Or could there be other possibilities? Could you please provide me with some reference advice? Thank you very much.
Best wishes!

Tim Tim, 40~49 year old female. Ask Date: 2008/05/19

Dr. Hong Guangliang reply Otolaryngology

Hello, a thyroglossal duct cyst is an embryological remnant that typically regresses and disappears after birth.
Most cases are discovered due to swelling caused by infection, at which point surgical intervention is often recommended because of the risk of recurrent infections.
Additionally, the likelihood of a thyroglossal duct cyst becoming malignant is higher compared to a normal thyroid gland; however, this does not mean that there is a definite or significantly high chance of it turning malignant! Given that your tumor is small and has been present for a long time, I would recommend monitoring your condition or possibly performing a fine-needle aspiration biopsy.
Furthermore, lymph nodes and thyroglossal duct cysts should theoretically be easy to differentiate (one is solid and the other is a cyst).
If you have concerns, it may be beneficial to seek a second opinion from another specialist!

Reply Date: 2008/05/19

More Info

Thyroglossal cysts are congenital anomalies that arise from the remnants of the thyroglossal duct, which is responsible for the descent of the thyroid gland during fetal development. These cysts are typically located in the midline of the neck and can vary in size, as you have noted with your cyst measuring 5mm x 9mm. Here’s a comprehensive overview addressing your concerns regarding thyroglossal cysts, their safety, treatment options, and potential complications.

1. Safety and Necessity of Treatment: In many cases, thyroglossal cysts are asymptomatic and do not require treatment. However, if the cyst becomes infected or symptomatic, surgical intervention is often recommended. The standard treatment is the Sistrunk procedure, which involves excising the cyst along with a portion of the thyroglossal duct to minimize the risk of recurrence. Leaving the cyst untreated is generally safe if it remains asymptomatic, but it is important to monitor it for any changes.

2. Potential for Size Change and Malignancy: Thyroglossal cysts can fluctuate in size, particularly if they become infected. While most cysts remain benign, there is a very small risk of malignancy, especially in adults. The likelihood of a cyst transforming into a malignant form is extremely low, but it is not impossible. Regular monitoring and imaging can help assess any changes in size or characteristics.

3. Need for Treatment After Many Years: Given that your cyst has been present for 43 years without causing any issues, it may not require immediate treatment. However, if you experience any symptoms such as pain, swelling, or infection, or if there are concerns about the cyst's characteristics, surgical evaluation may be warranted. The decision to treat should be made in consultation with your healthcare provider, considering your overall health and any potential risks.

4. Differentiating from Lymph Nodes: If the cyst is not palpable upon examination, it is possible that it is indeed a thyroglossal cyst, especially if imaging studies have confirmed its presence. However, it is also important to consider other possibilities, such as lymphadenopathy or other neck masses. A thorough evaluation by an ENT specialist or a surgeon can provide clarity. Imaging studies like ultrasound or CT scans can help differentiate between a thyroglossal cyst and other structures in the neck.

In conclusion, while thyroglossal cysts are generally benign and often do not require treatment, it is essential to monitor them for any changes. Surgical intervention is typically reserved for symptomatic cases or when there is uncertainty regarding the diagnosis. If you have any concerns about your cyst or experience new symptoms, it is advisable to consult with your healthcare provider for further evaluation and management. Regular follow-ups and imaging can help ensure that any potential issues are addressed promptly.

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