|Year : 2015 | Volume
| Issue : 3 | Page : 75-77
Thyroglossal cysts: A consideration in the elderly!
Satvinder Singh Bakshi
Department of ENT and Head and Neck Surgery, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
|Date of Web Publication||14-Mar-2016|
Dr. Satvinder Singh Bakshi
House No. B2, Shree Pushpa Complex, 15th Bharathi Street, Ananda Nagar, Puducherry - 607 402
Source of Support: None, Conflict of Interest: None
Although thyroglossal (TG) cysts are very common in children and young adults, their presentation in the elderly is very rare and often goes unnoticed unless we get the pathology report. This may lead to incomplete excision and recurrence of the cyst, together with the fact that there may be an increased risk of malignancy associated with the cysts in this subset of population. The early identification and complete removal of the cysts is prudent. Here, we endeavor to highlight a series of three cases in the elderly, who presented to us with midline cystic neck mass, which on further evaluation turned out to be a TG cyst.
Keywords: Adults, Thyroglossal cyst, Midline neck mass
|How to cite this article:|
Bakshi SS. Thyroglossal cysts: A consideration in the elderly!. Saudi Surg J 2015;3:75-7
| Introduction|| |
The most common midline congenital neck cyst is thyroglossal (TG) cyst; ,, it arises from remnants of the embryonic TG duct from the base of the tongue to the thyroid isthmus. , They are mostly asymptomatic but may also present with pain, difficulty in breathing or swallowing, neck discomfort. If they are not excised, then they may eventually become the site of recurrent infection, fistula, and even a carcinoma. Sistrunk surgery has been considered as the treatment of choice for this condition. ,,,
Adult TG cysts are also common, but there are only a few case reports of TG cysts presenting as a neck mass in the sixth decade and above.  Here, we present a case series of three patients who were in the sixth and eighth decades and who presented to us with midline neck swelling, which on subsequent investigations turned out to be TG cyst.
| Case Reports|| |
The first case is of a 67-year-old man who came for evaluation of a midline neck swelling for past 2 years which was progressively increasing in size and associated with mild dysphagia. There was no history of difficulty in breathing or change in voice. On examination, there was a 3 cm × 4 cm [Figure 1] cystic mass in the midline more on the right side just below the hyoid bone, which was moving with deglutition. There was no neck lymphadenopathy and the vocal cord function was normal. Fine needle aspiration cytology (FNAC) and ultrasonography neck were suggestive of TG cyst. Thyroid profile was normal. The patient underwent Sistrunk procedure and post of histopathological examination of the specimen was confirmative of TG cyst without any evidence of malignancy. The patient's postoperation period was uneventful.
The second case was a 72-year-old man who presented with a swelling on the neck for the past 5 years which had increased in size gradually. There was no history of pain over the swelling or increase in the size during episodes of upper respiratory tract infection. Clinical examination revealed a cystic fluctuant mass of 2 cm × 3 cm just over the hyoid bone which moved with deglutition and protrusion of tongue. Ultrasound of the neck revealed TG cyst and a normal situated thyroid gland. FNAC of the swelling was confirmatory of TG cyst. He underwent Sistrunk surgery [Figure 2] and the postoperation period was uneventful.
The third case is a case of 85-year-old woman who presented with an anterior neck swelling for the past 10 years and difficulty in breathing for the past 1 month which was gradually worsening. There was no history of dysphagia, pain, or change in voice. On examination, 10 cm × 8 cm cystic swelling was seen in the neck which moved with deglutition but not on protrusion of tongue. The rest of head and neck examination was unremarkable. FNAC of the lesion showed benign cells. She underwent excision of the cyst and the postoperative biopsy was reported as a TG cyst. There was no evidence of recurrence on subsequent follow-up.
| Discussion|| |
TG duct is an embryonic attachment of the thyroid gland and mostly involutes by the 5 th embryonic period of gestation. Failure of this involution to occur leads to the development of TG duct cyst. The cysts are generally located at the level of hyoid bone although they can be present anywhere along the TG tract. They may contain accessory thyroid tissue which in some cases may be the only functioning thyroid tissue in the body. FNAC is diagnostic and ultrasound neck should be performed to detect the presence of normal positioned thyroid gland. Treatment consists of Sistrunk procedure in which the whole cyst along with hyoid bone and base of tongue along with the tract is removed up to the foramen caecum. ,
TG cyst mostly presents in children and young adults and rarely in the elderly and therefore may be a diagnostic challenge as they are not often considered in the differential diagnosis of midline swelling in this age group. This can be detrimental as inadequate surgical resection may be done which can lead to higher rates of recurrence. 
Malignant transformation is known to occur in the cyst most common of which is papillary carcinoma. , There is not much difference in the presentation of benign and malignant TG cysts although rapid increase in size is mostly associated with malignant change. Some people have advised only observation in the treatment of TG cysts in the elderly,  but we consider early surgical excision to be more appropriate as there is a possibility of the cyst enlarging because of mucin production or infection and also the rate of malignant transformation is higher in the elderly. 
| Conclusion|| |
TG cysts although common in children should still be considered in the differential diagnosis of a midline cystic swelling in the elderly. Early diagnosis and complete excision of TG cyst is prudent in the elderly as there is a higher risk of malignant transformation in them.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]