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From infants to adults: Why can thyroglossal duct cysts exist quietly for decades?
A thryoglossal cyst is a fibrous cyst arising from a persistent thyroglossal duct and usually present at birth. These cysts are caused by cells and tissue that remain during the formation of the thyroid gland and arise through the development of the thymus gland. Although these cysts are present in infancy, they are often not diagnosed until later in life, especially in adult life.
Thyroglossal duct cysts are the most common cause of a midline neck mass, typically arising anywhere from the base of the tongue to the clavicular depression in the neck.
Symptoms and Signs
A thyroglossal duct cyst typically presents as a palpable, painless midline neck mass, usually located below the hyoid bone. These bumps rise with the movement of the tongue when swallowing or sticking out the tongue because they are connected to the tongue structure.
About half of thyroglossal duct cysts are not diagnosed until adulthood and may present with symptoms of infection without warning.
The lump may be painful because of infection and in some cases may cause difficulty swallowing. The primary location of thyroglossal duct cysts is in or near the midline, between the thyroid foramen and the hyoid bone.
Complications
Infection
If a thyroglossal duct cyst is not treated, it may become infected. Bacterial infection can cause a lump to grow rapidly and may cause difficulty breathing or swallowing, along with swelling of the surrounding soft tissue.
Thyroglossal duct fistula
When a cyst ruptures unexpectedly, it forms a waste channel called a thyroglossal fistula. This condition usually occurs because the thyroglossal duct was not completely removed during surgery, resulting in bleeding and swelling.
Thyroglossal duct cyst cancerAlthough extremely rare, in less than 1% of cases, thyroglossal duct cysts may harbor cancer, usually papillary thyroid carcinoma arising from ectopic thyroid tissue.
Causes
A thyroglossal duct cyst is a congenital defect that occurs when the thyroid gland begins to form at the base of the tongue during embryonic development and then creeps down a passage in the neck. In theory, the duct should disappear once the thyroid reaches its final position, but in some people, part of the duct remains, forming small cysts that may fill with fluid and mucus during life.
Diagnosis
Diagnosing a thyroglossal duct cyst requires evaluation by a qualified medical professional and is usually determined through a physical examination. It is important to identify whether the cyst contains thyroid tissue to assess the extent of the cyst.
Approximately 75% of cases present with a midline swelling that rises when the tongue is protruded.
Treatment options
Generally speaking, surgical removal is necessary if the patient has difficulty breathing or swallowing, or if the cyst becomes infected. Even if there are no obvious symptoms, surgery is an effective preventive measure to avoid future infection or tumor development.
The famous "Sistrunk operation" is one of the main surgical methods for thyroglossal duct cysts. It can effectively remove the cyst and its surrounding tissues, and remove part of the hyoid bone to ensure complete removal of the cyst waste duct.
EpidemiologyAbout 90% of cases are detected before the age of 10 years, and 70% of neck abnormalities are associated with thyroglossal duct cysts. Thyroglossal duct cysts occur in up to 7% of the population and may not cause any symptoms until the disease is diagnosed.
Behind this situation, why can this cyst exist silently in the human body for so long without causing any symptoms?
