Thyroglossal Duct Cysts in Children & Adults
What are thyroglossal duct cysts (TDC)?
Some people are born with small soft lumps in the middle of their throats. These lumps, which can be felt and seen, are called thyroglossal duct cysts (TDC). These cysts are small, typically measuring about 2 centimeters (cm) around. They’re also rare, typically affecting about 7% of the U.S. population.
Thyroglossal duct cysts can affect children and adults, but most cysts are found in children age 10 and younger. These cysts are almost always benign — less than 1% of all thyroglossal duct cysts become cancerous. Adults are more likely than children to develop TDC cancer. Thyroglossal duct cysts are treated with surgery. Once removed, most thyroglossal cysts don’t come back.
How serious is a thyroglossal duct cyst?
Most thyroglossal duct cysts don’t cause serious medical problems. There are exceptions, though, including:
- Very rarely, cysts become cancerous.
- Some cysts cause dysphagia (problems swallowing food or liquid.)
- Cysts can become infected. An infected cyst can hurt.
Can a thyroglossal duct cyst go away on its own?
No, thyroglossal cysts remain in place until they’re removed with surgery.
Symptoms and Causes
What are thyroglossal duct cyst symptoms?
If you or your child has a thyroglossal duct cyst, you might first notice the cyst because there’s a lump on your or your child’s throat that moves up when you or your child swallows. You also may spot a cyst when you or your child sticks out their tongue. Sometimes, healthcare providers discover these cysts while doing a physical examination for another reason. Other symptoms include:
- Thyroglossal duct cysts can be felt through your skin. If you touch the cyst, it may feel soft, smooth and round, like a tiny ball of cookie dough.
- These cysts can swell and hurt if you or your child develops an upper respiratory tract infection that spreads to the cyst.
- Thyroglossal duct cysts can rupture, oozing fluid through your or your child’s skin.
- These cysts can make it hard to swallow food or liquids.
What are the symptoms of thyroglossal duct cyst cancer?
Thyroglossal duct cyst cancer is extremely rare, with fewer than 300 cases reported over more than 100 years. And when it occurs, it affects more adults than children. People can have TDC cancer for years without having any symptoms. Healthcare providers often discover this cancer while treating other medical conditions such as goiters. Symptoms that may be signs of thyroglossal duct cyst cancer include:
- A noticeable lump in the front of your throat that appears to be getting larger.
- A noticeable lump in the front of your throat that feels hard.
- Swollen lymph nodes.
- Difficulty swallowing food or liquids.
What causes thyroglossal duct cysts?
These cysts develop during gestation when your body begins building your thyroid gland. That’s the butterfly-shaped gland that makes hormones that control your metabolism. Metabolism is the pace at which your body processes things (how fast it burns food to make energy and heat).
To build the gland, thyroid cells travel from the base of your tongue to your hyoid bone. That’s a U-shaped bone that supports your tongue. Thyroid cells make that journey through what’s called the thyroglossal tract. Typically, this tract closes off and dissolves once your thyroid glands are in place. But tracts that don’t close off can fill up with fluid and mucus and become thyroglossal cysts. Researchers don’t know why some people’s tracts remain don’t dissolve.
Diagnosis and Tests
How do healthcare providers diagnose thyroglossal duct cysts?
Healthcare providers diagnose a thyroglossal duct cyst by examining your or your child’s throat and by performing an ultrasound to determine the cyst’s size.
How do healthcare providers diagnose thyroglossal duct cyst cancer?
Many times, healthcare providers discover this form of cancer while treating other medical conditions, such as surgery to remove a cyst. If they suspect a cyst may be cancerous, healthcare providers may use these tests to confirm their preliminary diagnosis:
- Fine needle biopsy: Healthcare providers use a thin, hollow needle and a syringe to extract cells, fluid or tissue that’s then examined under a microscope or tested in a laboratory to learn if the cysts contain cancer cells.
- Computed tomography (CT) scan: CT scans use a series of X-rays and a computer to create three-dimensional images of your throat.
- Magnetic resonance imaging. (MRI): This is a painless test that uses a large magnet, radio waves and a computer to produce very clear images of your throat.
Management and Treatment
Does a thyroglossal duct cyst need to be removed?
Your healthcare provider may recommend surgery to remove the cyst if it’s infected or it makes it hard for you or your child to swallow food or liquid. They may also recommend surgery even if your cyst doesn’t have symptoms.
What surgery removes thyroglossal duct cysts?
The most common surgery is a procedure called Sistrunk surgery. To do this surgery, healthcare providers make an incision in your or your child’s throat so they can remove the cyst, any remaining thyroglossal tract and the middle part of your or your child’s hyoid bone.
How long does it take to recover from Sistrunk surgery?
People who have Sistrunk surgery can return to school or work one week after surgery. Healthcare providers may recommend waiting two to six weeks after surgery before starting strenuous activity, particularly lifting heavy objects.
How do healthcare providers treat thyroglossal duct cyst cancer?
If you have TDC cancer, healthcare providers may recommend you have a Sistrunk procedure, followed by a check of your lateral neck lymph nodes and your thyroid. Depending on what they find, they may recommend additional surgery such as:
- Total thyroidectomy: Healthcare providers remove all or part of your thyroid gland.
- Lateral neck dissection: Healthcare providers remove all lymph nodes in your neck that may be affected by your cyst.
- Radioactive iodine treatment (RAI): This treatment involves taking pills containing radioactive iodine to kill any remaining cancer cells.
Can thyroglossal duct cysts be prevented?
Thyroglossal duct cysts are congenital, meaning people are born with the cysts.
Outlook / Prognosis
What can I expect if my child has a thyroglossal duct cyst?
Most of the time, cysts removed with Sistrunk surgery don’t come back, essentially curing the condition.
What can I expect if I have thyroglossal duct cyst cancer?
Studies show surgery cures 95% of thyroglossal duct cyst cancers. Some people may have radioactive iodine treatment after surgery.
My child had a thyroglossal duct cyst removed. When should I contact their healthcare provider?
You should contact your child’s healthcare provider if:
- They have a fever: A temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher.
- They have any signs of infection, including redness, swelling or pain.
- Their incision is draining.
- They have pain that doesn’t go away after taking the prescribed pain medicine.
I had a cancerous cyst removed. When should I see my healthcare provider?
Healthcare providers may perform several procedures to treat thyroglossal duct cyst cancer. Ask your healthcare provider about specific post-surgery complications. Generally speaking, you should contact your healthcare provider if:
- You have a fever: A temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher.
- You show any signs of infection, including redness, swelling or pain.
- Your incision is draining.
- You’re in pain, and your pain doesn’t go away after taking your prescribed pain medicine.
What questions should I ask my healthcare provider?
Thyroglossal duct cysts are rare, so you may be surprised to learn your child has one. If you have a cancerous thyroglossal duct cyst, you’ll also have questions for your healthcare provider. Here are some suggestions for that conversation:
- What is a thyroglossal duct cyst?
- Why did I/my child develop one?
- Will I/my child need surgery?
- If I have/my child has surgery, will the cyst come back?
- My cyst is cancerous. What treatment do you recommend?
- What are treatment side effects?
A note from Cleveland Clinic
It may be unnerving to find an unusual lump on your or your child’s throat. If the lump turns out to be a thyroglossal duct cyst (TDC), you may take some comfort in knowing these cysts are almost always benign and don’t come back after they’re surgically removed. There are times, however, when thyroglossal duct cysts are cancerous. TDC cancer is treated with surgery. Studies show 95% of thyroglossal duct cyst cancer is cured with surgery and follow-up treatment. Thyroglossal duct cysts usually aren’t painful and most people don’t notice them unless the cyst makes it hard to swallow. If you notice a lump on your throat or your child’s throat, consider contacting your healthcare provider so they can examine the lump and recommend treatment.
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