Can you provide information on thyroglossal-duct cysts? Is there an alternative treatment besides surgery to reduce the swelling and tenderness? There is a fluctuation in size and an occasional clicking sound when swallowing.

Phyllis

At birth, the thyroid gland is located in front of the windpipe (trachea), just above the breastbone (sternum). It wasn't always there, however. In the embryo, there is a nest of cells located in the throat, in an area where the tongue will eventually form. As the embryo grows, this clump of cells descends lower into the neck to form the thyroid gland. The thyroglossal duct is a persistent connection between the thyroid gland and the region, near the base of the tongue, where the thyroid cells originated.

The thyroglossal duct usually disappears by the time of birth, but remnants of it may persist into childhood. These remnants can fill with fluid, forming thyroglossal-duct cysts (TGDCs). Usually, TGDCs appear in childhood, but they occasionally arise in older individuals.

TGDCs occur in the middle of the neck, and they are usually between the sternum and the hyoid bone. The hyoid bone is a free-floating, horseshoe-like bone located above the Adam's-apple cartilage (thyroid cartilage). TGDCs typically bob up and down when the individual swallows. Other lesions (particularly thyroid-gland cysts or tumors) can masquerade as TGDCs. Not all "bobbing lumps" in the middle of the neck are TGDCs.

A TGDC will not go away. TGDCs are cosmetically obvious, and they can become infected, causing pain and scarring. There is even a small chance of developing a thyroid cancer within a TGDC, if it is left untreated for many years.

Swelling and tenderness of a TGDC suggests the presence of infection. As with any bacterial infection, the acute problems will respond to antibiotics and "local care" (frequent application of a warm washcloth to the cyst). A doctor can also insert a needle into the cyst, to aspirate (suck out) the contents of the cyst. This will not eliminate the cyst, but it can temporarily ease the discomfort, and the aspirated material can be sent to a microbiology lab for further study. Such a study would be useful if your doctor needs guidance choosing an appropriate antibiotic to treat your infection.

In answer to your question: Antibiotics and local care will treat each infection, as it arises, but the only treatment that will truly rid you of this problem is an operation. The operation requires general anesthesia (meaning you will be completely asleep for the procedure). An incision is made over the cyst, and the cyst is carefully dissected from the surrounding normal tissues of the neck. It is then crucial for your surgeon to remove a core of tissue extending up and back from the cyst, a core that will include the mid-portion of the hyoid bone, and will extend up toward the base of the tongue. This is an essential step, because this tissue contains other remnants of the thyroglossal duct. If this step is omitted, recurrence rates are very high.

Your surgeon can give you more information about this procedure. You may want to ask the surgeon about the risks of surgery, the need for postoperative hospitalization, and the anticipated recovery time. It would also be prudent to ask your doctor, "How do you know this is a thyroglossal duct cyst?" This is an important question, because other neck masses would be treated very differently.

Finally, it is important for your doctor to be aware of the fact that such a mass is, on occasion, not a TGDC, but an ectopic thyroid gland. Ectopic means "out of place." Before removing a suspected TGDC, it is thus a good idea to make sure that the patient has a NORMAL thyroid gland in its NORMAL location. This can be readily accomplished with an ultrasound exam of the neck.