A 17-year-old boy is concerned as he has noticed a lump in the middle of his neck. His mother has hypothyroidism and is concerned that her son may have it too. He has no other symptoms and is otherwise well. On examination, you note a painless swelling in the midline that rises when he sticks out his tongue.
1. What is the most likely diagnosis?

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The diagnosis, in this case, is a thyroglossal cyst.

The lower part of the thyroglossal duct develops into the thyroid gland, and if a portion of this duct remains patent, it forms a thyroglossal cyst.

They usually present at 15-30 years of age and are located in the midline just above the hyoid cartilage. They can become inflamed and painful but mostly present as painless swellings that rise on tongue protrusion.

2. Give two complications that can occur.

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Potential complications include:

  • Infection
  • Thyroglossal fistula
  • Thyroglossal duct carcinoma
3. How is this condition treated?

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Treatment is with surgical resection of the duct to the base of the trunk and removal of the central portion of the hyoid bone (Sistrunk procedure).

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