Medbear thyroid

Question 1

Define thyroglossal cyst and its pathology

Answer 1

Congenital cyst of epithelial remnants of the thyroglossal tract

• Cystic expansion of the remnant thyroglossal tract
• Failure of the thyroglossal duct to obliterate after the descent of the thyroid from the FORAMEN CECUM

Normally duct disappears at 5-8 weeks of gestation

Question 2

If the thyroglossal cyst is infected, what is the appropriate management?

Answer 2

• Direct antibiotic coverage
• Avoid I&D (Risk seeding cells outside the cyst which can increase the risk of recurrence)
• Wait for 3 months for inflammation to resolve prior to surgery

Question 3

State the histology of thyroglossal cyst

Answer 3

Cyst lined by pseudostratified ciliated columnar epithelium and squamous epithelium

Question 4

What is the designated investigation and treatment for thyroglossal cyst?

Answer 4

• Pre-op TFT
• CT neck with contrast -> confirms diagnosis
• US thyroid and thyroglossal cyst -> WELL-DEFINED, THIN-WALLED, hypo-echoic mass with posterior acoustic enhancement in midline
• SISTRUNK OPERATION - en bloc cystectomy

Question 5

What is the risk factor of recurrence in thyroglossal cyst?

Answer 5

• Simple cyst excision (38 - 70%)
• Intra-operative cyst rupture
• Presence of cutaneous component secondary to infection
• Post-operative wound infection