Individualized Surgical Management for Thyroglossal Duct Cyst-Papillary Thyroid Carcinoma: A Case Series.

Abstract

Thyroglossal duct cyst (TGDC) associated carcinoma is rare, accounting for less than 2% of TGDC cases. The majority of cases are classified as papillary thyroid carcinoma (PTC). Standard treatment for TGDC-PTC involves a Sistrunk procedure and prophylactic total thyroidectomy (TT). However, the necessity of these extensive surgical interventions remains debated. This report aims to explore whether individualized surgical approaches may reduce morbidity while maintaining favorable oncological outcomes. Retrospective case series of three patients with TGDC-PTC. The age range at presentation for our patients with TGDC-PTC was 26 to 50. Case 1 involved a 38-year-old patient with a cystic mass near the hyoid bone and submental lymphadenopathy who underwent cyst excision with level Ia lymph node clearance. Case 2 is of a 50-year-old patient with a history of TGDC-PTC who presented with a recurrent neck mass 9 years after the initial surgery and underwent a revision Sistrunk procedure. Case 3 presents a 26-year-old patient with a large TGDC and a benign thyroid nodule who underwent a Sistrunk procedure. All three patients had PTC confirmed by final pathology. All had no evidence of recurrent disease at follow-up evaluations ranging from 1 to 12 years. This case series demonstrates the feasibility and safety of individualized surgical management for TGDC-PTC. Risk stratification allowed for tailored interventions and avoided overly aggressive approaches. Further studies are needed to establish definitive guidelines for managing TGDC-PTC, particularly in low-risk patients.