Endocrine Abstracts

JOINT134

Introduction: The thyroglossal duct cyst is a congenital cyst that arises during the embryological development of the thyroid, resulting from incomplete obliteration of the thyroglossal duct. Malignant transformation is rare (<1%), with papillary thyroid carcinoma being the most common malignancy encountered. Treatment remains controversial, particularly concerning the need for additional interventions following Sistrunk’s procedure, such as total thyroidectomy, lymph node dissection, and radioiodine therapy.

Aims: To assess the experience of our center in the management of papillary carcinoma arising from a thyroglossal duct cyst.

Materials and Methods: A retrospective study of patients diagnosed with papillary carcinoma arising from a thyroglossal duct cyst, followed at our center between 1987 and 2023.

Results: A total of 10 patients were included in the study, with a predominance of females (n = 6). The median age at diagnosis was 59 years. All patients initially presented with a painless cervical mass. In 9 cases, the diagnosis was established postoperatively. Seven patients underwent Sistrunk procedure, while 3 underwent cyst excision. Total thyroidectomy was performed in all cases, with 3 patients undergoing the procedure during the same surgical time and 7 in a subsequent operation. During total thyroidectomy, prophylactic central compartment lymph node dissection was performed in 4 patients, and 1 of these also underwent lateral cervical lymph node dissection due to the presence of lymphadenopathy. Papillary carcinoma was concurrently identified in the thyroidectomy specimen in 5 patients; 4 of these were microcarcinomas, and the remaining had a tumor measuring 12 mm. Lymph node metastases were identified in 3 patients. Nine patients received radioactive iodine therapy. An excellent response was observed in 9 patients, while 1 patient remains under surveillance with a biochemical incomplete response, exhibiting a stable thyroglobulin level of less than 1.8 ng/ml. The median follow-up period was 131 months.

Conclusions: Currently, there are no universally accepted guidelines for the management of papillary carcinoma arising from a thyroglossal duct cyst. While fine-needle aspiration cytology is commonly used, its diagnostic accuracy is limited, with the majority of diagnoses being confirmed postoperatively through histopathological examination. The diagnosis of papillary thyroid carcinoma originating from a thyroglossal duct cyst requires a thorough evaluation of both the thyroid gland and bilateral cervical lymph nodes. Regarding treatment, the favorable outcomes observed in our cohort suggest that an overly aggressive approach may not be necessary in most cases. Instead, an individualized treatment strategy, tailored to each patient’s specific risk factors, may be more appropriate.