A large thyroglossal duct cyst with atypical features in a 73-year-old male: A case report

Thyroglossal duct cysts (TGDCs) are congenital anomalies arising from incomplete obliteration of the thyroglossal duct (TGD), typically presenting in childhood. While rare in the elderly, they can occur in adulthood and may remain asymptomatic until complications such as infection or malignant transformation arise.

A 73-year-old male presented with progressively enlarging left-sided neck swelling over 15 years. Clinical and radiological evaluation confirmed the diagnosis of a TGDC. Surgical excision was performed via the Sistrunk procedure, with post-operative histopathology confirming the pre-operative diagnosis of TGDC. The patient recovered well with no complications or recurrence.

Clinical presentation of TGDC is typically an anterior neck enlargement or a non-tender midline neck mass, moving with swallowing, related to the hyoid bone. The typical differential diagnosis of TGDCs include cystic and midline neck masses. Atypically, our patient had a lateral cystic mass which was immobile with swallowing.

This case highlights the importance of considering TGDCs as a differential diagnosis in elderly patients despite their rarity. TGDCs may present with complications or atypical features of TGDCs which require more evaluation. Surgical intervention, specifically the Sistrunk procedure, remains the optimal management strategy for TGDCs, offering excellent outcomes and reducing the risk of recurrence.