Single-Stage Management of Benign Thyroglossal Duct Cyst in the Setting of Papillary Thyroid Cancer

The presented case is unique as the patient presented with biopsy-proven papillary thyroid carcinoma (PTC) of the thyroid gland with an incidentally found concurrent thyroglossal duct cyst (TGDC) on computed tomography (CT). The patient was managed with a one-stage procedure.

A 26-year-old previously healthy female presented with a progressively enlarging neck lump over 6 months. Thyroid ultrasound revealed a 2.6 cm mass of the inferior right thyroid lobe, classified as TIRADS 5. Subsequent fine-needle aspiration of the mass confirmed PTC (Bethesda VI). A neck CT scan revealed a calcified, heterogeneous 2.6 cm mass in the right thyroid lobe along with a cystic lesion at the base of the tongue with likely extension into the floor of the mouth, consistent with a TGDC. The patient underwent simultaneous thyroidectomy and TGDC excision in a single operative session after discussion due to concerns for possible malignancy within the thyroglossal duct as well as possible enlargement of the TGDC leading to dyspnea or even dysphagia. At follow-up, the patient was doing well.

TGDCs are typically benign which is consistent with the findings in this case. The presence of biopsy-proven glandular thyroid cancer and an incidentally found TGDC present a unique challenge in surgical decision-making. In this case, there were no signs on imaging of malignancy of the TGDC so it was likely a primary glandular PTC. In this case, a one-stage procedure, combining total thyroidectomy and Sistrunk procedure, was selected based on the confirmed diagnosis of PTC with slight potential for synchronous cancer in the TGDC as well as prophylaxis against future aerodigestive tract symptomatology caused by the TGDC.