Giant thyroglossal duct cyst causing hoarseness due to laryngeal compression in an elderly patient: a case report

Thyroglossal duct cysts (TGDCs) are among the most common congenital neck anomalies and account for a substantial proportion of congenital neck lesions. Although they usually present in childhood, often within the first decade of life, first presentation in elderly patients is distinctly uncommon. This report presents a case of a giant TGDC causing hoarseness due to laryngeal compression in an elderly patient treated at the Department of Otorhinolaryngology Head and Neck Surgery of the Affiliated Hospital of Guizhou Medical University. The patient presented with a 2-year history of an anterior midline neck mass and a 1-year history of progressive enlargement with hoarseness, occasional phonation difficulty, foreign-body sensation, and swallowing obstruction. Preoperative ultrasound and neck CT showed a giant cystic-solid midline cervical lesion surrounding the hyoid bone and extending inferiorly with compression and narrowing of the adjacent laryngeal cavity. CT also identified an incidental small nodule in the lower region of the left thyroid lobe. Preoperative FNAC and detailed thyroid function test results were not documented in the available record and are acknowledged as limitations. The patient underwent open excision based on the Sistrunk principle with partial hyoid bone resection. Histopathological examination supported TGDC with old hemorrhage and cholesterol crystal formation. Postoperatively, the patient's hoarseness and swallowing-related symptoms resolved, and no abnormality was observed on 3-month follow-up laryngoscopy.