Current management of thyroglossal-duct remnant

Thyroglossal-duct remnant (TGDR) should be differentiated from ectopic thyroid prior to surgical excision. The purpose of this study is to discuss our experience with TGDR and review the role of technetium 99m-labelled sodium pertechnetate (99mTc), thyroid function test (TFT), ultrasound (US), and computerized tomography (CT) scan in the management of TGDR.

This retrospective study comprised 24 (18 M:6 F) patients with TGDR, whose ages ranged between 3 and 52 years, 83.3% of whom were less than 30 years of age. The most common complaints were anterior neck swelling in 79% (19/24) and draining sinus in 37.5% (9/24). Other rare complaints include throat discomfort, hoarseness, and pain. Axial CT scan through the area of interest in four patients revealed intralaryngeal and extralaryngeal extension, with some cartilage destruction and pre-epiglottic extension in two patients. 99mTc and US and TFT demonstrated normal thyroid in 11 and 10 patient, respectively. Thyroid tissue element reported histologically in 58.3% (14/24) of cases. These 24 patients underwent 10 simple cyst excisions and 21 Sistrunk procedures. The rate of recurrence was 40% and 7%, respectively.

When the thyroid gland can be identified in the normal position, coexistent ectopic thyroid is seldom found. However, when ectopic thyroid is suspected, 99mTc and TFT are valuable tests. Furthermore, CT scan may be profitable when there is evidence of laryngeal involvement. Sistrunk's procedure replaces simple cyst excision and continues to be the mainstay treatment of TGDR.