Thyroglossal duct cyst carcinoma in a young female: reassessing the need for total thyroidectomy after Sistrunk operation

Abstract

Thyroglossal duct cyst carcinoma (TGDCCa) is a rare malignancy, accounting for approximately 1% of thyroglossal duct cysts. Preoperative diagnosis is challenging because clinical and imaging findings often mimic benign lesions. Papillary thyroid carcinoma is the most common histological subtype, and optimal management, particularly the role of total thyroidectomy remains controversial. A 24-year-old female presented with a slowly progressive midline neck swelling of three years’ duration. Ultrasonography and computed tomography (CT) revealed a cystic infra-hyoid lesion with a small solid component and microcalcifications. She underwent a Sistrunk procedure. Histopathological examination demonstrated a 4 mm focus of papillary carcinoma confined to the cyst wall with tumour-free margins, no hyoid bone invasion, and a normal thyroid gland. After counselling, she opted for surveillance rather than thyroidectomy. Postoperative thyroglobulin levels and serial imaging remained normal. This case highlights the indolent nature of low-risk TGDCCa and supports individualized management, with Sistrunk alone being adequate in select patients.