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Thyroglossal Cyst
Learn symptoms, causes, how to treat pediatric thyroglossal cyst, and when to contact a pediatric surgeon in Singapore.
What Is Thyroglossal Cyst In Children?
A thyroglossal cyst is a fluid-filled lump that appears in the front center of the neck, typically just below the Adam's apple. It's the most common type of neck lump that children are born with, though it may not be noticed until later in childhood. This cyst forms along the path where the thyroid gland traveled during early development in the womb.
The thyroglossal cyst forms from a small tube called the thyroglossal duct thyroglossal duct, which normally disappears before birth. When parts of this duct don't close completely, fluid can collect and form a cyst. The cyst is usually painless and may move up and down when your child swallows or sticks out their tongue, which is a characteristic feature that helps doctors identify it.
While thyroglossal cysts are benign, they often require treatment through thyroglossal cyst excision because they can become infected and cause problems. Understanding this condition helps parents know when to seek evaluation and what to expect from treatment.
Common Symptoms of Thyroglossal Cyst
What You Might Notice
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Painless lump right in the center of the neck, between the chin and collarbone
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Smooth, round bump that feels soft
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Moves when swallowing - goes up and down as your child swallows
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Moves with tongue - when your child sticks out their tongue, the lump moves
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Grows slowly over months or years
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Size varies from marble-sized to golf ball-sized
Signs of Infection
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Sudden swelling and rapid growth of the cyst
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Pain and tenderness in the neck
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Redness and warmth over the cyst
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Difficulty swallowing or discomfort when swallowing
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Fever indicating infection
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Drainage of pus if the cyst ruptures through the skin
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Voice changes in rare cases if swelling is significant
When to Call the Doctor
Contact us if you notice a lump in the front of your child's neck, and it moves when your child swallows. Your child might develop signs of infection or have difficulty swallowing or breathing. We'll perform an examination and may recommend imaging studies including a thyroid scan to ensure the thyroid gland is functioning normally before planning thyroglossal cyst excision.
What Causes Thyroglossal Cyst in Children?
Thyroglossal cysts result from normal developmental processes that don't complete as expected during pregnancy.
Thyroid Development in the Womb
During the very early weeks of pregnancy (around weeks 3-7), the thyroid gland begins forming at the base of the baby's tongue. As the fetus grows, the thyroid gland needs to move down to its final position in the lower neck. It travels along a specific path called the thyroglossal duct.
Normally, once the thyroid reaches its proper location, this duct closes up and disappears completely before the baby is born. However, in some children, parts of the duct remain open or form small pockets that don't disappear. These leftover portions can fill with fluid, creating a thyroglossal cyst.
Why It Happens
The exact reason why the thyroglossal duct fails to close completely in some children isn't fully understood. It's simply a variation in normal development. It’s important for parents to remember that this is not caused by anything you did during pregnancy, it cannot be prevented, it's not hereditary (doesn't usually run in families), and it's one of the most common developmental variations in the neck.
Where Cysts Can Form
Because the thyroid gland travels a specific path during development, thyroglossal cysts can form anywhere along that path. Most commonly, they form just below the hyoid bone in the midline of the neck. They can also appear above the hyoid bone, at the base of the tongue, or lower down near where the thyroid gland sits. The location affects the surgical approach for thyroglossal tract removal.
Consequences of Untreated Branchial Sinus
While branchial sinus is not dangerous, leaving it untreated often leads to repeated problems, especially infections.
Repeated Infections
The most common problem with thyroglossal cysts is that they can keep getting infected. Each time this happens, your child experiences pain, swelling, and fever, needs antibiotics, and may miss school. Without thyroglossal cyst excision, infections come back even after successful antibiotic treatment. Some children get infections several times a year.
Abscesses
Sometimes infections progress to form an abscess (a pocket of pus).Abscesses are very painful, cause rapid swelling, and may require emergency drainage. Multiple infections create scar tissue that makes thyroglossal tract removal surgery more complicated later.
Spontaneous Drainage
If a cyst becomes severely infected, it may rupture through the skin, creating an opening that drains pus. This opening (called a fistula) won't heal on its own and requires surgical thyroglossal tract removal including the Sistrunk procedure to fully resolve.
Difficulty Swallowing or Breathing
Large thyroglossal cysts can press on the throat, making swallowing uncomfortable or, in rare cases, affecting breathing. This is more likely to happen if the cyst becomes infected and swells rapidly.
Delayed Surgery Complications
Each infection episode causes inflammation and scarring around the cyst. When surgery is finally performed after multiple infections, the procedure becomes more challenging due to distorted tissue, increasing the risk of incomplete removal, recurrence, and more visible scarring. This is why many surgeons recommend thyroglossal cyst excision before complications occur, ideally during a time when there is no active infection.
How to Treat Thyroglossal Cyst in Children
The definitive treatment for thyroglossal cyst is surgical removal through a procedure called the Sistrunk procedure. At The Little Surgery, Dr. Ong Lin Yin provides comprehensive care including proper evaluation with thyroid scan when needed, expert thyroglossal cyst excision, and complete thyroglossal tract removal.
Diagnosis and Pre-operative Evaluation
Dr. Ong will examine the lump, check how it moves when your child swallows or sticks out their tongue (characteristic movements of thyroglossal cysts), assess the size and location, and look for signs of infection.
Before surgery, it's important to confirm that your child has a normally functioning thyroid gland in the correct location. We may order a thyroid scan (also called a thyroid ultrasound) to visualize the thyroid gland and confirm it is present and normal. We also use ultrasound to see the thyroglossal cyst clearly, determine its exact location, and check its relationship to nearby structures.
Thyroid function tests may be done to ensure the thyroid gland is working properly.
Treating Infection
If your child comes to us with an infected thyroglossal cyst, we first treat the infection before scheduling surgery.
Oral or intravenous antibiotics are prescribed to control the infection. If an abscess has formed, it may need to be drained with a needle or small surgical incision to provide immediate relief. This is only temporary, as definitive thyroglossal cyst excision will still be needed.
After treating an infection, we typically wait 6-8 weeks before performing thyroglossal cyst excision. This allows all inflammation to resolve, makes the surgery safer and more effective, and improves healing outcomes.
Surgery - The Sistrunk Procedure
The Sistrunk procedure is the gold standard for thyroglossal cyst excision and has the lowest recurrence rate.
Unlike simply removing the cyst, the Sistrunk procedure involves removing the cyst, the entire thyroglossal tract, and the middle portion of the hyoid bone. Hyoid bone excision is necessary because the thyroglossal tract is intimately connected to this bone. Removing the central portion of the hyoid bone ensures complete thyroglossal tract removal and dramatically reduces the chance of the cyst coming back. Don't worry; removing part of this small bone doesn't affect swallowing, talking, or neck movement.
The surgery is performed under general anesthesia, so your child will be asleep and comfortable. The procedure typically takes 1-2 hours. Dr. Ong plans the incision location, usually in a natural neck crease to minimize visible scarring.
Most children go home the same day or the next morning. Pain is usually mild to moderate and controlled with regular pain medication. There may be some swelling and bruising that improves over the first week.
Recovery at Home
Keep the incision clean and dry. Most children feel well enough for light activities within a few days. Avoid strenuous activities and contact sports for 3-4 weeks. Children typically return to school within a week. The sutures are dissolvable and don't need removal.
Your child can eat normally, though soft foods may be more comfortable for the first few days. Swallowing may feel slightly different initially but quickly returns to normal.
With careful surgical technique, the scar typically fades significantly over time. Most become barely noticeable within 6-12 months.
We schedule follow-up visits to check healing progress, ensure there are no complications, review the report from examining the removed cyst, and monitor for any signs of recurrence (which is rare with the Sistrunk procedure).
Why Choose The Little Surgery for Branchial Sinus Treatment
We provide expert care for thyroglossal cysts including thorough evaluation with thyroid scan, treatment of infections when needed, and precise thyroglossal cyst excision using the Sistrunk procedure with complete thyroglossal tract removal and hyoid bone excision.
Experienced Pediatric Surgeon
Dr. Ong Lin Yin brings over 20 years of experience in paediatric surgery, including extensive expertise in evaluating and treating swollen lymph nodes in children. As the former Head of Department of Paediatric Surgery at KK Women's and Children's Hospital, she has consistently achieved excellent outcomes of thyroglossal cyst treatment with very low recurrence rates.
Comprehensive Care
We ensure thorough evaluation before surgery including physical examination, thyroid scan to confirm normal thyroid gland location and function, ultrasound imaging to plan the surgical approach, and blood tests when needed.
Dr. Ong performs the complete Sistrunk procedure with careful attention to complete thyroglossal tract removal, proper hyoid bone excision, tissue dissection to minimize scarring, and protection of all important neck structures. Her experience with this specialized procedure ensures the best possible outcomes.
Family-centered Approach
We understand that parents have concerns when their child needs surgery. Dr. Ong provides clear explanations of the condition and why the Sistrunk procedure is the best treatment, along with detailed information about what to expect before, during, and after surgery. As a mother herself, she understands family worries and ensures everyone feels informed and comfortable.
Contact The Little Surgery Today
If your child has a lump in the front of the neck indicating thyroglossal cyst, we can help.
Contact The Little Surgery today and take the first step toward ensuring your child's health and happiness.