10/15/2025
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The answer to the previous post is…a thyroglossal duct cyst! A TGDC is a congenital anomaly that forms due to incomplete involution of the thyroglossal duct. This patient presented later in life with this painless mass (usually this is diagnosed at younger ages). Surgery (by an ENT surgeon) is required to remove the cyst (the Sistrunk procedure - which requires removing the center of the hyoid bone).
Diagnosis requires a physical exam and usually an ultrasound to confirm it’s a TGDC and not a thyroid mass, lipoma, swollen lymph node, etc. I forgot to record him sticking out his tongue because a TGDC will move with protrusion of the tongue, whereas the other pathologies would not.
There are a lot of USMLE pearls in this post! There are frequently questions about a TGDC. The main things to remember are: TGDC is a congenital lesion caused by leftover embryonic tissue, it moves with sticking out the tongue, and treatment is the Sistrunk procedure with the key part being removing the center of the hyoid bone and the segment of the TGDC at the base of the tongue (which is why the cyst moves with tongue protrusion).
