P-57 POST-OPERATIVE DYSPHONIA FOLLOWING SISTRUNK PROCEDURE IN A 43-YEAR-OLD FEMALE WITH THYROGLOSSAL DUCT CYST: A CASE REPORT
Authors: Yahia Seif Eldin , Terrance Steffy , Gautam Subash 
Published: January 2025

Abstract

Introduction
Thyroglossal duct cysts are congenital cervical anomalies that present as midline neck lumps, typically connected to the hyoid bone. Although common in children, they are less frequently observed in adults. The global prevalence of thyroglossal cysts is approximately 7%, with an equal distribution between males and females. Most of these cysts are benign, with only about 1% associated with malignancy. Recurrence is the most common postoperative complication, but dysphagia and dysphonia, as observed in our case, are also potential complications.

Clinical Case
We reported a case of a 43-year-old Omani woman who presented with a four-month history of neck swelling, pain, and difficulty eating. Her medical history included an incidental pituitary adenoma diagnosed two years prior, resolved childhood asthma, and a family history of hyperthyroidism. On examination, a 3 x 3 cm non-tender, mobile midline neck swelling was noted, with no lymphadenopathy.
Initial laboratory tests showed a white blood cell count of 3.57 x 10³/µL, hemoglobin of 10.2 g/dL, hematocrit of 32.3%, mean corpuscular volume of 78.6 fL, mean corpuscular hemoglobin of 24.9 pg, and red cell distribution width of 15.6%. Fasting blood glucose was 5.6 mmol/L. The differential count revealed decreased neutrophils at 38.60% and increased lymphocytes at 50.80%. Thyroid function tests and pituitary profile were normal.
Ultrasound confirmed an infected thyroglossal duct cyst. Histopathological evaluation identified a benign cyst lined with respiratory epithelium, featuring a thick fibrous wall, thyroid follicles, lymphoid aggregates, and mature bone with cartilage. The pathology report was negative for malignancy. The patient underwent an uneventful Sistrunk procedure. Postoperatively, she developed hoarseness and dysphonia, but no dysphagia or breathing difficulties. Auditory perceptual assessment indicated whispering aphonia, and indirect laryngoscopy showed bilateral mobile vocal folds with a minimal glottic gap. She was started on voice therapy.
Post-surgery, the patient was referred to the endocrinology clinic, where her the patient’s thyroid function tests and bone profile were normal, and she exhibited no symptoms of thyroid dysfunction. All other blood results were within normal ranges. Follow-up MRI showed no increase in pituitary adenoma size compared to two years prior. There were no recurrences or complications, and follow-up visits to ENT, surgical, and endocrinology clinics were satisfactory with no new complaints.

Conclusion
Thyroglossal duct cysts are rare in adults, but age or cyst size should not preclude their diagnosis. While these cysts typically range from 1.5 to 2.4 cm, larger cysts can pose challenges for diagnosis and surgical management or lead to various complications. To prevent postoperative dysphonia following a Sistrunk procedure, it is essential to ensure adequate voice rest after surgery, and initiate speech therapy early if needed.Figure 1Ultrasound showing a midline cystic lesion with internal echoes measuring 15 x 14 mm.