The thyroid gland originates from the median bud of the pharynx as an endodermal diverticulum during the third week of embryological development. The diverticulum migrates inferiorly as the thyroglossal duct and the caudal end becomes bilobed. By the seventh week, the gland reaches its final pretracheal position and the thyroglossal tract is obliterated. The origin of the tract remains as a pit on the base of the tongue called the foramen caecum. Ectopic thyroid tissue may be deposited in any position along the tract and can be mistaken for a thyroglossal cyst.
Initial evaluation includes a thorough head and neck examination.
Endoscopic examination of the upper airway is necessary to determine gland size and airway patency and to exclude other possible diagnoses. Palpation of the neck and ultrasound scanning are performed to check for presence of thyroid tissue in the normal position. 1 Using thyroxine to suppress TSH is the mainstay of conservative management, aiming to control gland size and local symptoms. Surgery is indicated when symptoms deteriorate despite medical treatment. Absolute indications are severe, repeated haemorrhage, dysphagia preventing adequate oral intake, and significant airway compromise.