The Cost of Not Looking: Preoperative Thyroid Evaluation and Staged Reoperation After Thyroglossal Duct Cyst Excision

Objective To examine a 26-year institutional experience of thyroglossal duct cyst (TGDC) excision, focusing on preoperative thyroid evaluation, incidental carcinoma diagnosis, and staged completion thyroidectomy. Methods Retrospective review of 227 consecutive TGDC patients (1999-2025) at a single tertiary institution. TGDC-confined, synchronous TGDC-thyroid, and thyroidal-only carcinoma subgroups were analyzed separately. Data were cross-validated against pathology records. Results Of 227 patients (median age 47; 58% female), TGDC carcinoma occurred in 14 patients (6.2%): 10 TGDC-confined and 4 synchronous TGDC-thyroid. An additional 8 patients had thyroidal-only carcinoma identified at concurrent thyroidectomy with histologically benign TGDC and are described separately. Preoperative thyroid ultrasound was performed in 41 of 227 patients (18.1%), increasing from 1.2% before 2015 to 29.4% afterward ( P < .001). Six of the fourteen TGDC carcinoma cases (43%) were diagnosed preoperatively by FNA; the rest were found on final pathology. Five patients required reoperation, and in four of these no preoperative thyroid ultrasound had been obtained. Conclusions Across this 26-year cohort, preoperative thyroid evaluation was infrequently performed relative to current ATA recommendations. This pattern coincided with a high incidental carcinoma diagnosis rate (64%) and with staged reoperations in patients whose synchronous thyroid disease was identified only on final pathology. Routine preoperative thyroid ultrasound, as the guidelines now recommend, may reduce the frequency of these outcomes in similar cohorts.