DIAGNOSIS AND TREATMENT OF THYROID, PARATHYROID, AND THYROGLOSSAL DUCT CYSTS

Forty euthyroid patients with cystic neck masses, diagnosed by echography, had these cysts aspirated percutaneously (35 patients) or at operation (5 patients). There were 25 women and 15 men; 36 had thyroid cysts, 2 had thyroglossal cysts, and 2 had parathyroid cysts. All cyst fluid was benign by cytological examination, and in the 14 patients treated by operation, the lesions were benign. All patients were given L-T4 after aspiration. The follow-up period ranged from 6 months to 4.5 yr, with a mean duration of 1.5 yr. Among the 35 patients treated by aspiration, 14 patients (40%) had complete regression of the cyst, including 1 patient with a parathyroid cyst, and 10 patients (29%) had marked regression with minimal residual lesion. The remaining 11 patients (31%), including 2 patients with thyroglossal duct cysts, had unsuccessful aspirations; 9 of these had persistent thyroid lesions immediately after aspiration. No complications occurred during 49 percutaneous aspirations or 14 operations. Analysis of the hormone concentration of the cyst fluid revealed that thyroid hormone concentrations (T4, T3, and rT3) were usually higher in the solitary thyroid cysts than in cysts associated with nodular goiter, and in the latter, thyroid hormone levels were generally higher than in thyroglossal duct or parathyroid cysts. TSH and calcitonin levels in cyst fluid from selected patients were similar to normal serum levels, and T4 levels after ethanol extraction revealed that the high levels were not due to thyroglobulin. Although there is overlap among groups, hormonal analysis of cystic neck masses is sometimes helpful in predicting the origin of the cyst. Aspiration of thyroid cysts is a safe and effective procedure and makes operation unnecessary in approximately 70% of patients. © 1979 by The Endocrine Society.