Huge thyroglossal duct cyst in elderly patient

INTRODUCTION: Thyroglossal duct cyst is the most common congenital neck mass. About 50% of cases present before the age of 10. A second group present in young adulthood. CASE: We present a case of an 85 years old male patient who presented to us with a huge swelling occupying the whole front of the neck, matching the characters of a thyroglossal cyst by history and clinical examination. The swelling first appeared in early adulthood. He received faulty advice that led him to believe that the operation was too risky. He lived without treatment or complications except for very slow progressive enlargement of the swelling over the years until it became cosmetically very bad and interfering with his daily activities. The swelling was cystic, non-tender with surrounding healthy skin except small area showing minimal signs of inflammation. Neck US and (CT) confirmed the diagnosis of thyroglossal cyst, 92*76 mm in size. INTERVENTION: We performed surgical excision of the cyst, tract and central part of hyoid bone (Sistrunk operation) and sent the specimen for histopathological evaluation, which confirmed pre-operative diagnosis. CONCLUSION: Diagnosis of TGDC shouldn't be excluded even in extremes of age, or extreme size, and can be managed according to standard lines of management.