KAREN H.CALHOUNMDRONALD B.KUPPERSMITHMD
THE ARTICLE by Tunkel and Domenech is an excellent, well-balanced discussion concerning the preoperative management of the suspected TGD cyst. The issues raised in this discussion are familiar, and the role of this commentary is to distinguish between the academic position and real-life treatment of these patients.
The goal of the entire workup of the patient with a midline neck mass or presumed TGD cyst is to be prepared preoperatively for the possibility of the removal of the total functioning thyroid tissue. Although Tunkel and Domenech state that this is not rare, I have not encountered this clinical situation. Nevertheless, I am always mindful of this possibility and direct my preoperative evaluation toward clarifying the situation. The preoperative discussion with the family and patient is extremely important. Full disclosure of the uncommon but possible complications is very meaningful. Sharing the physician's concerns will alert the parents to all the possible outcomes. I council the parents that in the unlikely case that the neck mass represents the only functioning thyroid tissue it is highly likely that the child would require thyroid replacement therapy, even if the neck mass were not excised.
Friedman EM. Radioisotope Scanning of the Thyroid Gland Prior to TGD Cyst ExcisionAcademic vs Actual Treatment. Arch Otolaryngol Head Neck Surg. 1998;124(5):600. doi:10.1001/archotol.124.5.600