How to treat a patient with a thyroglossal cyst presenting with signs of an abscess, including pain, redness, and hotness?

From the Guidelines

The most appropriate treatment for a patient with a thyroglossal cyst presenting with signs of an abscess, including pain, redness, and hotness, is incision and drainage (I&D) as the primary treatment, followed by antibiotic therapy and eventual surgical excision via the Sistrunk procedure. The patient's presentation with signs of an abscess, such as pain, redness, and hotness, indicates the need for prompt intervention to prevent further complications.

• The primary treatment for a cutaneous abscess, including those associated with thyroglossal cysts, is incision and drainage (I&D) 1.
• Antibiotic therapy is recommended for abscesses associated with severe or extensive disease, rapid progression, or signs of systemic illness, which may be the case in this patient given the presence of an abscess 1.
• Empirical therapy for community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is recommended pending culture results, with oral antibiotic options including clindamycin, trimethoprim-sulfamethoxazole, or a tetracycline 1.
• The Sistrunk procedure, which involves removing the cyst, its tract, and the central portion of the hyoid bone, is the definitive treatment for thyroglossal cysts to prevent recurrence 1.
• It is essential to note that simple drainage without complete excision carries a high risk of recurrence, and patients should be informed of this risk 1.
• The most recent and highest quality study, published in 2018, recommends surgical therapy, including incision and drainage, as the primary treatment for abscesses, with antibiotic therapy and empirical coverage for CA-MRSA as needed 1.

From the Research

Treatment Options for Thyroglossal Cyst with Signs of Abscess

• The patient presents with pain, redness, and hotness, indicating an infected thyroglossal cyst, which is a common complication of this condition 2.
• The appropriate treatment for an infected thyroglossal cyst is a topic of discussion, with some studies suggesting that incision and drainage (I&D) may not increase the risk of postoperative recurrence 3.
• However, other studies recommend avoiding I&D as much as possible, especially in pediatric patients, as it may increase the risk of recurrence 4.
• Antibiotic treatment is often recommended for infected thyroglossal cysts, and the Sistrunk procedure is considered the best treatment option to limit recurrence 2, 5.
• Admission for IV antibiotics (option D) may be necessary in severe cases of infection, especially if the patient shows signs of systemic infection or if the infection is not responding to oral antibiotics.
• Oral antibiotics (option A) may be sufficient for mild cases of infection, but the patient should be closely monitored for signs of worsening infection.
• Incision and drainage (option B) may be necessary in cases where the abscess is large or not responding to antibiotic treatment, but it should be performed with caution and only when necessary.
• Hot fomentation (option C) is not a recommended treatment for infected thyroglossal cysts, as it may not address the underlying infection and may even worsen the condition.

Considerations for Treatment

• The patient's age, overall health, and severity of infection should be taken into account when deciding on the best course of treatment.
• The Sistrunk procedure is considered the gold standard for treating thyroglossal cysts, but it may not be necessary in all cases, especially if the infection can be managed with antibiotics alone 5, 6.
• The risk of recurrence should be considered when deciding on the best treatment option, and the patient should be informed of the potential risks and benefits of each treatment option 3, 4.