comfortable with thyroid anatomy Elective excision involves removal of the cyst, the entire duct to the level of the foramen cecum, and often the midportion of the hyoid bone On rare occasions, ectopic thyroid tissue in a thyroglossal duct cyst is the patient’s only functioning thyroid Therefore, ultrasound, radioisotope scanning, or CT scan is recommended to confirm the presence of a normal thyroid gland before surgery Goiter , or diffuse enlargement of the thyroid gland, may be congenital or the result of infiltration, inflammation, or overstimulation of the gland Congenital goiter is usually apparent at birth and may be due to transplacental exposure to maternal antithyroid antibodies, antithyroid medications, as well as congenital errors in thyroid hormone synthesis or the thyroid-stimulating hormone (TSH) receptor By far, the most common acquired cause of pediatric thyroid enlargement is chronic lymphocytic thyroiditis (also called Hashimoto thyroiditis or autoimmune thyroiditis ) Other acquired causes of goiter in children include acute suppurative thyroiditis , iodine-deficiency (rare in children in the United States), colloid goiter, goiter secondary to hyperthyroidism (e.g., Graves disease ), infiltrative diseases of the thyroid and thyroid nodules (including malignancy) See Chapter 89 Endocrine Emergencies Lymphocytic thyroiditis is characterized by a defect in cell-mediated immunity that results in lymphocytic infiltration of the thyroid gland Females are more commonly affected, and peak occurrence is during adolescence The disorder has been associated with other autoimmune diseases including chronic urticaria and diabetes Usual presentation is one of a slow-growing, painless midline neck mass Occasionally, a patient may complain of sore throat Examination reveals a firm, nontender, diffusely enlarged gland in most affected children, but approximately one-third will have some lobular or nodular enlargement Evaluation includes assessment of thyroid function and the detection of thyroid autoantibodies in the serum Most patients with lymphocytic thyroiditis are euthyroid When thyroid dysfunction is present, it usually takes the form of hypothyroidism Any degree of nodularity of the gland warrants further investigation to rule out malignancy Inflammation of the thyroid gland secondary to infection, acute suppurative thyroiditis , is a rare cause of thyroid enlargement in children that can be associated with an underlying pyriform sinus fistula Presentation usually follows an upper respiratory tract infection or otitis media and is characterized by the abrupt appearance of a painful, tender, swollen mass in the region of the thyroid Systemic illness in the form of fever and chills and severe dysphagia are often present Flexion of the neck may alleviate pain, whereas extension worsens it