When Sleep Apnoea Signals Something More: A Rare Case of Thyroglossal Duct Cyst Carcinoma
Obstructive sleep apnoea (OSA) is a common sleep disorder that affects millions of people worldwide, causing pauses in breathing during sleep due to obstruction of the airway.
While the condition is often associated with factors such as obesity, smoking, and ageing, a 2012 case study has shed light on a rare and unexpected link between OSA and thyroglossal duct cyst carcinoma (TGDCa). In this article, we explore the details of this case, examining how symptoms that seemed ordinary led to an uncommon diagnosis—and what it means for patients and clinicians alike. Here’s a look at an instance when snoring can hide something more serious.
Key Takeaways
- A thyroglossal duct cyst is assessed clinically and with imaging, with treatment depending on its presentation.
- Thyroglossal duct cyst carcinoma is a rare cancer arising within tissue left from early thyroid development.
- It often presents as a neck lump and is found in about 1% of surgically removed thyroglossal duct cysts.
- One case report linked recurrent obstructive sleep apnoea to thyroglossal duct cyst carcinoma.
- In that case, a midline neck mass compressed the airway and contributed to recurrent sleep apnoea.
Understanding Thyroglossal Duct Cyst Carcinoma
The Case Study: A 39-Year-Old Woman with OSA Symptoms
The paper, published in The Journal of Laryngology & Otology, examines a case involving a 39-year-old woman who first presented five years earlier with symptoms of obstructive sleep apnoea, including snoring, excessive daytime sleepiness, and fatigue. At that time, clinical evaluation showed bilateral tonsillar hypertrophy, a low-lying palate, and no visible neck mass.
She was diagnosed with severe OSA via a sleep study and underwent uvulopalatopharyngoplasty (UPPP), which initially improved her symptoms. However, she did not return for regular follow-ups.
Five years later, she presented again with worsening snoring and excessive daytime somnolence. This time, physical examination revealed a 2×2 cm midline neck mass that moved with swallowing. Nasendoscopy showed a cystic mass involving the left aryepiglottic fold, partially blocking the airway.
Further investigation, including CT imaging and fine-needle aspiration cytology, revealed a thyroglossal duct cyst carcinoma. The tumour extended to the supraglottic larynx and caused airway compression, which explained the recurrence of her OSA symptoms.
Diagnosis and Treatment of TGDCa
The diagnosis of TGDCa is typically made through a combination of imaging studies, such as ultrasound or computed tomography (CT) scans, and fine-needle aspiration cytology (FNAC). However, the specificity of FNAC is low (around 50–66%), and the diagnosis is often confirmed only after surgical excision.
In this case, FNAC successfully identified papillary thyroid carcinoma within a thyroglossal duct cyst. The patient underwent a Sistrunk procedure (surgical removal of the cyst and part of the hyoid bone), followed by total thyroidectomy, bilateral neck dissection, and central neck dissection, due to confirmed lymph node metastases.
She subsequently received radioactive iodine therapy and thyroid hormone suppression therapy, and she had a full recovery.
Management and Relief of OSA Symptoms
The patient’s OSA symptoms, including snoring and daytime fatigue, were resolved after tumour removal, and her Epworth Sleepiness Scale score improved from 14 to 0.
While OSA is typically managed with CPAP therapy, oral appliances, or lifestyle changes, in this case, surgery to remove the tumour was curative, as the obstruction was due to a rare anatomical cause.
The case of a 39-year-old woman with OSA symptoms due to TGDCa highlights the importance of considering rare anatomical causes in patients with persistent or recurrent sleep apnoea. ENT specialists and sleep physicians can work together to ensure that patients with OSA undergo a thorough otolaryngological examination, especially when initial treatments fail or symptoms recur.
Practical takeaway:
If you have questions or concerns about your ears, nose, and throat,
you may book a consultation with Dr Dennis Chua, an ENT specialist in Singapore.
He has completed his training in otorhinolaryngology locally and attained qualifications internationally.
About Dr Dennis Chua
Dr. Dennis Chua is an Ear, Nose and Throat (ENT) specialist with more than a decade of experience. He is held in high regard within the field of Otolaryngology, having published many articles in peer reviewed journals on the topic of ENT.
As an ENT Specialist in Singapore, Dr Dennis Chua is committed to providing thorough, patient-centred care for both adults and children. Whether you’re managing allergies, sinus problems, hearing issues, or throat concerns, we take time to understand your condition and guide you through your treatment options.
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