Laryngotracheal invasion by well-differentiated thyroid cancer: diagnosis and management

Ten cases of laryngotracheal invasion by well-differentiated thyroid cancer are described. All the patients were over 40 years of age, with a male preponderance of 4:1. A mass in the neck, stridor, and hemoptysis was the common symptom. Bronchoscopy done in six of ten patients revealed an intraluminal tumour in all. Radiographs of the neck showed invasion of the trachea in six patients. Surgery consisted of tracheostomy alone (three of ten), total thyroidectomy with laryngectomy (one of ten), circumferential resection of trachea (one of ten), and total thyroidectomy with tracheotomy and "shaving" of the intraluminal disease in five of ten patients. Adjuvant external radiation, radioiodine, or laser therapy was given when indicated. Of the ten patients, three died and seven survived. Five of seven were alive without disease for 2.5 years or more, and one had skull metastasis 2 years later but no local disease.