Thyroid Cancer Surgery in a Patient With Frontotemporal Dementia: Balancing Oncologic and Neurocognitive Challenges

We describe the perioperative management of a patient with severe frontotemporal dementia (FTD) who presented with progressive dysphagia due to a large compressive thyroid mass. Despite a non-diagnostic fine needle aspiration (FNA - Bethesda I), a left lobectomy and isthmectomy were performed to relieve symptoms while minimizing risk of recurrent laryngeal nerve injury and reducing operative time. The patient had a poor neurological prognosis, severe cognitive impairment, and increased anesthetic risk. Airway management was challenging due to tracheal deviation and compression, limited neck mobility, and suspected oropharyngeal reflex impairment. Intubation was successfully performed using a videolaryngoscope and a gum elastic bougie, followed by placement of an armored orotracheal tube. Anesthesia was maintained with low-dose propofol administered via continuous infusion, guided by bispectral index (BIS) and clinical signs. BIS values remained low throughout the procedure. The patient was extubated safely and recovered uneventfully. Pathology revealed papillary thyroid cancer.