Thyroid Involvement in Laryngeal Squamous Cell Carcinoma-Should it be Spared?

To determine the prevalence and predictors of thyroid gland invasion in Hispanic patients with laryngeal squamous cell carcinoma undergoing total laryngectomy and to assess thyroidectomy-associated comorbidities.

Retrospective cross-sectional review.

University District Hospital, Puerto Rico Medical Center, San Juan, PR.

Records of adults with laryngeal squamous cell carcinoma who underwent total laryngectomy from 2009 to 2022 were reviewed. Tumor characteristics were correlated with histopathologic thyroid gland invasion, and postoperative hypocalcemia was documented. Categorical variables were compared using Fisher's exact or Pearson's chi-square tests, with effect size reported by Cramér's V; continuous variables were analyzed with the Wilcoxon-Mann-Whitney test.

Of 105 patients, 8 (7.6%) had thyroid gland invasion. Tumors with invasion were larger (5.0 ± 1.3 vs 3.3 ± 1.4 cm; P = .003) and were associated with thyroid cartilage invasion (100% vs 54.6%; P = .020). Patients with invasion underwent total thyroidectomy more often (75.0% vs 28.9%; P = .013). Postoperative hypocalcemia occurred in 41.9% (44/105) of patients overall and was more frequent after total than after partial thyroidectomy (79.4% vs 23.9%; P < .001). Intravenous calcium replacement was required in 19.0% (20/105) of patients, more often after total thyroidectomy (47.1% vs 5.6%; P < .001).

Thyroid gland invasion was uncommon but associated with larger tumors and thyroid cartilage invasion. Total thyroidectomy carried a higher risk and greater severity of hypocalcemia. These findings support selective thyroid management during total laryngectomy and provide evidence from an underrepresented Hispanic population.