Complex Thyroid Cancer Surgery with Retrosternal Extension and Tracheal Involvement Successfully Performed at Kailash Hospital Noida

Treatment of thyroid cancers is quite successful, provided they are properly diagnosed and treated. However, some cases become very difficult where the tumours grow extensively, have spread beyond the thyroid gland, reached the thoracic area, or invaded the adjacent vital organs like the trachea.

The case of a 60-year-old male patient at Kailash Hospital, Noida, with longstanding thyroid lump which had suddenly become very large was successfully managed by Dr. Manish Sahni, Consultant - Surgical Oncology. This was a very challenging case since the tumour had grown in a large size, it had extended to the retrosternal area, and had involved the trachea.

Presentation of Symptoms (if any)

The patient presented with a prolonged history of thyroid swelling, which had recently shown a sudden increase in size.

On clinical evaluation, findings included:

• A large swelling in the right thyroid region
• Rapid progression in tumour size
• Extension of swelling across the midline
• Involvement of deeper neck structures

Further examination revealed a massive 15 × 15 cm thyroid swelling extending posteriorly towards the tracheoesophageal groove with retrosternal extension.

The large size and location of the tumour raised concerns about compression and involvement of surrounding vital structures.

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Diagnosis

A detailed diagnostic evaluation was performed to understand the extent and nature of the disease.

Investigations revealed:

• Large right-sided thyroid tumour crossing the midline
• Extension behind the sternum (retrosternal extension)
• Close involvement with the trachea

Fine Needle Aspiration Cytology (FNAC) from the thyroid swelling confirmed:

Positive for malignancy

After complete evaluation and optimization, the patient was planned for definitive surgical management.

 

Condition Overview

Thyroid tumours with retrosternal extension and airway involvement are considered surgically challenging because of their close relationship with critical structures, including:

• Trachea (windpipe)
• Food pipe (oesophagus)
• Major blood vessels of the neck and chest
• Voice-related nerves (recurrent laryngeal nerves)

The uniqueness of this case was the presence of a large malignant thyroid tumour extending into the chest area while also being firmly adhered to the anterior tracheal rings, causing tracheomalacia (weakening of the tracheal wall).

Usually, large retrosternal thyroid tumours may require opening of the chest bone (sternotomy) for complete removal. However, with careful surgical planning and expertise, the tumour was successfully removed through a cervical (neck) approach only, avoiding the need for sternotomy.

 

Treatment Plan

Prior to the surgery, thorough pre-operative assessment and optimization of the patient had been carried out including good control of glucose levels to avoid any kind of risks during surgery.

Under the expertise of Dr. Manish Sahni, the patient underwent:

Total Thyroidectomy with Bilateral Neck Dissection

The procedure involved:

• Complete removal of the thyroid gland
• Bilateral neck node dissection for oncological clearance
• Careful separation of the tumour from trachea and carotid vessels and recurrent laryngeal nerve.

Management of Tracheal Involvement

During surgery:

• The tumour was found adhered to the anterior tracheal rings
• Tracheal shaving was performed carefully to remove tumour involvement while preserving airway integrity
• The retrosternal component was successfully removed through the neck incision itself

The surgical approach helped avoid:

• Sternotomy (opening of chest bone)
• Tracheostomy (creating an external airway opening)

This was achieved through meticulous surgical technique and close perioperative monitoring.

 

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Outcome and Follow-Up

Considering the complexity of airway involvement, the patient was kept intubated and closely monitored for the first 24 hours after surgery.

Recovery milestones included:

• Successfully weaned off ventilator support on Postoperative Day 1
• Oral liquids started from Postoperative Day 2
• Soft diet started from Postoperative Day 3
• Smooth recovery without major airway complications

The patient developed temporary hypocalcemia, a known complication after extensive thyroid surgery, which was effectively managed with calcium and Vitamin D supplementation.

He recovered well and was discharged in stable condition on Postoperative Day 6.

Final Histopathology Report

The final diagnosis revealed:

• Biopsy is encapsulated Follicular variant of Papillary thyroid carcinoma.
• Extrathyroidal extension involving strap muscles
• Bilateral neck lymph nodes negative for tumour involvement

 

Conclusion

The case represents a successful surgical management of a unique type of thyroid cancer with extensive tumour size, retrosternal spread, and tracheal infiltration. The uniqueness of this case is related to the possibility of performing complete tumour resection by means of cervical approach without the necessity of performing sternotomy in spite of the retrosternal tumour spread. Moreover, proper surgical treatment of the tumour infiltration of the trachea helped to avoid tracheostomy in this case. With the assistance of Dr. Manish Sahni, Consultant – Surgical Oncology at Kailash Hospital, Noida, this complicated case shows how advanced preparation and precise surgery can result in successful treatment of thyroid cancer.

Clinical Significance:

The case shows that complicated thyroid malignancies, particularly those affecting vital structures, may be managed successfully without any complications, provided there is a proper diagnosis and treatment with experienced surgical skills and post-surgical care.