Endocrine Abstracts

Introduction: Locally extended thyroid cancer is a rare situation that lead to management discussion. Therapeutic strategy depend on the histological type of the cancer and the extension limits. We through this study to discuss therapeutic strategy and relate the evolution features of such cancers.

Materiel and Methods: We performed a retrospective descriptive study collecting all locally extended thyroid cancer managed in our department over a period of ten years [2009-2023].

Results: They were four women and two men. The mean age was 64 years [49-80 years]. The main complaint was an anterior basicervical mass in all cases. It was associated with laterocervical mass in three cases. Dyspnea was reported in two cases and dysphonia in one case related to a recurrent paralysis. Ultrasound was suggestive of malignancy in all cases. A cervical CT scan, was performed in four cases, showed an invasive heterogeneous goiter extended to the trachea in three cases and the trachea and larynx in the fourth one which required emergency tracheostomy due to severe inspiratory dyspnea. Total thyroidectomy was performed in all cases, it was enlarged to the larynx in one case of medullary carcinoma. A recurrential lymphadenctomy was performed in all cases. Lateral lymphadenctomy was performed in four cases: it was unilateral radical in two cases, unilateral functional in one case and bilateral functional in one case. The definitive histological examination concluded to an invasive papillary carcinoma in three cases, a poorly-diffrentiated carcinoma two cases and medullary carcinoma associated with papillary carcinoma in one case. Distant metastases were noted in the two cases poorly-diffrentiated carcinoma: it was a bone in one case and pulmonary in the other case. Ablative iodine-131 radiotherapy was performed in all cases. It was associated to an external radiotherapy in two cases and radio-chemotherapy for the poorly differentiated carcinoma with lung metastases. The course was marked by loco-regional recurrence in one case, and the appearance of distant metastases in one case. The average follow-up was four years.

Discussion/Conclusion: Locally advanced thyroid cancer is a challenging situation. Surgery is the standard and the efficient treatment, even though it can be mutilating in some cases. External radiotherapy remains a complementary treatment and can be an alternative in non-operable tumors.

Disclosure of interest: none declared