1. Locally advance thyroid cancer
Dr Sudhi Agarwal

2. R; 35/F
c/o left upper cervical swelling x 5 years
Painless, gradually progressive
No other complaints
Consulted a local surgeon due to recent rapid increase in size of swelling

3. u/w biopsy 2 months back (records not available)
Post op developed discharging sinuses at the operated site (A) and drain site (B)
H/P- Metastatic PTC
Referred by the surgeon to “higher centre for further management” A B

4. Patient consulted in SMC
o/e- hard, partially fixed conglomerate mass of left cervical LNs involving levels 2,3,4 and 5
Upper limit – not reachable completely
Left carotid displaced medially with relatively slightly feeble pulsations
Thyroid gland – not palpable
Right subcm cervical LNs

5. Work up Blocks review- CECT neck- Metastatic PTC (follicular variant)
Conglomerate mass of lymph nodes (levels 2,3,4,5) extending from base of skull to clavicle, involving carotid sheath
1.5 cm left IJV thrombus
Carotids pushed medially
Right subcm LNs +
Hypodense lesion in left lobe of thyroid

6. USG thyroid with doppler
Left IJV thrombus +
Carotids- displaced with normal flow
IDL-
Bilateral vocal cords mobile
TFT
WNL
Other fitness work-up- NAD
Diagnosis
Papillary thyroid cancer with left cervical lymph nodes metastasis with left IJV thrombosis

7. TT + CCLND + left Radical neck dissection on 27-4-2012

8. Differentiated Thyroid Cancer
Right Superior parathyroid gland and EBSLN and recurrent laryngeal nerve identified and saved
Rt Lobe Thy
Rt Sup PTG
Rt RLN
Differentiated Thyroid Cancer

9. Differentiated Thyroid Cancer
Total thyroidectomy complete; left inferior parathyroid gland (circle) identified and saved
Thyroid
Differentiated Thyroid Cancer

10. Differentiated Thyroid Cancer
Left radical neck dissection; conglomerate mass of lymph nodes involving skin and carotid sheath; IJV ligated and divided at base of neck (circle); carotid (C) and vagus (V) identified and saved T V C
Differentiated Thyroid Cancer

11. Differentiated Thyroid Cancer
Tumor is adhered densly with carotid, separated completely by meticulous dissection till base of skull
Tumor C
Differentiated Thyroid Cancer

12. Differentiated Thyroid Cancer
Tumor dissected out completely from base of skull
Base of skull
Tumor apex
Differentiated Thyroid Cancer

13. Differentiated Thyroid Cancer
Neck following complete tumor removal
Trachea
Clavicle
Differentiated Thyroid Cancer

14. Differentiated Thyroid Cancer
Central compartment following complete tumor removal
Differentiated Thyroid Cancer

15. Differentiated Thyroid Cancer

16. Post-operative period- uneventful
Adjuvant 30 mCi of RAI required for ramnant ablation and 6 monthly follow up