e-ORL Dr G Raju,Chennai

Lakshmi 50F
C/o Dyspnoea,stridor -- 3days.
No dysphagia,change of voice.
Mild to moderate Stridor.
Mass Rt.side of neck 5yrs. Soft to firm mobile neck mass in the thyroid region.
?Enlarged Lt.lobe/ expanded thyroid cartilage. No nodes.
I/L -- normal mobile cords; hypopharynx. Pinkish mass seen in subglottic area.
Xray Neck – Soft tissue mass subglottis,upper trachea.
Xray Chest – Lt.Pleural effusion.
CECT Neck – Multilobulated mass Lt.lobe of thyroid with extension into subglottic & trachea Lt.side. Enhancing mass Rt.lobe with central hypodensity.
CT Chest --- Loculated Lt.Pleural effusion with collapse of Lt.Lower lobe.
Other Haematological,biochemical tests wnl.
24/5 Pleural Aspiration – Frank pus – Cytology No malignant cells; Culture Sterile
AFB –ve.
FNAB(23/5 -322/08) – Rt.lobe – Colloid; Lt.Lobe – Cellular smear s/o Papillary Ca.(Follicular variant)
TFT(24/5) -- FT3 -- 1.23(1.8 – 4.2)
FT4 – 1.40(0.8 – 1.9)
TSH – 0.33(0.4 – 4)
Thyroglobulin -- 76.1(<55)

Thyroid scan(26/5) – Photopenic area(?Cold nodule) Lt.Lobe; vascular cold nodule Rt.Lobe.
Pleural tap has been done & she is now on ATT.
Total Thyroidectomy is planned.
How to manage her Subglottic part of papillary Ca?
I feel that tracheal resection is not possible as the tumor is extending into submucosa of Cricoid cartilage.
One option is endoscopic shaving of the tumor with a microdebrider.
Should the larynx be stented after that?
Can the procedure(tumor shaving) cause subglottic stenosis?
Intra-tracheal mass is too large to be ablated by Radio-iodine.
Photos of case & CT films of neck attached.