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Recurrent Thyroid Carcinoma

In 2007, a 56-year-old Nigerian woman presented for surgical excision of recurrent thyroid cancer prior to 1311 ablation. She had undergone thyroidectomy 12 years earlier for thyroid cancer. She had experienced a recurrence in 2003 that was treated surgically and another recurrence in 2005 for which she refused surgical intervention. Physical examination revealed the presence of a large left-sided thyroid mass and areas of extension into the subdermis, inferiorly to the clavicle, medially to the midline of the neck, laterally to the sternocleidomastoid muscle, and superiorly to the level of the thyroid cartilage ( figure 1). Laryngoscopy revealed paralysis of the left true vocal fold. Magnetic resonance imaging (MRI) of the neck showed deep extension of the mass to the cervical spine (figure 2, A). The trachea was noted to be displaced to the right and severely narrowed to a diameter of less than 5 mm (figure 2, B). Computed tomography (CT) of the chest revealed a meta-