A 70-year-old man presents with a rapidly enlarging neck mass over 4 weeks, hoeness of voice, and inspiratory stridor. CT shows a 6 cm thyroid mass invading the trachea and extending into the mediastinum. No distant metastases are identified. What is the most appropriate initial management?
- A Tracheostomy to secure airway, followed by tissue diagnosis and chemoradiation ✓
- B Total thyroidectomy with tracheal resection and reconstruction
- C Radioactive iodine therapy after confirming differentiated thyroid cancer
- D External beam radiotherapy alone as the mass is unresectable
Correct answer: A. Tracheostomy to secure airway, followed by tissue diagnosis and chemoradiation
Explanation
This presentation is classic for anaplastic thyroid carcinoma. The immediate priority is securing the airway with tracheostomy given the stridor. Tissue diagnosis should be obtained, and treatment is typically chemoradiation. Anaplastic carcinoma is not responsive to radioactive iodine. Surgical resection is rarely possible due to local invasion and is not the initial step when airway compromise exists.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.