I would be pleased to know the opinion of the Surgeons about this case (i.e. what would you do and why):
White, female, age 60. "Cold" left lobe thyroid nodule 2 cm diameter, FNA (1 month ago) positive for anaplastic carcinoma. She was waiting for operation. Last friday she came to the ER (I was on duty there) complaining sovraclavear "swelling" and a mild hoarseness since a couple of weeks. At physical examen I found a "stone" thyroid tightly adherent to subcutaneous tissues, the skin was locally blushing (like in neoplastic lymphangitis of some breast tumors) and multiple enlarged nodes both laterocervical and sovraclavear were appreciable on the left. An US scan confirmed nodal involvement and found also an almost complete trhombosis of the left internal jugular vein. Chest RX: enlarged upper mediastinum, "free" lungs. ORL: hypomotility of the right (!) vocal cord, respiratory space adequate although reduced.
Everybody knows she has the worst prognosis. What would be your strategy in this case? Thyroidectomy to avoid tracheal compression? Tracheostomy before is too late? Radiotherapy? Radical (!?)extended surgery?