Mechanism of Thyroid Gland Invasion in Laryngeal Cancer and Indications for Thyroidectomy

Abstract

Invasion of thyroid gland (TG) by laryngeal cancer is rare. However, ipsilateral hemithyroidectomy is routinely performed during total laryngectomy (TL) for laryngeal cancers. Even hemithyroidectomies are associated with hypothyroidism in 23-63% and hypoparathyroidism in 25-52%. Most of the studies on laryngectomy have advised thyroidectomy for T3 and T4 lesion, transglottic growth, subglottic disease or extension and involvement of anterior commissure. The role of tumour differentiation in TG invasion is unknown. The cases with TG invasion have been reported to have poorer prognosis. This is a retrospective study of 45 patients undergoing thyroidectomy along with TL. Of these, five had TG invasion. Extra-laryngeal soft tissue involvement [RR 1.89 (1.02, 4.24)] and transglottic growths [RR 1.18 (1.02, 1.36)] had a significant association with TG invasion. The mode of spread, contiguous or non-contiguous, depended on tumour differentiation. Well differentiated cancers had propensity for contiguous spread and moderately differentiated cancers for non-contiguous spread (p=0.05). The 5years survival of T4a cases was 30%. The difference in survival between TG invasion (p=0.618), cartilage invasion (p=0.111) and soft tissue infiltration (p=0.474) was statistically insignificant. Anatomically direct TG invasion can only occur through extralaryngeal soft tissue which is includes cricopharyngeus and cricothyroid muscles. We recommend thyroidectomy only when these muscles are involved by the tumour in case of well differentiated cancers. The probability of TG invasion increases with transglottic growths with subglottic extension more than 10mm. We recommend ipsilateral hemithyroidectomy in less differentiated cancers as they have propensity for non-contiguous spread.