Predictors of Thyroid Gland Invasion in Laryngeal Squamous Cell Carcinoma

Document Type : Original


1 Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Pathology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran.

3 International Campus, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran

4 Faculty of medicine, Tehran University of Medical Sciences, Tehran, Iran.


Laryngeal squamous cell carcinoma (SCC) can invade the thyroid gland leading to unnecessary thyroidectomies with subsequent hypothyroidism and hyperparathyroidism. Thus, clinicopathological variables should be defined in order to predict thyroid gland invasion preoperatively.
Materials and Methods:
We performed a retrospective analysis of 1,465 patients with laryngeal SCC referred to our center between March 2009 and January 2016. Among these patients, 60 individuals underwent total laryngectomy and either thyroid lobectomy and isthmectomy or total thyroidectomy.
Thyroid gland invasion was observed in 20% of samples. The following variables were associated with thyroid gland invasion: transglottic spread of the tumor (odds ratio [OR]: 2.04, 95% confidence interval [CI]: 1.15–5.81, P=0.004), thyroid cartilage involvement (OR: 1.53, 95% CI: 0.94–2.50, P=0.02), and anterior commissure involvement (OR: 5.75, 95% CI: 0.86–38.42, P=0.01). In addition, the largest dimension of the tumor was significantly associated with thyroid gland involvement (r=0.36, 95% CI 0.05–0.67, P=0.004). Multivariate linear regression analysis confirmed these findings.
The rate of thyroidectomies performed in cases of laryngeal SCC is much higher than the actual rate of thyroid gland invasion. Thus, preoperative evaluation to find transglottic spread of the tumor, thyroid cartilage, and anterior commissure involvement should be considered.


Main Subjects

1. Hilly O, Raz R, Vaisbuch Y, Strenov Y, Segal K, Koren R, et al. Thyroid gland involvement in advanced laryngeal cancer: Association with clinical and pathologic characteristics. Head Neck. 2012; 34(11):1586-90.
2. Elliott MS, Odell EW, Tysome JR, Connor SEJ, Siddiqui A, Jeannon J-P, et al. Role of thyroidectomy in advanced laryngeal and pharyngolaryngeal carcinoma. Otolaryngology--Head and Neck Surgery. 2010;142(6):851-5.
3. Nayak SP, Singh V, Dam A, Bhowmik A, Jadhav TS, Ashraf M, et al. Mechanism of thyroid gland invasion in laryngeal cancer and indications for thyroidectomy. Indian Journal of Otolaryngology and Head & Neck Surgery. 2013;65(1):69-73.
4. Dadas B, Uslu B, Çakir B, Ozdogan HC. Intraoperative management of the thyroid gland in laryngeal cancer surgery. Journal of Otolaryngology-Head & Neck Surgery. 2001;30(3):179.
5. Scherl C, Mantsopoulos K, Semrau S, Fietkau R, Kapsreiter M, Koch M, et al. Management of advanced hypopharyngeal and laryngeal cancer with and without cartilage invasion. Auris Nasus Larynx. 2016.
6. Gaillardin L, Beutter P, Cottier JP, Arbion F, Morinière S. Thyroid gland invasion in laryngopharyngeal squamous cell carcinoma: prevalence, endoscopic and CT predictors. Eur Ann Otorhinolaryngol Head Neck Dis. 2012;129(1):1-5.
7. Galbo AML, Kuik DJ, Lips P, von Blomberg BME, Bloemena E, Leemans CR. A prospective longitudinal study on endocrine dysfunction following treatment of laryngeal or hypopharyngeal carcinoma. Oral Oncol. 2013;49(9):950-5.
8.Kim JW, Han GS, Byun SS, Lee DY, Cho BH, Kim Y-M. Management of thyroid gland invasion in laryngopharyngeal cancer. Auris Nasus Larynx. 2008;35(2):209-12.
9. Mourad M, Saman M, Sawhney R, Ducic Y. Management of the thyroid gland during total laryngectomy in patients with laryngeal squamous cell carcinoma. The Laryngoscope. 2015; 125(8): 1835-8.
10. Pfister DG, Laurie SA, Weinstein GS, Mendenhall WM, Adelstein DJ, Ang KK, et al. American Society of Clinical Oncology clinical practice guideline for the use of larynx-preservation strategies in the treatment of laryngeal cancer. J Clin Oncol. 2006;24(22):3693-704.
11. Moubayed SP, Bélair M, Saliba J, Bibeau-Poirier J, Christopoulos A, Nguyen-Tan P-F, et al.
 Prognostic value of cartilage sclerosis in laryngeal cancer treated with primary radiation therapy. Otolaryngology--Head and Neck Surgery. 2012; 147(1):57-62.
12. Stenson KM, MacCracken E, Kunnavakkam R, Cohen W, Ezra E, Portugal LD, et al. Chemoradiation for patients with large‐volume laryngeal cancers. Head Neck. 2012;34(8):1162-7.
13. Mendelson AA, Al-Khatib TA, Julien M, Payne RJ, Black MJ, Hier MP. Thyroid gland management in total laryngectomy: meta-analysis and surgical recommendations. Otolaryngology—Head and Neck Surgery. 2009;140(3):298-305.
14. Mangussi-Gomes J, Danelon-Leonhardt F, Moussalem GF, Ahumada NG, Oliveira CL, Hojaij FC. Thyroid gland invasion in advanced squamous cell carcinoma of the larynx and hypopharynx. Braz J Otorhinolaryngol. 2016.
15. Joshi P, Nair S, Chaturvedi P, Nair D, Shivakumar T, D'Cruz AK. Thyroid gland involvement in carcinoma of the hypopharynx. The Journal of laryngology and otology. 2014; 128(1): 64.
16. Mortimore S, Thorp MA, Nilssen ELK, Isaacs S. Hypoparathyroidism after the treatment of laryngopharyngeal carcinoma. The Journal of Laryngology & Otology. 1998;112(11):1058-60.
17. Brennan JA, Meyers AD, Jafek BW. The intraoperative management of the thyroid gland during laryngectomy. Laryngoscope. 1991; 101(9): 929-34.
18.Garas J, McGuirt WF. Squamous cell carcinoma of the subglottis. Am J Otolaryngol. 2006;27(1):1-4.
19. Kim JW, Han GS, Byun SS, Lee DY, Cho BH, Kim YM. Management of thyroid gland invasion in laryngopharyngeal cancer. Auris Nasus Larynx. 2008; 35(2):209-12.
20. Schultz NT. Trends and Patterns in the Ossification of Thyroid Cartilage. 2015.
21. Sion-Vardy N, Fliss DM, Prinsloo I, Shoham-Vardi I, Benharroch D. Neoangiogenesis in squamous cell carcinoma of the larynx - biological and prognostic associations. Pathol Res Pract. 2001; 197(1):1-5.
22. Lin P, Huang X, Zheng C, Cai Q, Guan Z, Liang F, et al. The predictive value of MRI in detecting thyroid gland invasion in patients with advanced laryngeal or hypopharyngeal carcinoma. Eur Arch Otorhinolaryngol. 2017;274(1):361-6.