Anesthetic Challenges in a Patient with Retrosternally Extended Thyroid Carcinoma undergoing Posterior Spinal Decompression: A Case Report

Abstract

Follicular thyroid carcinoma (FTC) typically spreads hematogenously and often presents with bony metastases. Retrosternal thyroid tumors can cause tracheal deviation, airway narrowing, and positional compromise due to chronic compression. We report the perioperative management of a 58-year-old male with long-standing FTC, presenting with a large retrosternal mass causing tracheal deviation and narrowing, along with metastasis to the posterior rib extending into posterior vertebral elements and T6–7 neural foramina. The patient underwent spine decompression and fusion (T5–T9) followed by rib metastasectomy. Despite radiological airway narrowing, he remained asymptomatic. Awake fiberoptic bronchoscopy revealed a deviated but patent trachea with mild dynamic narrowing. A wire-reinforced flexometallic endotracheal tube was positioned deeper to splint the narrowed segment, preventing airway compromise during surgery in the lateral position. Head fixation on a Mayfield head holder minimized tube migration and nasal cartilage damage during spine surgery. This case underscores the importance of dynamic airway assessment, careful planning, and multidisciplinary management.