Introduction: Extrathyroidal extension is a major risk factor for poor prognosis in papillary thyroid cancer, notably when infiltrating the tracheal wall. Total tumor excision en-bloc with tracheal resection is the treatment of choice. Thus, a multidisciplinary team approach should be followed to obtain the best oncological outcomes and patients' quality of life.

Aim: Presentation of an interesting case, who was re-operated for recurrent papillary thyroid cancer with extrathyroidal extension.

Case description: A 73-year-old man presented to our department on December 2021 with symptoms of cough, hoarseness, hemoptysis and cervical fullness. The patient had had a subtotal thyroidectomy for an enlarged multinodular goiter 6 months ago at an outside hospital. Biopsy results at the time indicated follicular carcinoma, R2 resection. He received postoperative radioactive I-131 therapy, however there was recurrence of the carcinoma with worsening symptomatology, suspicious for tracheal invasion. In view of the above, we decided to go ahead with completion thyroidectomy, combined with en-bloc resection of the invaded tracheal segment and end-to-end tracheal anastomosis, inferior to the cricoid cartilage. Postoperatively he received a further dose of radioactive I-131, and currently he is under surveillance as an outpatient, disease free.

Conclusion: Invasion of the trachea by a well-differentiated thyroid follicular carcinoma is rare and a bad prognostic index. Complete surgical resection is the therapeutic option with the best chance of long-term survival. Technical difficulties related to the vital anatomy of the area may be overcome by an experienced surgical team, comprised of different specialists.