We present a case of giant sternal metastasis from differentiated thyroid carcinoma. Following our experience, we conducted a literature review concerning the complex and multidisciplinary management of these patients.

A 58-year-old male presenting with a visible and palpable tumor at the sternal notch. Investigations revealed a large disrupting soft tissue lesion involving the manubrium sterni, first two ribs and bilateral costoclavicular joints. Small bilateral pulmonary disease was demonstrated on CT scan too. Core needle biopsy of the mass was consistent with follicular thyroid carcinoma metastasis.

Therapy success of these isolated cases relies, as reflected in literature, on a multidisciplinary surgical approach and the effectiveness of adjuvant radioactive iodine (131-I). Our primary goal was to achieve metastatic debulking to facilitate subsequent iodine intake by remnant disease. In this context, a total thyroidectomy was performed, along with resection of the manubrium sterni, both costoclavicular joints, and the first two ribs. In collaboration with thoracic and orthopedic surgery departments, a complex chest wall reconstruction was carried out using a titanized polypropylene mesh in the anterior mediastinum, covering the heart and major vessels, and grafting a new sternum from a cryopreserved cadaver. The patient required re-intervention due to displacement of the titanized mesh, but was discharged after a 15-day hospital stay. After ablative therapy,131-I uptake scan shows no evidence of disease.

The need for a multidisciplinary strategy in the management of such cases, often involving extensive, aggressive and a broad range of surgical procedures, along with adjuvant radioidine therapy, proves crucial to ensure treatment success.