Thyroid carcinoma with discharging sinus – a rarity: a case report

This is a report of a 62 year old male patient with a long standing history of thyroid swelling which has metastasized to neck nodes and ulcerated over the midline resulting in a discharging sinus.Extra thyroidal extension is seen in 4% to 16% of all well differentiated thyroid cancers. However there is only an isolated report of skin ulceration over the thyroid. This is a unique case where the ulceration resulted in a discharging sinus. Patient is alive after 2 years following successful therapy. Aggressive surgery is warranted for locally advanced thyroid cancer.Thyroid is enclosed in pretracheal fascia. Local invasion would usually involve the recurrent laryngeal nerve or the trachea. Involvement of skin is extremely rare more so when seen in isolation without tracheal or recurrent laryngeal nerve involvement. We report one such case with discharging sinus over the involved skin.A 62 year old male patient presented to our hospital with a 9 year history of swelling in the neck. The swelling was situated in front of the neck in the thyroid region which gradually increased and 6 years later further swellings appeared in the left side of the neck. There were no other associated symptoms including those of hypo or hyperthyroidism. There was no difficulty in swallowing or breathing. Six months prior to presentation at our hospital, patient noticed a small ulceration in the skin over the tumor in the supra-sterna notch which did not heal (Figure 1). A small quantity of discharge from this sinus has persisted since then.Examination revealed a swelling in the thyroid region, more prominent on the left side with multiple palpable nodes in the left neck. The skin surrounding the sinus was inflamed and thickened. Investigations revealed euthyroid status. There was neither infiltration of trachea nor retro-sternal extension on CT scan of the neck and upper chest. No contrast was used as it could interfere with post operative radio-iodine scans. There was no vocal cord palsy.W