Papillary thyroid carcinomas (PTCs) usually extend to lymph nodes in the neck and mediastinum. Rarely, they invade the neighboring upper airway anatomical structures. We report a 56-year-old woman who presented with symptoms of upper airway obstruction. Imaging studies revealed a lesion derived from the thyroid which invaded and obstructed the trachea, which appeared to be a highly differentiated PTC. Total thyroidectomy was performed, with removal of the endotracheal part of the mass along with the corresponding anterior tracheal rings. Two months later, a whole body I131 scan after recombinant human thyroid-stimulating hormone (rh-TSH) administration was performed and revealed a residual mass in upper left thyroid lobe. Subsequently, 150？mCi I131 were given following rh-TSH administration. Nine months later, there was no sign of residual tumor. This case is the first one reported in the literature regarding rh-TSH administration prior to RAI ablation in a PTC obstructing the trachea. 1. Introduction Papillary thyroid carcinoma (PTC) represents approximately 75% of all thyroid cancers [1]. Their extrathyroidal extension often involves regional lymph nodes in the neck and mediastinum [1]. It is relatively rare that a PTC invades the upper airway anatomical structures or the digestive tract [2]. Therefore, invasion of the trachea by a PTC could mimic other common clinical conditions, and this could result in pitfalls in the diagnosis and management of this extraordinary manifestation. This rare entity requires a high index of clinical suspicion and a multidisciplinary approach by a group of specialists in order to provide an effective therapeutic outcome. We report a rare case of PTC invading the trachea who presented with symptoms of upper airway obstruction (UAO) and we describe our therapeutic approach. 2. Case Report A 56-year-old woman was admitted to the Pulmonary Outpatient Clinic complaining of fluctuating cough and dyspnea. She had been under immunotherapy for 2 years due to allergic asthma, and, spontaneously, she complained of sore throat and mild haemoptysis. Clinical examination revealed scattered wheezes from the lungs without any abnormal findings from the pharynx. Spirometry showed a typical obstructive pattern, attributed to asthma. Her medical history was remarkable of subclinical hypothyroidism, adequately treated with levothyroxine. The patient was lost to follow-up and returned 3 years later with increased dyspnea, neck discomfort, deepening voice, and wheezing. On examination, she had prolonged expiration with wheezing and worsening
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