The Contentious Management of Anaplastic Thyroid Carcinoma with Acute Airway Obstruction during COVID-19 Pandemic

Ahmad Izani  Mohd Safian; Kamaruddin  Ibrahim; Seoparjoo Azmel  Mohd Isa; Norhafiza Mat Lazim; Irfan Mohamad

doi:10.33102/uij.vol33no3.314

Authors

Ahmad Izani Mohd Safian Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia (USM)
Kamaruddin Ibrahim Department of Anaesthesiology & Intensive Care, School of Medical Sciences, Universiti Sains Malaysia (USM)
Seoparjoo Azmel Mohd Isa Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia (USM)
Norhafiza Mat Lazim Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia (USM)
Irfan Mohamad Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia (USM)

DOI:

https://doi.org/10.33102/uij.vol33no3.314

Keywords:

Coronavirus disease 2019, thyroid cancer, upper airway obstruction, Malaysia

Abstract

There are many important concerns and issues raised in managing acute airway obstruction cases with regards to the current COVID-19 pandemic. As a further matter, a patient with a huge thyroid mass in anaplastic thyroid carcinoma (ATC) presenting with impending airway obstruction poses treatment challenges, as immediate active intervention is necessary despite the risk of spreading of COVID-19 viruses. The unknown status of COVID-19 of the patient will add additional concerns during active assessment and treatment as patients with this undifferentiated thyroid carcinoma commonly deteriorate fast. This carcinoma may also invade the trachea and result in upper airway obstruction leading to a fatal outcome. Therefore, an appropriate treatment strategy is essential. This report highlights a case of an ATC patient who presented with diffuse cemented-hard anterior neck, whereby the whole management of ATC with acute airway obstruction during this COVID-19 pandemic is purely contentious and challenging. The issue of providing artificial ventilation either via intubation or tracheostomy is made more complicated as the patient presents with an acute upper airway obstruction whilst the COVID-19 status is unknown. While endotracheal intubation approach was not easy, the trachea was also difficult to be identified externally due to the huge ‘cemented-hard’ mass plastered over the compressed trachea. Due to the advanced disease, surgical intervention was not an option.

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