ABSTRACT
In the majority of cases, differentiated thyroid cancer carries an excellent prognosis and behaves in an indolent manner. However, in advanced disease, including direct spread beyond the thyroid capsule or extranodal spread, surgical management is challenging with higher associated morbidity and mortality. Spread of disease beyond the thyroid capsule into surrounding tissues represents a poor prognostic sign with significant potential for increased post-operative morbidity and early mortality. Patient factors that increase the risk of extracapsular spread mirror the risk factors for detecting malignancy in a thyroid nodule and include extremes of age at presentation, size of primary tumour, advanced nodal disease or clinical evidence of distant metastases. Pharyngeal and oesophageal invasion are rare in thyroid cancer and most commonly occur from direct primary tumour extension rather than extranodal disease in the central compartment. Local disease recurrence is most often seen in the thyroid bed with the central and lateral neck compartment less commonly affected.
