[Management of thyroid carcinoma with metastases in the upper mediastinum and axillary area].

Objective: To investigate the clinical characteristics and management of thyroid carcinoma with the upper mediastinal and axillary metastasis.
Methods: Six cases of thyroid carcinomas with metastases to mediastinum and axillary, in addition to the neck, undergoing surgeries from 2006 to 2011 were reviewed. Five cases was papillary carcinoma and one was follicular carcinoma. Of six patients, five underwent surgical treatment at least one time previously and one of them received a radiotherapy with total dose of 60 Gy. (131)I treatment and thyroxine were used postoperatively in all cases.
Results: The numbers of metastatic nodes in the axillary were 2/7, 3/12, 2/6, 1/5, 3/7 and 3/10 respectively, while the numbers in the upper mediastinum ranged from 2 to 6, with a 4.3 average, a metastatic lymph node in the retropharyngeal space was also found in one patient. Horner's sign occurred in three cases, temporary hypocalcemia in two cases and chylous fistula in one case. No injury to the recurrent laryngeal nerve or to important vessels. Neck or lower mediastinum recurrence and new lung metastasis occurred in three cases separately. No recurrence in the upper mediastinum or axillary area was found with the follow-up of 23-77 months. One died of heart disease 4 years after operation.
Conclusion: The surgical treatment of node metastases in the upper mediastinum and axillary from the well-differentiated thyroid cancer is safe and has a promising outcome.