Patient 3 was a 67-year-old female who presented with hoarseness and dysphagia for a few weeks. CT scans showed a 3.8 cm left thyroid tumor with superior mediastinal and tracheal involvements, i.e., stage pT4bN0M0. Complete resection of the tumor was successfully achieved by total thyroidectomy and central neck dissection. Postsurgical chemotherapy was applied (docetaxel 120 mg/m2 and cisplatin 30 mg/m2), followed by a course of intensity modulated radiotherapy (70 Gy at 2.5 Gy per fraction). She remains well 4 years after diagnosis.
Patient 2 was a 48-year-old male pathologically diagnosed with stage pT4aN0M0 CASTLE postsurgery. He presented with rapidly growing thyroid nodules with fixation to underlying structures. He underwent total thyroidectomy with central neck dissection. On exploration, the thyroid mass was seen extended to the left laryngeal nerve, strap muscle, trachea, and esophagus. Curative wide local excision was attempted on patients with gross residual local disease. Postoperative external beam radiation therapy (50.4 Gy/28 fractions) was given to the thyroid bed and bilateral cervical lymph node area. He remained well 2 years post therapy with no palpable neck disease.