Hello XXXXXXX

Thanks for posting your query.

I understand that she has recurrent disease in the Tracheo-oesophageal groove and several nodes with Bilateral lung metastasis, with a normal Thyroglobulin level.

The nuclear medicine experts have ruled out Radioiodine as an option of treatment since Thyroglobulin is normal.

The oncosurgeons have ruled out surgery as an option in view of her extensive nodes and Lung metastasis, also considering her age.

In this scenario, if she has any significant symptoms in the neck (like feeding difficulty, pain), then I would recommend palliative radiotherapy to relieve those symptoms.

A good and firm decision needs to be taken at this point considering the advantages to the patient.

Since she is able to manage her needs herself, carefully come to a decision, as any wrong choice would hamper her personal physical performance.

I personally feel she does not have to undergo surgery, since the risk of Pulmonary embolism is high.

Even if you resort to surgery, please outweigh the risks of surgery as chances of pulmonary embolism is very high due to metastasis and could further limit her physical activity.

Since she is doing normal physically, it is best left alone instead of going ahead with the surgery.

Unfortunately, I don't think there is any role for treatment with curative intent any more.

Chemotherapy has very little to offer.

Hope my suggestions and recommendations will help you in arriving at the right decision.

I will be available for your follow up queries if any.

wishing you good health.

Thanks and Regards,

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