There is a paucity of publications detailing how to deal with the difficult thyroid cancer. When compared to other cancers, it is relatively rare with several histopathological subtypes which run differing clinical courses and respond to different therapies. It is a condition predominately treated by specifically trained General and now ENT surgeons who already have a thorough knowledge of vocal fold assessment and rehabilitation as well as emergency airways management both to avoid and treat common complications should they occur.Good surgery involves a team effort to produce good results consistently. All members of the team are essential to quality service delivery. Communication with the team and the patient is paramount. We describe our approach to the difficult thyroid.

Background Primary neuroendocrine carcinomas (NECs) are very rare entities accounting for 0.49% of all malignancies. Within the head and neck, the most common sites are the larynx and paranasal sinuses, while the hypopharynx is seldom described. Case We present a patient with a poorly differentiated metastatic NEC of the hypopharynx treated palliatively with organ‐preserving surgery and post‐operative chemotherapy, and literature review for well‐documented pure hypopharyngeal NECs. Our patient died of chest infection during chemotherapy, 4 months after surgery. Conclusion Chemotherapy remains the mainstay of treatment in the presence of metastases with 2‐year overall survival of 15.7%. Due to the aggressive nature of poorly differentiated metastatic NECs, surgical management is seldom considered. We report and advocate the successful palliative role of organ‐preserving, minimally invasive trans‐oral LASER micro‐surgery and neck dissection to control loco‐regional head and neck disease, safe‐guarding better quality of home life, despite limited life expectancy for this condition.