Objectives: This study aims to evaluate the management of advanced thyroid carcinoma with extra-thyroidal extension.Patients and Methods: The study included 58 patients (26 males, 32 females; mean age 45.1±8.3 years; range 24 to 72 years) who were referred from general surgery or other otolaryngology departments and had undergone surgery for T4a well-differentiated thyroid carcinoma or T4b anaplastic carcinoma between January 2007 and January 2011 with a minimum of five years of follow-up. The patients with laryngotracheal invasion were divided into two groups according to type of surgery. Patterns of invasion and techniques of surgical resection were evaluated.Results: Of the patients in group 1 (n=24), total thyroidectomy was performed in all (100%), partial laryngectomy in six (10.4%), tracheal resection in eight (13%), and tracheal window resection in 16 (27%), and the free margins were verified by frozen section. Patients in group 2 (n=34) were performed total thyroidectomy (100%) by shaving the tumor off the underlying cartilage or skeletonizing laryngotracheal segments. During the follow-up period, one patient died because of carotid involvement and four patients died because of local recurrence.Conclusion: The results of this study suggest that the depth of the invasion and postoperative morbidity should be considered when choosing a surgical approach for patients with advanced thyroid carcinoma with extra-thyroidal extension. Also, patients who undergo tumor shaving should be followed-up closely