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Management of an insular thyroid carcinoma invading the larynx and trachea. Carcinomas of the thyroid gland are usually classified into four types: papillary, follicular, medullary and anaplastic and into two main groups depending on their clinical behaviour: low and high grade malignancy. Insular carcinomas represent a rare subtype of follicular thyroid carcinoma, which are poorly differentiated. It is an aggressive and often lethal tumour. Thyroid cancers rarely invade the upper airways. We report the case of an insular carcinoma invading the larynx and trachea, which was treated by total laryngectomy, bilateral neck dissection and external beam irradiation. The patient presented no signs of tumour recurrence two years after treatment. Conservative treatment is usually recommended for thyroid carcinomas. Total laryngectomy is reserved for some extensive tumours invading the upper airways. A multidisciplinary approach is necessary to manage these cancers correctly.