Background and Aims Surgery is the preferred treatment for locally advanced thyroid cancer that invades the trachea. According to the location and degree of trachea invasion, the treatment methods are varied. Appropriate treatment choice is crucial for patients' prognosis and quality of life. Usually, tracheal invasion of thyroid cancer is accompanied by lymph node metastasis, adhesion of vessels, and even invasion of esophagus and larynx. Due to its complex and variable anatomical structure, there are still no high-level evidence-based medical recommendations to guide the treatment. This study was designated to investigate the clinical features and surgical management of locally advanced thyroid carcinoma with tracheal invasion.Methods The data of 20 patients with locally advanced thyroid cancer and accompanying tracheal invasion from July 2019 to July 2021 were reviewed. Of the patients, 16 cases were males, and 4 cases were females, aged from 13 to 78 years with a median age of 53.5 years; there were 2 cases of thyroid follicular carcinoma, 2 cases of medullary carcinoma and 16 cases of thyroid papillary carcinoma; three cases underwent shave resection for superficial tracheal invasion, 5 cases underwent window resection for tracheal mucosal and luminal invasion, 10 cases underwent tracheal sleeve resection and end-to-end anastomosis, one case underwent total laryngectomy and trachea permanent tracheostomy, one case underwent total laryngectomy and permanent tracheostomy with pectoralis major myocutaneous flap repair. All patients received systemic treatment, including radioiodine therapy or molecular targeted therapy.Results The follow-up time of the patients ranged from 4 months to 2 years. No tumor recurrence or tracheal fistula was found in the 3 patients undergoing tracheal shave excision; all 5 patients receiving tracheal window resection had phase I tracheal repair with tracheal wound suture; no airway stenosis or bilateral vocal cord paralysis occurred in the 10 patients undergoing sleeve resection and end-to-end anastomosis, of whom, one case developed a local infection and local trachea fistula after the operation, which healed after dressing change; two cases undergoing total laryngectomy and permanent tracheostomy lived with an indwelling catheter. There was no tumor progression in all patients included as of the submission of this paper.Conclusion Resection and reconstruction of cervical trachea is a complex problem that surgeons may usually face and should deal with. The authors' treatment principle is that surgical treatment is generally the first choice whenever possible on the premise of complete lesion removal and the treatment tolerance of patients. For patients with locally advanced thyroid cancer invading the trachea and its adjacent organs, treatment plans should be developed collaboratively under the guidance of MDT discussion, and sufficient preoperative preparations, as well as measures for complications, should be made. The appropriate range of tracheal resection and reconstruction methods should be selected according to the different degrees of invasion. The first choice is a phase I repair and reconstruction, followed by phase Ⅱ or multiple stages. However, whether surgical or comprehensive treatment is selected, the purpose of treatment is to prolong the survival period and improve the quality of life of thyroid cancer patients.