Purpose <p>To explore methods of tracheal defect repair in patients with thyroid carcinoma invading the cervical trachea.</p> Methods <p>We retrospectively analyzed the clinical data of patients who underwent partial tracheal resection and reconstruction for thyroid carcinoma invading the cervical trachea between January 2013 and January 2023. Among these patients, 15 underwent sleeve tracheal resection with end-to-end anastomosis, 11 underwent tracheal window resection with adjacent flap reconstruction, and 15 underwent tracheal spiral anastomosis.</p> Results <p>Across all groups, two patients failed successful decannulation, yielding an overall decannulation rate of approximately 95.1%. In the end-to-end anastomosis group, one patient could not undergo decannulation because of bilateral vocal cord paralysis, and another developed postoperative anastomotic scar hyperplasia and stenosis. All patients in the adjacent tracheal flap reconstruction group were successfully decannulated‌ postoperatively. One patient in the spiral anastomosis group initially failed decannulation ‌because of bilateral vocal cord paralysis; however, successful decannulation was achieved after subsequent unilateral arytenoidectomy. During follow-up, there were three cases of local tumor recurrence, two cases of lymph node recurrence, one case of combined local and lymph node recurrence, and two cases of lung metastasis. The 5-year disease-specific survival rate after surgery was 90.2%.</p> Conclusion <p>Appropriate tracheal resection and reconstruction should be selected for patients with thyroid carcinoma invading the trachea based on the size and location of the tracheal defect.</p>