Thyroid hurthle cell cancer is the fourth most common of all thyroid cancers. It can also be called “hurthle cell carcinoma of the thyroid” since carcinoma implies a certain type of cancer. Since thyroid cancer is relatively common, it is very likely that you will know somebody that had or has a form of thyroid cancer. However, hurthle cell carcinoma of the thyroid is a very uncommon type of thyroid cancer. Most patients and even thyroid specialists have had very little to no experience with this type of rare thyroid cancer. Try not to think about hurthle cell cancer as you would other thyroid cancers, since this assumption will likely lead you to decisions that are not necessarily justified.

Hurthle cell cancer typically starts within the thyroid as growth, or bump (nodule) in the thyroid that grows out of the otherwise normal thyroid tissue.


Important

If you have been told that your fine needle aspiration biopsy of your lump in your thyroid gland is a hurthle cell cancer….beware. Whoever told you that does not understand hurthle cell cancer of the thyroid. Hurthle cell cancer cannot be diagnosed by FNA of your thyroid mass!!! In contrast, if an abnormal lymph node in your neck is noted on ultrasound, hurthle cell cancer of the thyroid can be diagnosed by FNA of your lymph node in your neck!!!)

A thyroid mass can be a hurthle cell lesion or a hurthle cell neoplasm based upon FNA, but not until it is removed, can the thyroid pathologist diagnose a hurthle cell cancer of the thyroid!!!


Hurthle Cell Cancer: What About Lymph Nodes?

We have lymph nodes all over our body that are made up of groups of infection-fighting and cancer fighting immune cells. We all have had "swollen glands" in our neck when we had a sore throat or tonsils. These same glands that get swollen when we have a neck infection can help fight cancer by preventing the cancer cells from spreading from the thyroid to the rest of the body. Hurthle cell cancer certainly can spread into the lymph nodes of the neck. In fact, at least 20% of hurthle cell cancers will have spread to neck lymph nodes on their initial presentation. Failure to recognize that your hurthle cell cancer has spread to neck lymph nodes is one common cause of persistent hurthle cell cancer. This is a common oversight of inexperienced thyroid cancer surgeons and has a major impact on the ability to control your hurthle cell cancer. Make sure you have identified a thyroid cancer surgery expert if you are preparing for surgery of a hurthle cell neoplasm or lesion. If you underwent surgery and have persistent disease, don’t make the same decision again which brought you to your current circumstance.

Since hurthle cell cancer usually doesn’t have any symptoms, the cancer grows slowly for years and has time for the hurthle cell cancer to spread into the lymph nodes which are doing their job of capturing the cancerous cells before they can spread further. The hurthle cell cancer basically gets “stuck” in the lymph node something like a filter. Our bodies don’t have any ability to remove the cancer from this filter system and therefore the cancer cells begin growing within the lymph nodes.

Hurthle cell cancer has a greater risk of growing into blood vessels in and around the thyroid. This is called angioinvasion. This occurs, in fact, more frequently than hurthle cell cancer spreads to lymph nodes. It is important to make sure the diagnosis of hurthle cell cancer is correct.

Hurthle cell cancer which has spread to lymph nodes of the neck may be associated with a higher chance that the cancer may come back months or years later (a higher recurrence rate). However, having hurthle cell cancer spread to neck lymph nodes does not necessarily mean that there is a higher mortality rate. In fact, among patients less than 45 years of age, even with spread to neck lymph nodes, survival rates of fhurthle cell cancer exceed 95%. Distant metastasis (spread to other organs of the body) is more common in hurthle cell cancer in patients above 50 years of age and with larger cancers. The overview of the importance of lymph nodes in hurthle cell cancer ends here, but if you have this problem, then please continue reading our page on Hurthle Cell Cancer Staging.

The Best Cure Rates Come From The Most Experienced Doctors!

What is critically important to you is that you are evaluated and managed by a highly experienced thyroid cancer team whom are experts in the imaging (ultrasound and Xrays), staging, pathologic analysis (the way individual cells look under a microscope) and surgery management of hurthle cell cancer.


Fact Check
Editorial note: Studies have clearly shown that 11% of patients with thyroid cancer have cancer that remains in the neck after initial surgery (persistent disease) for the most favorable early diagnosed thyroid cancers!!! Further, among those patients undergoing surgery for thyroid cancer which is located just in the thyroid gland itself and/or lymph nodes in the neck, up to 30% will develop recurrence of their cancer in their necks! Locally persistent and recurrent follicular thyroid cancers are largely preventable events if the initial treatment is obtained by an expert thyroid surgeon!!!! When surgery is performed by the most skilled thyroid surgeons, patients with T1 (the earliest) to T4a cancers (very advanced) have a local control rate (where the cancer began in their thyroid) of greater than 98%.

How Is Hurthle Cell Cancer Staged?

Hurthle cell cancers are not all alike. Some are big and some are small. Some have thick capsules, some have cancer found in blood vessels, some have spread outside of the thyroid gland itself. Some will spread to neck lymph nodes. To separate out the cancers that are easy to cure from those that are more difficult to cure, doctors have come up with a grading or "staging" system. All cancers have their own staging system, but hurthle cell cancer has a staging system that is not like other cancers. This staging system for hurthle cell cancer takes into account the age of the patient. The staging system also includes the size of the hurthle cell cancer in the thyroid gland itself and whether or not the cancer has spread into lymph nodes around the thyroid or sides of the neck. The staging system for hurthle cell cancer also includes whether or not the cancer has spread into the fat and muscles around the thyroid (called local extension). Finally, this staging system includes the “differentiation” of the cancer which is what it looks like under a microscope and whether or not the thyroid cancer cells look mature or young and more “angry”. The last component of hurthle cell cancer staging is the presence of distant metastases, which means whether the cancer has spread to distant (far away) areas like the lungs. If you or someone you know has hurthle cell cancer, then please read our more detailed page on Hurthle Cell Cancer Staging. The stage of the cancer will determine how aggressive the cancer operation needs to be, and other things like whether or not radioactive iodine should be given.

What Surgery May Be Indicated for Hurthle Cell Cancer

Hurthle cell cancer is almost always treated with surgery as its first therapy. It is important to understand that the best chance of cure is to have an expert thyroid cancer surgeon from the beginning. A surgeon who performs surgery for thyroid cancer several times per week (or more often) has a higher cure rate than a surgeon who performs thyroid surgery once or twice per week, or does primarily other types of thyroid surgery (like for goiters). Surgery for thyroid cancer has become very specialized so it is important for you to be comfortable with your choice of surgeon. Surgery for hurthle cell cancer is filled with a number of choices. If the cancer is big (over 4 cm or 1.75 inch) then the entire thyroid is usually removed. However, there is controversy over how much thyroid should be removed if the cancer is small and exhibits little evidence of invasion of the thyroid capsule or blood vessel invasion. Some expert thyroid surgeons contend that if the cancer is small and not invading other tissues (the usual case) then simply removing the half of the thyroid (called the thyroid lobe) which contains the cancer will provide as good a chance of cure as removing the entire thyroid. See a thyroid lobectomy surgery. This is a brief surgical procedure of around 30 minutes. It is a very small incision and the surgery spares all critical structures and removes only the thyroid gland itself. It can be the correct surgical procedure for many small cancers. Sometimes operative findings will determine that the whole thyroid gland must be removed despite the initial plan to just do a thyroid lobectomy. See how critical it is for your surgery to be performed by a highly experienced surgeon to change the surgery to a total thyroidectomy due to findings noted at the time of surgery.

Many surgeons prefer the older method of removing the entire thyroid (see a total thyroidectomy) for all thyroid cancers. How much surgery is performed has an important impact on how you are managed afterwards, how much thyroid hormone you need and many other factors. Because there are many choices to make, it is important that you have a surgeon that understands every option and how it will affect your overall cure rate, whether more surgery will be needed in the future, and many other things. Get the best thyroid cancer surgeon that you can!

What About Thyroid Hormone Pills After Hurthle Cell Cancer Surgery?

Regardless of whether a patient has just half of the thyroid removed, or the entire thyroid gland removed, most experts agree they should be placed on a thyroid hormone pill for the rest of their lives. This is to replace the hormone in those who have no thyroid gland remaining, and to suppress further growth of thyroid cells (and hurthle cell cancer cells) in those with some thyroid tissue left in the neck. There is good evidence that hurthle cell cancer responds to thyroid stimulating hormone (TSH) secreted by the pituitary, therefore, a thyroid hormone pill is given which results in decreased TSH hormone levels and a lower potential for any remaining microscopic cancer cells to grow. Recurrence and mortality rates have been shown to be lower in patients receiving adequate amounts of thyroid hormone pills. Much more is written for you in sections of Diagnosis of Hurthle Cell Cancer and determining what extent of surgery is right for you.

After Surgery: Radioactive Iodine and Long-Term Follow-up

Almost all people who had surgery for hurthle cell cancer will need to see a doctor for many years to have periodic examinations and certain blood tests to make sure the cancer has been cured, and to detect any return of the cancer as soon as possible should it return. Many people with hurthle cell cancer will need to take radioactive iodine to help cure the cancer. Much more is written about radioactive iodine treatment for hurthle cell cancer and long term follow-up of hurthle cell cancer. We have several very important pages on these topics.