Introduction to Hurthle Cell Thyroid Cancer

Since the 1970’s, the incidence of thyroid cancer has doubled. Until recently, thyroid cancer was the fastest growing cancer in the United States, mainly due to our ability to detect these cancers so well (Ultrasound, CT scan, MRI, etc.). Thyroid cancer is the 5th most common cancer in women. Overall, the 5-year survival rate for people with thyroid cancer is 98%, with long-term survival being 95% or higher.

Hurthle cell nodules (tumors, neoplasms, etc.) are uncommon, and the overwhelming majority of them are benign. A small percentage of these nodules, however, are cancerous. Like benign Hurthle cell tumors, Hurthle cell thyroid cancers arise from normal cells that are found in the thyroid gland. This type of cell is seen in more abundance in patients with an autoimmune condition called Hashimoto’s disease. As with all thyroid nodules or lumps, determining whether there is a thyroid cancer present, and being cured if one is diagnosed, are every patient’s top priorities.

Hurthle Cell Thyroid Cancer: Top 3 Things to Know

Below I will discuss the top 3 things to know about Hurthle Cell Thyroid Cancer, including the diagnosis, treatment, and why thyroid surgery is curative. For additional information on all types of thyroid disease, thyroid cancer, and expert thyroid care, check out our comprehensive thyroid cancer website.

#1 Top Thing to Know About Hurthle Cell Thyroid Cancer: They are rare and different

Hurthle cell thyroid cancers are rare. While thyroid cancer is relatively common, Hurthle cell thyroid cancer is very uncommon. In fact, like most thyroid nodules, the vast majority of Hurthle cell nodules are benign. Hurthle cell thyroid cancer only accounts for roughly 3% of all thyroid cancers.

Hurthle cell cancer typically starts within the thyroid as growth, or bump in the thyroid, that grows out of the otherwise normal thyroid cells (Hurthle cells) and tissue. Because this type of thyroid cancer is so uncommon, most thyroid specialists have had very little or no experience with Hurthle cell thyroid cancer. Additionally, this type of cancer is different from the more common types of thyroid cancer, i.e. papillary thyroid cancer. As such, diagnosis and treatment must be managed by an expert thyroid surgery team such as ours.

As you will read below, not only is the diagnosis very challenging, curing the cancer with the first surgery is paramount. Hurthle cell thyroid cancers are different with respect to how they spread and exhibit aggressive features when compared to the two most common types of thyroid cancer (papillary and follicular). Patients who seek care and treatment where these Hurthle cell nodules are managed in the same fashion as more common thyroid nodules and cancer will have poor outcomes and recurrent disease.

Learn more about Hurthle cell thyroid cancer, staging, and diagnosis.

#2 Top Thing to Know Hurthle Cell Thyroid Cancer: Diagnosis is challenging

Many thyroid cancers are a challenge to diagnose because they rarely cause symptoms and are not detected with blood tests. Hurthle cell thyroid cancers, however, present even more of a challenge for definitive diagnosis primarily because they cannot be diagnosed by needle biopsy of a thyroid mass (nodule). Additionally, the newer molecular/genetic tests that are done on cells from the needle biopsy are poor at diagnosing Hurthle cell thyroid cancer as well.  Most patients that have Hurthle cell thyroid cancer will not know their diagnosis until after the surgical removal of their thyroid nodule, which was likely initially called a Hurthle cell tumor. Interestingly, if an abnormal cancerous lymph node in neck is noted on ultrasound, Hurthle cell cancer of the thyroid that has spread can be diagnosed by needle biopsy of a lymph node in the neck.

The reason almost every Hurthle cell thyroid cancer is not able to be diagnosed until surgical removal has to do with the cells of the tumor. The pathologist needs to visualize not only how the cells look, but also how they are behaving. Hurthle cells that exhibit more aggressive features, such as spread into lymphatic channels and lymph nodes, small blood vessels (angioinvasion), or into surrounding tissue (i.e. capsule or covering of the thyroid gland), are indicative of a cancer. These features are not able to be discerned on needle biopsy or rapid analysis (frozen section analysis) of a nodule or sample in the operating room. Bottom line is the vast majority of Hurthle cell nodules need to be removed by an experienced, skilled thyroid surgeon for a definitive diagnosis and cure.

#3 Top Thing to Know About Hurthle Cell Thyroid Cancer: An expert, appropriate thyroid surgery is the definitive cure

Expert thyroid surgery is the mainstay of treating Hurthle cell thyroid cancer. There are 2 main types of thyroid removal (thyroidectomy): thyroid lobectomy (removal of half of the thyroid) and total thyroidectomy (removal of the entire thyroid). Many Hurthle cell thyroid cancers can be treated by removal of half the thyroid along with the lymph nodes that are located behind and around the thyroid (central compartment). Studies have shown that at least 20% of these thyroid cancers have spread to lymph nodes at the time of diagnosis and surgery. The extent of surgery is often determined by the pathologic analysis of the cancerous nodule. If the Hurthle cell thyroid cancer is aggressively growing into blood vessels, tissue around the thyroid (windpipe, nerve to voice box, esophagus, etc.) or thyroid capsule, or the lymph nodes, then complete removal of the thyroid is necessary. Expert evaluation and complete removal of all cancer with the first surgery are extremely important to avoid complications and leaving cancer behind.

Learn more about how to find an expert thyroid surgeon and the importance of choosing the best thyroid surgeon.

In some instances, complete removal of the thyroid for Hurthle cell cancer is indicated from the outset (large cancers, multiple areas of cancer in the thyroid, lymph node spread, etc.). Again, removal of the lymph nodes behind and around the thyroid in the central compartment on both sides is important to ensure the cancer is completely cured. Complete thyroid removal is even riskier than thyroid surgery for half the thyroid. This is because both sides of the neck are worked on, exposing all 4 parathyroid glands (calcium control glands) as well as all the nerves to the voice box to potential damage. Thus, total thyroid removal for Hurthle cell thyroid cancer should only be done by high-volume, experienced surgeons at busy centers such as ours.

Finally, Hurthle cell thyroid cancer that has spread to lymph nodes in the side of the neck is treated by removing the whole thyroid (total thyroidectomy) along with lymph node dissection (neck dissection). This thyroid surgery is done for thyroid cancers that have spread to lymph nodes in the side of the neck (on the left, right, or both) or to the lymph nodes in the center of the neck around and behind the thyroid. Surgery in these cases must address the lymph node areas that are known to contain cancer as well as those that are at significant risk of having thyroid cancer.

Hurthle cell thyroid cancers must have appropriate, expert, and experienced evaluation, work-up, and surgery. These cancers are very problematic when not addressed and cured the with the first surgery.

For more information about thyroid surgery for cancer, check out our blogs on thyroidectomy for thyroid cancer and the best thyroid operations for thyroid cancer. 

Summary

Hurthle cell thyroid cancers are rare and different from the more prevalent thyroid cancers. How the Hurthle cells are behaving relative to surrounding tissue, blood vessels, and lymphatics are key in the diagnosis of a cancerous tumor. As noted above, you almost certainly will not know that you have a Hurthle cell thyroid cancer until after surgery. These cancers are very challenging to diagnose, and they are almost always diagnosed after surgical removal. Needle biopsy and further molecular/genetic testing of the cells from the biopsy almost never are able to diagnose a Hurthle cell cancer.

Hurthle cell thyroid cancer surgery should only be done by expert surgeons. By choosing the correct surgeon and surgery, you are cured. The wrong choice may lead to repeated surgeries, complications, and even an inability to control and cure the Hurthle cell cancer! Be aware, the wrong first surgery with a Hurthle cell cancer can be a dire misstep!

Our team of thyroid cancer experts is here to help and guide you every step along the way. We will be there for you after your thyroid surgery for Hurthle Cell Thyroid Cancer. To learn more and become a patient, please see our resources below.

Additional Resources

• Become our patient by filling out the form at this link. 
• Learn more about The Clayman Thyroid Center here. 
• Learn more about our sister surgeons at the Scarless Thyroid Surgery Center, Norman Parathyroid Center, and Carling Adrenal Center
• Learn more about the Hospital for Endocrine Surgery.