Hürthle cell thyroid cancer is a rare type of cancer that involves abnormal cell growth originating in the thyroid gland and accounts for approximately 4% of cases of thyroid cancer. It is similar in some respects to follicular thyroid cancer, although they have a different appearance when examined under a microscope.
It is more likely to affect women than men and is usually diagnosed at around 50 years of age.
Hürthle cell is the terminology used to reference abnormal cells that are developed in the thyroid gland, which can exist in patients with malignant or benign thyroid disease.
The signs and symptoms of Hürthle cell thyroid cancer are similar to other types of cancer of the thyroid gland and may include:
- A growth or lump on the thyroid gland (at the base of the neck)
- A chronic hoarse voice
- Dysphagia (difficulty swallowing)
- Dyspnea (shortness of breath)
- Persistent cough
Hürthle cell thyroid cancer is less likely to spread to the lymph glands in the neck than follicular thyroid cancers. However, it can affect other parts of the body in advanced cases.
There are several diagnostic tests that may be used to diagnose Hürthle cell and other types of thyroid cancer.
An ultrasound scan is helpful to view the thyroid gland and investigate the presence of a cancerous growth.
A needle biopsy involves taking a sample of cells from the thyroid gland, which can be analyzed in a laboratory. This is useful to determine the presence of Hürthle cells in the growth on the thyroid gland, although it may not be able to show if they are malignant or benign.
In most cases, when Hürthle cells are present, the lump is removed and can then be examined by a pathologist to determine if it is cancerous in nature. The outcome of these results will affect the future treatment decisions.
The first-line treatment for Hürthle cell thyroid cancer is usually surgery to remove the growth. This may involve a procedure to partially remove the thyroid gland, known as a lobectomy, or complete removal of the thyroid gland, known as a total thyroidectomy.
Complete removal is associated with reduced risk of the cancer returning. However, it requires ongoing treatment to replace the thyroid hormones in the body for the lifetime of the patient.
Radioactive iodine is also used in the treatment of Hürthle cell thyroid cancer for some patients, typically after surgery. However, this technique is less successful for Hürthle cell thyroid cancer than other thyroid cancers because the Hürthle cells do not readily take up the radioactive iodine.
Ongoing care with follow-up appointments is essential for patients who have had treatment for Hürthle cell thyroid cancer. This is particularly true for patients who have had a total thyroidectomy, as they will require replacement thyroid hormone medication and the dose will need to be adjusted according to blood tests and hormone levels.
Over time, the frequency of check-up appointments usually decreases slightly but it is important that patients continue to have regular contact with they general practitioner. There is always a small risk of recurrence of cancer, or the formation of a secondary cancer and patients should be encouraged to discuss any changes or worries they may have with their health care provider.
Reviewed by Susha Cheriyedath, MSc