Hurthle cell surgery questions

evenkeeled

Hi everyone,

I have been found to have a Hurthle cell lesion based on FNA and am being suggested to go for lobectomy to check for cancer. I have been told that my 1.5 cm nodule is most likely due to my newly diagnosed Hashimoto's thyroiditis, but since cancer can't be ruled out, to do the surgery. I have done substantial reading about the cancer and know it can be either localized or metastasized, and tends to reoccur. My questions are: Does anyone know or can point to information that discusses the efficacy of total thyroidectomy if the cancer is found? I know it depends on how much spreading has occurred. Secondly, when they analyze the removed lobe, can they definitively tell if there is cancer or not? Third, if they analyze the removed lobe and conclude the nodule is a benign tumor, what is the chance they are wrong or the benign tumor will turn into a carcinoma? Fourth, how quickly does this type of cancer grow; is it always slow-growing like papillary?

Thanks to any and all responses I get!

Grace

loispol1

Hi Gwen you sound exactly like me
I have had all of your same questions and there are a ton of answers over at the other hurthle cell postings. I am having a TT because I am 59 with other health problems and over 8 nodules. I do not think I could two surgeries either. I am already on full replacement thyroid medication. Please go over and read my same lengthy questions(sorry - I was feeling freaked out).

thurston

Hi Gwen
I am 11 years into this battle. you say that your nodule is 1.5 cm mine was 6.5 cm when it came out and due to its size it was an incomplete removal because it had burst. so what i can say to you is do not wait get it out. yes they can tell you exactly what type of tumour. the efficiency of the removal i was told depended on how quick it came out. unfortunatly when i was diagnosed the surgeon that i was dealing with did not know anything about hurthle cell. mine then after 8 years appeared on my voice box which necessitated a vertical resection, the right side of my voice box is now gone. it now has appeared in my lungs.

I tell you this not to frighten you but to tell you that if you do nothing it will only get worse.

i have been told by my current hospital team that i would not have had my current problems if the first surgen had acted sooner.

Please Gwen act now. all the best.

Peter

weberdns

Gwen I had a Hurthle cell neoplasm
Ended up being a 1.5 cm Hurthle cell carcinoma. You can't tell if it is cancer or not until it is removed and totally dissected. It will be tested and you will get a definite diagnosis of cancer or adenoma. The other side must also be removed because there is a chance that there is a nodule on the other side that isn't known about yet, plus it can also grow new nodules on that side. The recommended course of treatment is to remove the other side anddo it quickly. I had the second side removed 8 days after theh first one. There are theories that benign nodules will turn into the carcinoma but this is open to discussion. There could also be cells in your remaining side that are not yet nodules. Don't know how fast it grows, but I know that my doctor who said that I could wait to have the nodule removed, wanted it out quickly once he got the path report. Do it now, and do it quickly so that you don't have to worry and can know what you are dealing with.

evenkeeled

weberdns said:

Gwen I had a Hurthle cell neoplasm
Ended up being a 1.5 cm Hurthle cell carcinoma. You can't tell if it is cancer or not until it is removed and totally dissected. It will be tested and you will get a definite diagnosis of cancer or adenoma. The other side must also be removed because there is a chance that there is a nodule on the other side that isn't known about yet, plus it can also grow new nodules on that side. The recommended course of treatment is to remove the other side anddo it quickly. I had the second side removed 8 days after theh first one. There are theories that benign nodules will turn into the carcinoma but this is open to discussion. There could also be cells in your remaining side that are not yet nodules. Don't know how fast it grows, but I know that my doctor who said that I could wait to have the nodule removed, wanted it out quickly once he got the path report. Do it now, and do it quickly so that you don't have to worry and can know what you are dealing with.

diagnosis of tumor
Hi Weberdns,

So I read that somewhere tumor diagnosed as benign can turn cancerous--and you affirm there are such theories. What I am confused about is how they are able to know this? My surgeon said that he would take out the lobe to dissect the nodule; if it is benign he said that's the end of the story. If the nodule is already out of your body (along with half your thyroid), how could the nodule ever turn cancerous? I'm missing something...

And I heard about a RNA/receptor test on TSH...basically another blood test can tell if cancer cells--done by Cleveland Clinic--anyone know how to get these tests done?

Also, my endo never ran an radionucleotide test on me to see if mine is cold or not. Anyone recommend this extra step?

Finally, I was told that you can tell about vascular invasion from an ultrasound scan? anyone know anything on this?

Thanks!!

weberdns

evenkeeled said:

diagnosis of tumor
Hi Weberdns,

So I read that somewhere tumor diagnosed as benign can turn cancerous--and you affirm there are such theories. What I am confused about is how they are able to know this? My surgeon said that he would take out the lobe to dissect the nodule; if it is benign he said that's the end of the story. If the nodule is already out of your body (along with half your thyroid), how could the nodule ever turn cancerous? I'm missing something...

And I heard about a RNA/receptor test on TSH...basically another blood test can tell if cancer cells--done by Cleveland Clinic--anyone know how to get these tests done?

Also, my endo never ran an radionucleotide test on me to see if mine is cold or not. Anyone recommend this extra step?

Finally, I was told that you can tell about vascular invasion from an ultrasound scan? anyone know anything on this?

Thanks!!

If it's benign then taking out half the thyroid is the last step
Of course you will still be on Thyroid hormones to keep the activity of the remaining thyroid tissue down to discourage future nodules. If it is cancer, then the next step is to remove the remaining part of the thyroid, as there could be cancer cells in it! You can tell about vascular invasion from the ultrasound, but they will also test the nodule itself it if it is cancer. If the nodule is benign it isn't a problem.
Sue

weberdns

weberdns said:

Gwen I had a Hurthle cell neoplasm
Ended up being a 1.5 cm Hurthle cell carcinoma. You can't tell if it is cancer or not until it is removed and totally dissected. It will be tested and you will get a definite diagnosis of cancer or adenoma. The other side must also be removed because there is a chance that there is a nodule on the other side that isn't known about yet, plus it can also grow new nodules on that side. The recommended course of treatment is to remove the other side anddo it quickly. I had the second side removed 8 days after theh first one. There are theories that benign nodules will turn into the carcinoma but this is open to discussion. There could also be cells in your remaining side that are not yet nodules. Don't know how fast it grows, but I know that my doctor who said that I could wait to have the nodule removed, wanted it out quickly once he got the path report. Do it now, and do it quickly so that you don't have to worry and can know what you are dealing with.

Left out a phrase....sorry....really hypo....
I said...."The other side must also be removed because there is a chance that there is a nodule on the other side that isn't known about yet, plus it can also grow new nodules on that side. The recommended course of treatment is to remove the other side anddo it quickly"

What I meant to say was If the biopsy comes back as cancer the other side must also be removed because there is a chance that there is a nodule on the other side that isn't known about yet, plus it can also grow new nodules on that side. The recommended course of treatment is to remove the other side anddo it quickly.

Sorry for the confusion!

loispol1

weberdns said:

Left out a phrase....sorry....really hypo....
I said...."The other side must also be removed because there is a chance that there is a nodule on the other side that isn't known about yet, plus it can also grow new nodules on that side. The recommended course of treatment is to remove the other side anddo it quickly"

What I meant to say was If the biopsy comes back as cancer the other side must also be removed because there is a chance that there is a nodule on the other side that isn't known about yet, plus it can also grow new nodules on that side. The recommended course of treatment is to remove the other side anddo it quickly.

Sorry for the confusion!

Just found this recent information:
Endocr Regul. 2010 Apr;44(2):65-8.

Clinical significance of Hürthle cells in fine needle aspiration biopsy for multinodular goitre.
Keskek M, Ocak S, Ozalp N, Koc M, Tez M.

Abstract
Objective. So far, the significance of Hürthle cell predominance in fine needle aspiration biopsy (FNAB) in multinodular goitre (MNG) appears not definitely clarified. The aim of this study was to determine if there are any clinical factors that can be used to distinguish either malignant or benign disease with the aid of FNAB specimen that contains a predominance of Hürthle cells in multinodular goitre patients.
Methods. Among 623 patients who were evaluated for multinodular goitre between July 2004 and March 2009, 411 had a FNAB specimen. In 37 (9 % of them) the FNAB specimen was interpreted as consistent with a Hürthle cell lesion. These patients comprised the study population and were reviewed retrospectively and their demographical and clinical factors were investigated to determine if there is any predictor of malignancy.
Results. Among 37 patients with Hürthle cell predominance in FNAB, 29 had benign diseases and 8 had malignant diseases resulting in 21.6 % prevalence of malignancy. There were no differences in age, sex, functional status of the thyroid gland, and nodule size between patients with benign versus malignant disease.
Conclusion. Total thyroidectomy should be recommended for all multinodular goitre patients with Hürthle cell predominance in FNAB, since there is no preoperative predictor of malignancy in these cases. Keywords: Hürthle cell - Fine needle aspiration biopsy - Multinodular goitre.

PMID: 20429635 [PubMed - in process]Free Article