Hurthle Cell Cancer

Diagnosis

Diagnosis of Hurthle cell cancer involves several tests and examinations to determine the presence, extent, and nature of the thyroid tumor. These procedures help your healthcare provider understand the condition and plan the appropriate treatment.

Physical exam

Your healthcare provider will examine your neck to check for thyroid enlargement or swelling of the lymph nodes. Any noticeable growths or abnormalities in the thyroid region may indicate further evaluation.

Blood tests

Blood tests can help identify changes in thyroid function. These results give your provider valuable information about whether your thyroid is producing normal levels of hormones.

Imaging tests

Imaging studies such as ultrasound and CT scans help detect growths or nodules in the thyroid. These images also help determine whether the tumor has spread to nearby tissues or lymph nodes.

Examining the vocal cords (laryngoscopy)

If there is concern that cancer has affected the vocal cords, your provider may perform a laryngoscopy. This test allows visual examination of the vocal cords using either a lighted mirror or a fiber-optic camera inserted through the nose or mouth. It helps assess the movement of the vocal cords, especially if you experience voice changes.

Thyroid biopsy

A fine-needle aspiration biopsy is typically performed to confirm the diagnosis. Under ultrasound guidance, a thin needle is inserted through the skin of the neck to collect a tissue sample from the thyroid. The sample is then examined under a microscope by a pathologist to check for cancer cells.

Additional imaging tests, such as MRI, PET scans, and ultrasound, may be used to evaluate the spread or characteristics of the tumor.

Treatment

Treatment for Hurthle cell cancer usually focuses on surgical removal of the thyroid gland. Additional treatments such as radioactive iodine therapy, radiation therapy, or targeted drug therapy may be recommended depending on the stage and spread of the disease.

Surgery

The primary treatment for Hurthle cell cancer is total or near-total thyroidectomy, in which the entire thyroid gland is removed. During surgery, small portions of thyroid tissue near the parathyroid glands may be left intact to reduce the risk of damaging these glands, which help regulate calcium levels in the body.

If cancer is suspected to have spread, nearby lymph nodes may also be removed.

Possible risks associated with thyroidectomy include:

• Injury to the recurrent laryngeal nerve, which may cause hoarseness or voice changes

• Damage to the parathyroid glands, potentially affecting calcium balance

• Excessive bleeding

After surgery, patients are prescribed levothyroxine (Synthroid, Unithroid, others), a thyroid hormone replacement, which must be taken for life.

Radioactive iodine therapy

Radioactive iodine therapy may be recommended after thyroid surgery to destroy any remaining thyroid tissue or cancer cells. It involves swallowing a capsule containing radioactive iodine, which specifically targets thyroid tissue.

Temporary side effects may include:

• Dry mouth

• Reduced sense of taste

• Neck tenderness

• Nausea

• Fatigue

This therapy may also be used if the cancer has spread beyond the thyroid.

Radiation therapy

Radiation therapy uses high-energy beams, such as X-rays or protons, to destroy cancer cells. It may be considered if cancer remains after surgery and radioactive iodine therapy or if the disease spreads to other parts of the body.

Possible side effects include:

• Sore throat

• Skin irritation resembling a sunburn

• Fatigue

Targeted drug therapy

Targeted drug therapy involves medications designed to block specific pathways that cancer cells use to grow and survive. It is usually recommended when Hurthle cell cancer returns after initial treatment or spreads to distant organs.

Common side effects may include:

• Diarrhea

• Fatigue

• High blood pressure

• Liver problems

Targeted therapies continue to be an area of active research, with new drugs being studied to improve treatment outcomes for people with advanced thyroid cancers.