Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • More aggressive variant of follicular thyroid neoplasms• History of radiation to the neck in some patients• Painless or enlarging nodule, dysphagia, or hoarseness• Firm or hard, fixed thyroid nodule; cervical lymphadenopathy• Normal thyroid function; solid nodule stippled with calcium (US), cold (radioiodine scan), positive or suspicious cytologic studies• Family history of thyroid cancer +++ Epidemiology + • Accounts for approximately 2% of all malignant thyroid tumors• Appears later in life than papillary thyroid cancers, with peak incidence in fifth decade• More common in women +++ Symptoms and Signs + • Thyroid nodule: Hard, rubbery, or soft• Enlarged or hard cervical lymph nodes• Pain in the thyroid or paralaryngeal neck• Hoarseness• Dyspnea• Stridor• Dysphagia +++ Laboratory Findings + • Normal thyroid-stimulating hormone (TSH) +++ Imaging Findings + • Solid or cystic nodule on US• Nonfunctioning (cold) on radioiodine scan + • Fine-needle aspiration (FNA) is unable to reliably differentiate the atypical cells of invasive Hürthle adenocarcinoma from its counterpart benign adenoma• Sometimes bilateral and multicentric• Commonly metastasize to cervical lymph nodes• 95% resistant to radioiodine +++ Rule Out + • Concurrent hyperparathyroidism (so that it can be treated during the same operation if necessary) + • Complete history and physical exam-With attention to risk factors, family history, palpable characteristics of the nodule, or lymphadenopathy• Measurement of serum TSH and calcium• FNA biopsy + • Treatment starts with operative removal• External beam radiation may palliate nonresectable metastases that are resistant to radioiodine +++ Surgery +++ Indications + • All Hürthle cell neoplasms should be excised unless the Hürthle cell adenoma can be diagnosed with certainty on FNA• Bulky or palpable nodal recurrences +++ Medications + • Suppressive doses of thyroid hormone after thyroid ablation or thyroidectomy +++ Treatment Monitoring + • Semiannual or yearly neck exams, serum thyroglobulin, thyroglobulin antibodies, and whole body radioiodine scan +++ Complications + • Neck hematoma• Superior laryngeal nerve injury• Recurrent laryngeal nerve injury• Transient of permanent hypoparathyroidism• Wound infection +++ Prognosis + • Worse prognosis predicted by extensive angioinvasion, older age, and presence of distant metastases• 10-year survival rate, approximately 70% +++ References ++Cooper DS et al: Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006;16:109. [PubMed: 16420177] +++ Practice Guidelines + • NCCN web sitehttp://www.nccn.org/ Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth