Hürthle cell metaplasia on fine-needle aspiration biopsy is not by itself an indication for thyroid surgery

Thyroid surgery in children

“…There is some suggestion that Hürthle cell changes alone may not require surgical resection (39) and there is hope that molecular diagnostic markers may define the patients in these indeterminate groups who are at higher risk of malignancy and allow low-risk patients to avoid surgery (17).…”

Hurthle Cell Lesion: Controversies, Challenges, and Debates

“…Some authors considered it a HCL when oncocytes exceed 50 % of follicular cells in fine-needle aspiration biopsy (FNAB) [17][18][19]. However, most authors used the figures 75 [20][21][22][23][24][25] and 50 % [9,[26][27][28][29][30] to refer to neoplastic rather than non-neoplastic HCL. Others required more than 90 % oncocytes to define the lesion as oncocytic neoplasm [26,31].…”

“…Given the high incidence of malignancy in their series, Azidan et al [85] concluded that the cytological detection of HCs in FNAB was an indication for surgery after excluding Hashimoto's thyroiditis. On the contrary, subsequent studies suggested that the percentage, rather than the mere detection, of HCs should guide the operative decision with the detection of more than 50 % HCs being an adequate criterion for opting surgery [30,86]. The second debate is, if to operate, how much to resect.…”