Hürthle Cell Neoplasms of the Thyroid Gland: Reassessment of Functional Capacity

Abstract

We treated a hyperthyroid man and a euthyroid woman who had autonomously functioning Hürthle cell adenomas and demonstrated uptake of radioactive 131I in a woman with recurrent Hürthle cell carcinoma. Since these tumors are thought to be inactive, we reassessed the functional capacity of Hürthle cell neoplasms by reviewing the medical records of all patients operated upon for these tumors at our medical center from 1950 through November, 1993. We also reviewed series of Hürthle cell neoplasms identified from a MEDLINE search of papers published from 1960 to November, 1993. We identified 92 patients with Hürthle cell neoplasms. Thyroid scintigraphy was performed in 28 of 72 patients with benign adenomas and six of 20 patients with Hürthle cell carcinomas. In addition to the two index cases, four euthyroid patients had hot nodules that partially suppressed the extranodular tissue; seven patients had warm nodules. Thyroid scans performed in patients with Hürthle cell carcinomas revealed five cold nodules and one warm nodule. Our index patient with carcinoma displayed elevated serum thyroglobulin levels when the cancer recurred. This patient and another had uptake of 131I by recurrent or metastatic cancer that allowed for treatment with this nuclide. Of 539 patients identified in a literature survey, 489 had benign Hürthle cell adenomas and 50 had Hürthle cell carcinoma. Thyroid scans performed in 282 patients revealed 247 cold nodules, 20 warm nodules, and 8 hot nodules. Our results, added to those published in case series of Hürthle cell neoplasms, indicated that 4.4% of thyroid scans were hot and 8.9% were warm.(ABSTRACT TRUNCATED AT 250 WORDS)

The Role of Radioactive Iodine in the Treatment of Hürthle Cell Carcinoma of the Thyroid

“…In the literature, there is a paradigm (2,7,8,14) that HCTC does not accumulate RAI; so, reports about effective radioiodine therapy (20,21) of HCTC were considered as anecdotal (22). In contradiction with this paradigm is the observation by Samaan et al (23) on the patients with HCTC treated at MD Anderson Cancer Center.…”

Survival Analysis of 19 Patients with Toxic Thyroid Carcinoma

“…In opposition to hyperfunctioning ToxTCa, most cases of oncocytic TCa scarcely concentrate iodine and do not present as ToxTCa. Exceptionally, however, an oncocytic TCa may harbor an activating mutation of the TSH receptor gene (11,41).…”

Hürthle cell carcinoma: diagnostic and therapeutic implications

“…HCC is less responsive to radioactive iodine therapy [20] and taking into account the aggressive behaviour, it has been suggested that every Hürthle cell tumour greater than 2 cm should be treated by total thyroidectomy [21]. In 1990 they showed that recurrent disease was noted in 17% of patients treated with total thyroidectomy compared to 59% in cases where a more limited procedure was carried out [21,22].…”