Hurthle Cell Cancer (HCC)
Hurtle cell cancer is thought to be a variant of FTC. Overall the same diagnostic issues exist and the treatment approach is similar. Hurthle cell cancer may be more aggressive than FTC with spread to the lungs being more common. Hurthle cell cancer may not respond to RAI as well as PTC or FTC. For this reason some surgeons recommend a level 6 node dissection as a preventative measure. This is appropriate if the diagnosis of cancer is confirmed at the initial surgery. However, from a practical standpoint, the diagnosis is usually made only after initial surgery. Removal of the lymph-nodes would involve a second surgery that may be high risk for complications do to inflammation and scaring associated with the first surgery. For this reason, we don’t usually proceed with a node dissection as a second procedure in the immediate post-op setting. We do recommend a level 6 node dissection at the initial surgery if HCC is proven. If early follow-up with ultrasound or elevated thyroglobulin levels suggest gross disease in the neck then a neck dissection 4-5 months later, after the initial inflammation and scarring have decreased, may be more safely done with a similar therapeutic benefit. The follow-up is similar to FTC.