Hurthle Cell Carcinoma

What is Hürthle cell carcinoma?

Hürthle (pronounced “HEERT-luh” or “HER-THUL) cell carcinoma is a rare, aggressive form of thyroid cancer. Your thyroid is a small gland in the base of your neck. Your thyroid releases hormones that help regulate your metabolism. Hürthle cell carcinoma causes tumors that may affect your ability to speak and breathe. Left untreated, it may spread to other areas of your body, including your lymph nodes, lungs and bones. Healthcare providers treat this cancer with surgery to remove all or part of your thyroid.

How does this condition affect my body?

People may have Hürthle cell carcinoma without noticing changes in their bodies. Some people are diagnosed after having tests for unrelated issues. When Hürthle cell carcinoma does begin to cause symptoms, they may start as lumps or bumps on your thyroid that make noticeable lumps on the front of your throat. As the tumors grow, they may press on your esophagus, making it hard for you to swallow, or on your trachea (windpipe) so you have trouble breathing. The tumor may press on your vocal cords, changing how you sound when you talk.

Is Hürthle cell carcinoma always cancer?

Noncancerous and cancerous Hürthle cell tumors may cause similar symptoms. Sometimes, healthcare providers can’t tell if a tumor is cancerous or noncancerous until they can examine tumor cells under a microscope.

Who is affected by Hürthle cell carcinoma?

Anyone can develop Hürthle cell carcinoma, but it’s more common among people ages 55 and older. Women and people assigned female at birth (AFAB) are more likely to develop this condition than men and people assigned male at birth (AMAB).

Is this a common condition?

No, it’s not. About 14 in 100,000 people are diagnosed with thyroid cancer annually. Hürthle cell carcinoma represents about 3% of all cases of thyroid cancer.

What are Hürthle cell carcinoma symptoms?

Most people with this condition don’t have symptoms until tumors grow large enough to affect other parts of their bodies. For example, tumors may press on your vocal cords, making your voice sound different. Other symptoms may include:

• Difficulty breathing or swallowing (dysphagia).
• Feeling as if you’re choking.
• A painful lump in the front of your throat below your Adam’s apple.
• Swollen lymph nodes.
• Fatigue.
• Unintentional or unexplained weight loss.

What causes Hürthle cell carcinoma?

Medical researchers haven’t identified a specific cause, but they’ve found some risk factors that increase the chance you’ll develop this condition, including:

• Having a family history of thyroid cancer: This means your biological parents or siblings have thyroid cancer.
• Long-term iodine deficiency: Iodine is a mineral your body needs to make thyroid hormones. You get iodine from the food you eat.
• Exposure to radiation: Many healthcare providers believe exposure to X-rays or radiation therapy increases your risk of developing Hürthle cell carcinoma.

How do healthcare providers diagnose Hürthle cell carcinoma?

They diagnose this condition by doing a physical examination and asking about your symptoms, your medical history and your family medical history. Healthcare providers may do tests, including:

• Blood tests: Healthy thyroids release a protein called thyroglobulin. Healthcare providers may check your thyroglobulin levels. A high thyroglobulin level is a sign of Hürthle cell carcinoma.
• Thyroid uptake scan: This test checks for cancer cells in your thyroid. Healthcare providers do this test by injecting a small amount of radiative iodine into your bloodstream. This iodine builds up in any cancer tissues in your thyroid. Then, providers use positron emission tomography (PET) scan to look for cancer cells.
• Laryngoscopy: Providers may do this test to check your vocal cords.
• Fine needle aspiration (FNA): Healthcare providers use a small thin needle to take a sample of your thyroid tissue. They’ll examine the tissue under a microscope for signs of cancer. This technique is sometimes referred to as needle biopsy.
• Lobectomy: Sometimes, FNA or needle biopsy results don’t provide enough information for healthcare providers to make a firm diagnosis. If that happens, they may do surgery to remove the part of the thyroid with cancer.
• Computed tomography (CT) scan: If tests show you have Hürthle cell carcinoma, healthcare providers may do CT scans and other imaging tests to see if the cancer has spread.

Are there stages of Hürthle cell carcinoma?

Healthcare providers use cancer staging systems to plan treatment. They stage Hürthle cell carcinoma with the TNM staging system. (T stands for tumor. N stands for lymph node involvement. M stands for metastasis, whether cancer has spread.) Hürthle cell carcinoma stages range from Stage I to Stage IV.

Healthcare providers also factor in people’s ages when staging Hürthle cell carcinoma. People who are ages 55 and younger when they’re diagnosed have Stage I Hürthle cell carcinoma, regardless of tumor size or tumor effect on lymph nodes. If tumors have spread to more distant lymph nodes or organs, people ages 55 and younger have Stage II cancer.

Tumor size

• TI: A tumor is 2 centimeters or smaller. A centimeter (cm) is about the width of a fingernail or about ¾ inch.
• TII: A tumor is 2 cm to 4 cm.
• TIII: A tumor is larger than 4 cm and hasn’t spread from your thyroid gland but has spread to your infrahyoid (strap) muscles in the front of your neck.
• TIIIa: A tumor is larger than 4 cm but hasn’t spread from your thyroid.
• TIIIb: A tumor has spread to your strap muscles.
• TIVa: A tumor has spread beyond your thyroid gland into nearby soft tissues, your larynx, trachea, esophagus or nerves attached to your larynx.
• TIVb: A tumor has spread toward your spine or into your carotid artery or vein or mediastinal vessels (blood vessels in your chest).

Tumor effect on lymph nodes

• N0: A tumor hasn’t spread to nearby lymph nodes.
• NI: A tumor has spread to nearby lymph nodes.
• NIa: A tumor has spread to lymph nodes in your central neck.
• NIb: A tumor has spread to lymph nodes on the side of your neck.

Metastasis

• M0: There’s no sign that a tumor has spread to more distant lymph nodes or organs.
• MI: A tumor has spread to more distant lymph nodes or organs.

How do healthcare providers treat Hürthle cell carcinoma?

Surgery is the most common treatment for this condition. Depending on your situation, surgeons may remove all or part of your thyroid gland. They may also remove affected lymph nodes. Thyroid surgery may eliminate the cancer.

After surgery, you may receive medication that stops your thyroid from making hormones that increase the chance cancer will come back. Other treatments include:

• Hormone therapy: Hormone therapy removes cancer cells or stops them from growing.
• Radioactive iodine therapy: This treatment kills thyroid cancer cells.

Is Hürthle cell carcinoma curable?

Yes, it is. Surgery to remove all or part of your thyroid eliminates the cancer. If you have this surgery, you’ll take medication to replace your thyroid hormones.

How can I reduce my risk of developing this condition?

There’s no sure way to reduce your risk. Some people develop this condition because they have a family history of thyroid cancer. If that’s your situation, talk to a healthcare provider about symptoms that may be signs of Hürthle cell carcinoma.

What is the survival rate for Hürthle cell carcinoma?

A recent study showed 95% of people with this condition were alive five years after diagnosis. The same study showed 93% of people were alive 10 years after diagnosis.

How do I take care of myself?

Depending on your treatment, you may need to take thyroid hormone replacement medication for the rest of your life. Hürthle cell carcinoma can come back. Ask your healthcare provider what symptoms may be signs your condition has come back.

A note from Cleveland Clinic

Hürthle cell carcinoma is a rare type of thyroid cancer. If you have symptoms, healthcare providers may need to do thyroid surgery to confirm you have this condition. Surgery to diagnose the cancer often eliminates the issue. But surgery doesn’t solve all the issues Hürthle cell carcinoma may cause.

People who have thyroid surgery need to take hormone medication for the rest of their lives. And Hürthle cell carcinoma may come back after treatment. If you have this condition, please know you can count on your healthcare providers for support and help if Hürthle cell carcinoma returns.