---
title: "Hurthle cell Carcinoma of Thyroid"
description: "ENT notes on Hurthle cell Thyroid Carcinoma - Risk factors, Clinical Features, Histology, Investigations and Treatment."
source: "The ENT Resident"
author: "Dr. Mausumi Das"
canonical_url: "https://www.theentresident.com/ent-notes-lectures/hurthle-cell-thyroid-carcinoma"
categories: ["Thyroid"]
video: "https://www.youtube.com/watch?v=yZydslg2Dw8"
image: "https://media.theentresident.com/og-images/hurthle-cell-thyroid-carcinoma.png"
---

# Hurthle cell Carcinoma of Thyroid

ENT notes on Hurthle cell Thyroid Carcinoma - Risk factors, Clinical Features, Histology, Investigations and Treatment. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=yZydslg2Dw8

## 🧬 Hurthle Cell Carcinoma of Thyroid

### 📖 Definition of Hurthle Cell Carcinoma of Thyroid

**Hurthle Cell Carcinoma** is a **malignant thyroid tumor** composed predominantly of **Hurthle cells**.

It accounts for **3–10%** of all **differentiated thyroid cancers**.

>What are Hurthle cells?

>What are some other names of Hurthle cells?

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### 🧠 Historical Background

- **Previously classified as:** A variant of *follicular carcinoma*.  

- **Now (WHO classification):** Recognized as an **independent tumor type** due to:
  - Distinct **molecular alterations**
  - Different **biological behavior**
  - Unique **clinical course**

>Where does Hurthle Cell Carcinoma of Thyroid originate from?

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### 👩‍🦳 Epidemiology of Hurthle Cell Carcinoma of Thyroid

- **Age:** More common in **elderly individuals**

- **Sex:** Predominantly **females**

- **Incidence:** 3–10% of differentiated thyroid malignancies

---

### 🔬 Cytological & Histological Features of Hurthle Cell Carcinoma of Thyroid

🔹 Hurthle Cells — The Characteristic Cell

>What is the microscopic appearance of Hurthle cells?

#### 🧫 Microscopy

- The tumor is usually **encapsulated** with a **thick capsule**.  

- Sheets or nests of **Hurthle cells** with granular cytoplasm are seen. 

- **Capsular or vascular invasion** must be demonstrated to confirm **carcinoma** (similar to follicular carcinoma).


> 📸 **Key Diagnostic Point:**  
> The presence of **capsular and/or vascular invasion** differentiates **Hürthle cell carcinoma** from **Hürthle cell adenoma**.

---

### 🩺 Clinical Features of Hurthle Cell Carcinoma of Thyroid

Patients usually present with:

- A **thyroid nodule**, which can be:
  - **Solitary** or **multifocal**
  - **Unilateral** or **bilateral**

- The swelling is typically **firm and non-tender**.

- **More aggressive** course than follicular carcinoma.

- **Local invasion** and **recurrence** are common.

**Metastatic Spread:**

- **Hematogenous spread:** To **lungs, bone, liver**

- **Lymphatic spread:** More common than in follicular carcinoma

---

### 🔍 Investigations of Hurthle Cell Carcinoma of Thyroid

1. **Fine Needle Aspiration Cytology (FNAC)**

- Shows presence of Hurthle cells.
- Cannot differentiate between **adenoma** and **carcinoma** — histological evidence of **capsular/vascular invasion** is essential.

2. **CT Scan / MRI Neck**

- Evaluates **local extension** and **regional lymph nodes**.

3. **Bone Scan**

- To detect **bony metastases**.

> 🧠 **Note:** Hurthle cell carcinoma may show **reduced iodine uptake** on radioisotope scanning.

---

### 💊 Treatment of Hurthle Cell Carcinoma of Thyroid

1️⃣ **Surgery — Mainstay of Treatment**

- **Total Thyroidectomy** is the treatment of choice.  

>Why is Total Thyroidectomy the treatment of choice in Hurthle Cell Carcinoma of Thyroid?

2️⃣ **Radioiodine Ablation**

- **Not effective** in most cases  

>Why is radioiodine therapy of limited benefit in Hurthle Cell Carcinoma of Thyroid?

3️⃣ **Thyroid Hormone Suppression Therapy**

- **Lifelong TSH suppression** with **Levothyroxine** is essential  
  - Prevents stimulation of residual tumor cells.

---

### 📉 Prognosis of Hurthle Cell Carcinoma of Thyroid

Hürthle Cell Carcinoma has a **worse prognosis** compared to follicular carcinoma.

>Why does Hurthle Cell Carcinoma of Thyroid have the worst prognosis?

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### 🧾 Summary Table

| Feature | Hürthle Cell Carcinoma |
| --- | --- |
| **Cell of Origin** | Follicular epithelial cells |
| **Cell Type** | Hurthle cells |
| **Nature** | Malignant tumor |
| **Capsular/Vascular invasion** | Required for diagnosis |
| **Common in** | Elderly women |
| **Spread** | Both hematogenous & lymphatic |
| **Radioiodine uptake** | Poor |
| **Treatment** | Total thyroidectomy + lifelong TSH suppression |
| **Prognosis** | Poorer than follicular carcinoma |

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## About This Note

This free ENT note on Hurthle cell Carcinoma of Thyroid was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/hurthle-cell-thyroid-carcinoma

When citing or referencing this content, please credit The ENT Resident and link to the canonical page above.

## Related Notes by Category

- Thyroid: https://www.theentresident.com/ent-notes-lectures/category/thyroid.md

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