Tests and procedures used to diagnose Hurthle cell cancer include:
- Physical exam of the thyroid. Your doctor will examine your neck, checking the size of your thyroid and seeing whether your lymph nodes are swollen.
- Blood tests to check thyroid function. Blood tests may reveal abnormalities in your thyroid function that give your doctor more information about your condition.
- Imaging tests. Imaging tests can help your doctor determine whether an abnormal growth is present in the thyroid. Ultrasound is often used to create images of the thyroid gland. In other cases, imaging tests may include computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET).
- Removing a sample of thyroid tissue for testing. If your doctor finds a tumor on your thyroid, a biopsy can help determine whether the tumor is cancerous or not. During a thyroid biopsy, your doctor passes a fine needle through the skin of your neck. Ultrasound imaging may be used to guide the needle into the tumor. The needle is attached to a syringe, which is used to withdraw thyroid tissue through the needle. The sample is sent to a laboratory where it's examined for signs of cancer.
Treatment for Hurthle cell cancer may include:
Surgery to remove the thyroid
Total or near-total thyroidectomy is the most common treatment used for Hurthle cell cancer. During this operation, all or nearly all of the thyroid gland is removed. The surgeon leaves tiny edges of thyroid tissue near the adjacent parathyroid glands to lower the likelihood of parathyroid injury. These small parathyroid glands regulate your body's calcium level. Surrounding lymph nodes may be removed if there's suspicion that the cancer has spread to them.
The greatest risk associated with the operation is unintended injury to the recurrent laryngeal nerve, which could cause temporary or permanent hoarseness or a loss of your voice. Other complications include damage to the parathyroid, excessive bleeding and infection.
After surgery for Hurthle cell cancer, your doctor will prescribe the hormone levothyroxine (Levoxyl, Levothroid, others), which replaces the hormone no longer being produced because of the absence of the thyroid. You'll need to take this synthetic hormone for the rest of your life.
Radioactive iodine therapy
Radioactive iodine therapy involves swallowing a capsule that contains a radioactive liquid.
Radiation therapy using a capsule containing radioactive iodine-131 is often prescribed following surgery for Hurthle cell cancer. It may help to destroy any microscopic thyroid tissue that remains after surgery. At times, a higher dose of radioiodine can be used to eliminate any malignant cells that have spread to other parts of the body.
Radioiodine therapy can cause temporary side effects including sore throat, dry mouth, decrease in taste sensations, neck tenderness and nausea.
Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. During radiation therapy, you're positioned on a table with a machine moved around you delivering the radiation to specific points on your body. Radiation therapy may be an option if cancer cells remain after surgery and radioactive iodine treatment.
Radiation therapy side effects include a sore throat, a sunburn-like skin rash and fatigue.
Jan. 25, 2012
- Lai SY, et al. Management of thyroid neoplasms. In: Flint PW, et al. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2010. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-0-323-05283-2..X0001-8--TOP&isbn=978-0-323-05283-2&uniqId=230100505-57. Accessed Dec. 28, 2011.
- Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Falls Church, Va.: American Thyroid Association. http://thyroidguidelines.net/revised/taskforce. Accessed Dec. 28, 2011.
- Thyroid carcinoma. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed Dec. 28, 2011.
- What you need to know about thyroid cancer. National Cancer Institute. http://cancer.gov/cancertopics/wyntk/thyroid. Accessed Dec. 28, 2011.