What Is Hurthle Cell Carcinoma

  • Snehanjana Patra M.sc Biotechnology, Amity University
  • Geraint DuffyMSc, Medical Biotechnology and Business Management, University of Warwick, UK

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Overview

Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably. The cancerous cells can invade and destroy surrounding healthy tissue and spread to other areas of the body. There are more than a hundred types of cancer with thyroid cancer affecting the thyroid gland. The thyroid is a butterfly-shaped gland at the base of the neck that secretes hormones that are essential for regulating the body’s metabolism.

Hurthle Cell Carcinoma (HCC) is a rare but aggressive form of thyroid cancer that occurs mostly in older age and more commonly in women. It causes tumours that can affect your breathing and speech. There are many methods to manage and treat this type of cancer, and this depends on the severity of the cancer.

Causes of hurthle cell carcinoma

Like some other cancers, it is not clear what the exact cause of Hurthle cell carcinoma is and the pathological and biological behaviour of HCC remains unclear.1 The cancer begins when cells in the thyroid gland start to develop changes in their DNA. These mutations cause cells in the thyroid to grow and multiply quicker than normal.2

Signs and symptoms of hurthle cell carcinoma

Hurthle cell carcinoma may not cause any symptoms and will only be detected during a routine physical examination or an imaging test conducted for another reason. A patient may have thyroid nodules or lumps in the neck, just below the Adam’s apple, which will cause pain or discomfort in the throat or neck.3 

The large nodules may cause difficulties in breathing – which can worsen when lying down, or swallowing food and can even produce changes in vocal quality as the tumour may press onto the vocal cords, causing hoarseness. For some patients, they may start to suddenly lose weight and may find themselves feeling fatigued.

Some of these symptoms may not be an indication of HCC, but other conditions such as inflammation of the thyroid gland or a goitre, which is an enlargement of the thyroid. Therefore, it is important to see a doctor if you have any concerns. 

Diagnosis

HCC is usually diagnosed when patients find lumps or nodules in the thyroid. Several tests can be done to diagnose HCC including:

  • Physical examination: The doctor will start with a physical examination of the neck to see the size of the thyroid and examine if the lymph nodes are swollen4 
  • Blood tests: Blood tests are also common as they can identify thyroid function and levels of thyroid hormones
  • Imaging tests: This includes ultrasound or CT scans to see if there is a growth that is present in the thyroid5
  • Fine-needle aspiration (FNA): If the doctor finds that there is a risk the cancer has spread – a biopsy may be done, which involves removing a sample of the thyroid tissue, so it is examined under a microscope for signs of cancer5

Management and treatment for hurthle cell carcinoma

As HCC is a rare but aggressive form of cancer, effective treatment includes the need to shrink the tumour which reduces the chance of cancer returning. To do this a team of healthcare experts will discuss the best course of treatment. 

Treatment options 

Surgery (thyroidectomy) 

The most common method in the treatment of HCC is surgery - Thyroidectomy involves the surgical removal of a part or all of the thyroid gland, which is located in the front of the neck, by making an incision in the centre of the neck to access the thyroid gland.6 If a part of the thyroid is removed, the thyroid gland may still work normally after surgery.

However, if all of the thyroid gland is removed, thyroid hormone replacement will be needed. This is a safe procedure but as it is a type of surgery it may be linked to complications such as neck pain, bleeding, infection, and weakness of the voice.7

Radioactive iodine therapy 

This involves swallowing a capsule that contains a radioactive liquid. This will usually be done after surgery, to ensure that any remaining thyroid tissue with cancer cells can be destroyed. This is also the method that is used if HCC has spread to other parts of the body.5

External beam radiation therapy 

This method involves using high-powered energy beams such as X-rays to kill cancer cells. A patient will be asked to lie on the table and the machine will move around the body, releasing radiation to specific parts of the body. This method is commonly used after surgery and iodine therapy to kill any remaining cancer cells.8 This method may cause side effects such as weakness and fatigue but will improve with rest following the treatment.

Targeted therapy and chemotherapy 

Targeted therapy includes taking medication that will attack specific cancer cells to control the growth. This is for patients who find that their cancer has returned or if it has spread to other parts of the body. This is associated with side effects such as fatigue and high blood pressure. An example of a targeted therapy for HCC is lenvatinib, a tyrosine kinase inhibitor that can increase the survival of patients.9

Chemotherapy for HCC is not commonly used. In some cases, it may be used in addition to or after radiation therapy if the cancer is higher in severity and has spread to other organs, to reduce the risk of the cancer returning. One study found that docetaxel and cisplatin were an effective form of chemotherapy in patients with HCC with lung and liver metastasis.10 

Role of follow-up care 

It is important for patients with any type of cancer, including Hurthle cell carcinoma, to engage in follow-up care. This includes going for regular checkups with a healthcare provider once treatment is over. This can consist of blood work and other tests to see if any changes in your health may have been caused due to the cancer treatment and for any signs that the cancer is returning. 

Management and lifestyle considerations 

Thyroid hormone replacement therapy 

If HCC is treated by surgery and the thyroid has been removed, the body cannot make the thyroid hormones it needs. Thyroid hormone pills such as levothyroxine will need to be taken daily to replace the hormone and maintain normal metabolism, this can also help to lower the risk of the cancer returning.11 This will also include regular checkups to monitor thyroid function. 

Nutritional and dietary considerations 

Although there is limited evidence to suggest that avoiding fatty foods will reduce the risk of cancer developing. It is important to maintain good health while being diagnosed with cancer, therefore, the diet should include fruits and vegetables, whole grains, and fish. 

Emotional and psychological support 

A diagnosis of HCC can be challenging, and patients may feel many different emotions such as being confused, anxious, and upset. Therefore, cancer patients need to find support from family and friends whom they feel comfortable enough to talk about their feelings with or to join support groups to talk with people who may understand their situation.

There is also professional psychological support available for cancer patients to receive counselling and reduce feelings of anxiousness. It may also be good to engage in activities that patients enjoy doing. 

Risk factors

Long-term iodine deficiency

Iodine is a mineral in the body that is necessary to make thyroid hormones.12 This can be from foods you eat. Some examples of iodine-rich foods are fish such as cod and tuna and sea vegetables such as seaweed.

Having an iodine deficiency can cause swelling in the neck, so it is important to have this checked so that it does not develop into cancer. 

Having another thyroid disorder

One of the main symptoms of iodine deficiency is hypothyroidism which occurs when the iodine level decreases and the thyroid gland is unable to produce the thyroid hormone. 

Family history of thyroid cancer

If someone in your family has a history of thyroid cancer, then you are more at risk of being diagnosed with HCC. This doesn’t mean you will get cancer but compared to others, there may be a higher chance. This can be due to errors in specific genes that can cause the cells to grow and multiply at a faster rate, to be inherited. 

Being exposed to radiation

Exposure to X-rays or radiation therapy can increase the risk of developing HCC. This is more of a risk factor if the radiation exposure is to the head, neck, and chest, even if this was done during childhood. 

Age

Older age is a risk factor for HCC, as it is mostly diagnosed in those over the age of 40. 

Gender

Thyroid problems and cancers are most commonly identified in those assigned female at birth, this is also found in the case of HCC.13 The reason for this is not clear, therefore research is being done to see the relationship between thyroid cancers and hormones, pregnancy, and periods.

However, some research suggests that women face thyroid problems more as these can be triggered by autoimmune responses, where antibodies produced by the immune system may disrupt the thyroids hormone production, and women have a more vigorous immune response compared to men.14 

FAQs

How can I prevent hurthle cell carcinoma?

Although there is no specific prevention of cancer, to prevent HCC it is important to maintain a healthy lifestyle by consuming healthy foods and staying active through exercise. It is also important to avoid radioactive exposure and important to have an adequate iodine intake. 

How common is hurthle cell carcinoma?

Compared to some other cancers, around 14 in 100,000 people are diagnosed with thyroid cancer and HCC is a rare type of cancer that represents about 5% of all differentiated thyroid carcinomas.17 

What can I expect if I have hurthle cell carcinoma?

If you have been diagnosed with HCC, you can expect problems with swallowing and breathing. Therefore, treatment should be started as soon as possible, and this will depend on the severity of the cancer. Treatment will mostly involve the removal of the thyroid. 

When should I see a doctor?

If you notice any changes in your health and feel any concerns, it is important to see your GP so that the cancer can be diagnosed sooner and there is a better chance of getting treatment and preventing the spread of the cancer. 

Summary

Hurthle cell carcinoma (HCC) is a rare but aggressive type of cancer that affects the thyroid gland but it may spread to other organs in the body. Some patients may not notice any symptoms such as a lump in the neck but may find themselves feeling tired and losing weight, so if a person finds any changes in their health, they should talk to a doctor to find a diagnosis at an early stage of cancer so that treatment can begin sooner. 

References

  1. Kure S, Ohashi R. Thyroid hürthle cell carcinoma: clinical, pathological, and molecular features. Cancers (Basel) [Internet]. 2020 Dec 23 [cited 2024 Mar 18];13(1):26. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793513/
  2. Hlozek J, Pekova B, Rotnágl J, Holý R, Astl J. Genetic changes in thyroid cancers and the importance of their preoperative detection in relation to the general treatment and determination of the extent of surgical intervention—a review. Biomedicines [Internet]. 2022 Jun 27 [cited 2024 Mar 23];10(7):1515. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9312840/
  3. Adhikari Y, Marasini A, Adhikari N, Paneru LD, Upadhaya Regmi B, Raut M. Hurthle cell carcinoma: a rare variant of thyroid malignancy – a case report. Ann Med Surg (Lond) [Internet]. 2023 Apr 5 [cited 2024 Mar 23];85(5):1940–3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10205327/
  4. Hanief MR, Igali L, Grama D. Hürthle cell carcinoma: diagnostic and therapeutic implications. World J Surg Oncol [Internet]. 2004 Aug 11 [cited 2024 Mar 23];2:27. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC514721/
  5. Fariduddin MM, Syed W. Hurthle cell thyroid carcinoma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Mar 23]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK568736/
  6. Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg [Internet]. 2009 Feb [cited 2024 Mar 23];52(1):39–44. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2637645/
  7. Christou N, Mathonnet M. Complications after total thyroidectomy. Journal of Visceral Surgery [Internet]. 2013 Sep 1 [cited 2024 Mar 23];150(4):249–56. Available from: https://www.sciencedirect.com/science/article/pii/S187878861300060X
  8. Foote RL, Brown PD, Garces YI, McIver B, Kasperbauer JL. Is there a role for radiation therapy in the management of hürthle cell carcinoma? International Journal of Radiation Oncology*Biology*Physics [Internet]. 2003 Jul [cited 2024 Mar 23];56(4):1067–72. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0360301603001998
  9. Shirode PS, D’cruz A, Chatterjee S, Bhandarkar S. Lenvatinib as a promising treatment option for unresectable hürthle cell carcinoma: a case report. Cureus [Internet]. [cited 2024 Mar 23];15(4):e37460. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10175712/
  10.  Zhang H, Zeng L, Liang C, Qiu H, Zhang M, Zhu Y, et al. Successful treatment of hurthle cell thyroid carcinoma with lung and liver metastasis using docetaxel and cisplatin. Japanese Journal of Clinical Oncology [Internet]. 2012 Nov 1 [cited 2024 Mar 23];42(11):1086–90. Available from: https://academic.oup.com/jjco/article-lookup/doi/10.1093/jjco/hys146
  11. Oluic B, Paunovic I, Loncar Z, Djukic V, Diklic A, Jovanovic M, et al. Survival and prognostic factors for survival, cancer specific survival and disease free interval in 239 patients with Hurthle cell carcinoma: a single center experience. BMC Cancer [Internet]. 2017 May 25 [cited 2024 Mar 23];17(1):371. Available from: https://doi.org/10.1186/s12885-017-3370-x
  12. Zimmermann MB, Galetti V. Iodine intake as a risk factor for thyroid cancer: a comprehensive review of animal and human studies. Thyroid Res [Internet]. 2015 Jun 18 [cited 2024 Mar 23];8:8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490680/
  13. Guerrero MA, Suh I, Vriens MR, Shen WT, Gosnell J, Kebebew E, et al. Age and tumor size predicts lymph node involvement in Hürthle Cell Carcinoma. J Cancer [Internet]. 2010 Jun 2 [cited 2024 Mar 23];1:23–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931345/
  14. Mammen JSR, Cappola AR. Autoimmune thyroid disease in women. JAMA [Internet]. 2021 Jun 15 [cited 2024 Mar 23];325(23):2392–3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10071442/
  15. Bhattacharyya N. Survival and prognosis in hürthle cell carcinoma of the thyroid gland. Archives of Otolaryngology–Head & Neck Surgery [Internet]. 2003 Feb 1 [cited 2024 Mar 23];129(2):207–10. Available from: https://doi.org/10.1001/archotol.129.2.207

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Alina Khan

Alina is a recent graduate with a degree in Biomedical Science. She is always ready to expand her knowledge in health and science in topics such as oncology and neurology. As a medical writer at Klarity she would like to share her interest and educate others about a variety of healthcare topics to improve public awareness.

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