Hürthle cell tumor behavior: dilemma and resolution.

Thirty-four patients with the diagnosis of Hürthle cell tumor occurring from 1971 to 1984 were reviewed to help delineate an acceptable treatment policy. Twenty-nine of these occurred in the last 5 years of study so that extensive follow-up was not possible. Patients varied from age 17 years to 82 and consisted of five males and 29 females, most of whom had an asymptomatic solitary cold nodule. There was a 26% incidence of malignancy. One patient died of cancer caused by anaplastic change of underlying disease; this woman had refused surgery after an incisional biopsy specimen showed benign Hürthle cell tumor. Surgery consisting of lobectomy in 16 patients and near-total thyroidectomy in 18 was uncomplicated. No nodal surgery was necessary. Eighteen percent of patients had multicentric disease of which one half were malignant. Twelve percent of patients developed contralateral Hürthle cell tumor after lobectomy. Associated thyroid lesions occurred in 30% of patients, hyperparathyroidism in 10%. There are polar views in the literature on the management of these patients. While our own tumor experience has been reassuring, we feel that in view of the paucity of cases, those who view this tumor in a serious light deserve attention. Accordingly we advocate near-total thyroidectomy as a primary operation for those who are fit, lesser procedures for the disabled, and the difficult situation, and node sampling to detect early metastasis and improved survival in this group. It is apparent that further reporting of long-term follow-up experience is necessary for complete resolution of dilemmas in the treatment of this problem.