A 38-year-old woman presents with a 4 cm right thyroid nodule. FNAC shows oxyphilic (Hurthle cell) cells arranged in a microfollicular pattern with scant colloid, classified as Bethesda IV. She undergoes diagnostic lobectomy. Final pathology shows a 4 cm Hurthle cell carcinoma with vascular invasion. What is the next appropriate step?
- A No further treatment; surveillance only
- B Completion thyroidectomy ✓
- C Total thyroidectomy with modified radical neck dissection
- D Radioactive iodine ablation without further surgery
Correct answer: B. Completion thyroidectomy
Explanation
Hurthle cell carcinoma (oxyphilic variant of follicular carcinoma) >2 cm with vascular invasion is considered higher risk. Current ATA guidelines recommend completion thyroidectomy for follicular/Hurthle cell carcinomas with vascular invasion >4 foci or extensive invasion, as RAI therapy requires total thyroidectomy for optimal remnant ablation. Modified radical neck dissection is reserved for clinically involved lateral neck nodes.
Reference: ATA Guidelines for Management of Thyroid Nodules and Differentiated Thyroid Cancer, 2015 ed.
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Written and medically reviewed by the StethoPrep medical team.