A 50-year-old woman with a 3.5 cm right thyroid nodule undergoes fine-needle aspiration. Cytology shows abundant Hürthle cells with scant colloid, reported as Bethesda Category IV. She opts for diagnostic lobectomy. Histopathology confirms a 3.5 cm Hürthle cell carcinoma with vascular invasion. What is the next step in management?
- A Observation with thyroid function monitoring
- B External beam radiotherapy to the neck
- C Completion total thyroidectomy ✓
- D Radioactive iodine ablation without further surgery
Correct answer: C. Completion total thyroidectomy
Explanation
Hürthle cell carcinoma (oxyphilic variant of follicular thyroid carcinoma) greater than 1 cm or with vascular invasion warrants completion total thyroidectomy to facilitate subsequent radioactive iodine therapy and thyroglobulin monitoring for recurrence. Observation is inappropriate for invasive carcinoma. RAI cannot be administered effectively without total thyroidectomy. External beam radiotherapy is not standard adjuvant treatment for differentiated thyroid cancer.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.