A 55-year-old woman undergoes hemithyroidectomy for a 3 cm Hurthle cell neoplasm (Bethesda IV). Final pathology confirms a 3 cm Hurthle cell carcinoma with extensive vascular invasion. What is the recommended further management?

• A Completion total thyroidectomy alone without radioactive iodine
• B Observation with serial thyroglobulin measurements
• C External beam radiotherapy to the neck
• D Completion total thyroidectomy followed by radioactive iodine ablation ✓

Explanation

Hurthle cell carcinoma with extensive vascular invasion is considered high risk. Completion total thyroidectomy is indicated to enable radioactive iodine ablation and subsequent thyroglobulin monitoring. RAI is effective in Hurthle cell carcinoma for adjuvant therapy and treatment of residual or metastatic disease. Observation alone would be inadequate given the adverse pathological features.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.