Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
What Are My Chances Of Cancer I Have Majority Of Hurthle Cells
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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What Are My Chances Of Cancer I Have Majority Of Hurthle Cells

Dear Dr.Lupo,

On thursday I had a FNA of my 8mm isthmus thyroid nodule and I spoke today to the Dr.who did my biopsy and the pathologist who reviewed it,and they are sending my results out for a FERMA test because I have a majority of oncocytic Hurthle cells at least 75% or more and no lymphocytes and little colloid! When I had all 3 of my small nodules biopsed in June 2008,the first report from Quest Diognostics didn't even mention any hurthle cells,I sent it to University of Penn for a second opinion and Dr.Baloch reviewed my samples. He wrote a note to my endo who wasn't at University of Penn,and he said that he saw some oncocytic cells and lympoctyes with collloid.

I was so worried at the time I called him and left a message with his assistant and Dr.Baloch called me back. He reassured me that it's normal to find Hurthle cells in the thyroid,that he could have them in his thyroid,and that children have them in their thyroids.He said it's only a concern when there is a lot of them.My endo said the same thing at the time.I had posted my June 2008 FNA results to you on here and you responded. I had also said that my endo told me that he put the cell samples from my right nodule and isthmus nodule in the same container. My isthmus nodule was only 3mm when he biopsed it then. I have totally normal thyroid blood tests.

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8mm is still small - the risk of cancer for "indeterminate" varies by the cytopathologist (may be 10-50% risk - average is 20% usually).
Afirma depends on this risk of cancer question - ie, the negative predictive value of the test is higher if the risk of indeterminate being cancer is lower.  This is very complicated statistics but for a small nodule like this, assuming no other susicious ultrasound features a "benign" Afirma test would favor observation.  Would consider a second opinion from an endocrinologist who does his/her own ultrasound to review the situation with you.
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My post was too long so I have to post the rest.


The pathologist and the Dr.who just did my FNA told me that my nodule is classified as a indeteriminate follicular neoplasm with oncocytic features! My isthmus nodule was the only one biopsed this time because it grew 50% in almost 3 years. I just turned 48 April 1,how likely is to be Hurthle or follicular cancer? And how accurate is the FERMA test? I was told today by both the pathologist and the doctor who did my recent FNA that I have a 20% chance of cancer now.I'm obviously very scared now. You had reassured me and others on here that Hurthle cells are a common benign FNA finding,and that it's only a concern when you have 75% or more,little or no colloid and lympocytes.

If you could please answer when you can,I really would appreciate it.

Thank You.
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Also, I forgot to mention that my isthmus orginally described as almost all cystic for about 6 years,I hadn't had an ultrasound since May 2010 until January of this year because the nodules were stable and the one on the left,the largest 1cm which I think is only a little bigger now,was the only one that was mostly solid. But now this isthmus nodule is mixed cystic and solid and the solid part is what grew,it's always been hypoechoic,and none were described as hypervascular before,until in January the isthmus nodule that grew 50% now is described as midly hypervascular.
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I just found out I spelled the Affirma test wrong!
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
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