Follicular Thyroid Cancer - Hurthle Cell Type Diagnosis

I think barbaral will be able to explain this better than I can, so awaiting her input, but I’ll have a go at explaining it in the mean time.

So there are 4 main types of thyroid cancer: Papillary, Follicular, Medullary, the Anaplastic (the nastiest one). Papillary and Follicular tend to behave quite similarly and are treated in exactly the same way. These are also the most common ones, which is good because Medullary can be a bit more difficult to treat and Anaplastic is pretty much incurable.

Within Papillary and Follicular, there are a number of sub-variants. For example, I had a Papillary Thyroid Carcinoma with 30% tall cell features (Tall cell is one of the slightly more aggressive variants of PTC). Hurthle cell is one of the variants of FTC that *some* researchers think is more aggressive than the normal variant.

What is very important for me to stress at this point is that the evidence for this is limited at best and the worst thing you can do is start googling research papers. I did this when I found out about my tall cell features and spent the period between then and my RAI treatment convinced that my cancer had spread everywhere and the RAI would be useless. Ultimately they found nothing other than residual tissue in the thyroidectomy bed and I was discharged into follow up with no intention of further treatment.

The biggest predictors of a poor outcome in differentiated thyroid cancer (differentiated is just the fancy term for “Papillary or Follicular”) are whether the cancer has grown large enough to invade into key neck structures like the oesophagus or trachea (yours hasn’t, because you’ve been staged as a T3, whereas this would mean T4), and whether or not it has distant metastasis outside of your neck. These fancy variants may make those two things slightly more likely to happen, but if they’ve managed to get it out before that happened, then I’m very much unconvinced that these variants are any worse than the normal one. Like I say, the evidence is sketchy at best and three different NHS doctors have told me that the only difference is you might get flagged for slightly more regular follow up (which really isn’t a bad thing, as they’ll catch any local recurrence very quickly and treat you before you even get any symptoms)

One last thing, that R0 on your report is very good news indeed. What that means is that when they looked at your tumour under the microscope, the surgeon has managed to cut all the way around it and leave a margin of healthy tissue as well. This means that it is likely that the entire tumour has been removed, so that’s good news. 

I hope this can help answer some of your questions, although as mentioned at the start Barbaral knows far more than I do about this stuff so hopefully she will be able to correct any errors in my post and point out anything I may have missed. 

DM, thanks for the mention. I didn't get an alert for this post so I wouldn't have known without your call out. You did an amazing job - honestly, I really wouldn't have explained it any better than you did.

I'm not sure if you knew but I had a Hurthle Cell variant follicular TC 11 years ago. It was a big beast - nearly 7 cm across - but it was a slow and lazy cancer that got comfy on the one side and didn't bother to spread to the other. It was minimally invasive - like AnnieJo's - but it's done me no further harm in the past 11 and a bit years.

I did panic about the HCC thing - like you did with your tall cell, and like everybody who finds out they've got a sub-variant that 'might' be more problematic, but Dr Google taught me that more often than not, these variants don't make much difference. There aren't enough of us that get them for the papers to be statistically significant. 

The treatment is the same regardless of the variants and looking for too much detail will only take you down a rabbit hole of self-doubt and confusion.

Many thanks DM for your reply and also BarbaraL, you are both so knowledgable about this condition and explained a complicated subject in a very clear way.  I am pleased I posted my question here, because I felt quite down last week until I received your explanation of my diagnosis, and feel a lot better about it now that I understand the staging terms used.  Glad the operations are behind me and it will be good to progress with the iodine treatment.  Trying to take things “one day at a time”.  Thanks again, Annie.