HURTHLE CELL NEOPLASMS OF THE THYROID-GLAND - REASSESSMENT OF FUNCTIONAL-CAPACITY

We treated a hyperthyroid man and a euthyroid woman who had autonomous ly functioning Hurthle cell adenomas and demonstrated uptake of radioa ctive I-131 in a woman with recurrent Hurthle cell carcinoma. Since th ese tumors are thought to be inactive, we reassessed the functional ca pacity of Hurthle cell neoplasms by reviewing the medical records of a ll patients operated upon for these tumors at our medical center from 1950 through November, 1993. We also reviewed series of Hurthle cell n eoplasms identified from a MEDLINE search of papers published from 196 0 to November, 1993. We identified 92 patients with Hurthle cell neopl asms. Thyroid scintigraphy was performed in 28 of 72 patients with ben ign adenomas and six of 20 patients with Hurthle cell carcinomas. In a ddition to the two index cases, four euthyroid patients had hot nodule s that partially suppressed the extranodular tissue; seven patients ha d warm nodules. Thyroid scans performed in patients with Hurthle cell carcinomas revealed five cold nodules and one warm nodule. Our index p atient with carcinoma displayed elevated serum thyroglobulin levels wh en the cancer recurred. This patient and another had uptake of I-131 b y recurrent or metastatic cancer that allowed for treatment with this nuclide. Of 539 patients identified in a literature survey, 489 had be nign Hurthle cell adenomas and 50 had Hurthle cell carcinoma. Thyroid scans performed in 282 patients revealed 247 cold nodules, 20 warm nod ules, and 8 hot nodules. Our results, added to those published in case series of Hurthle cell neoplasms, indicated that 4.4% of thyroid scan s were hot and 8.9% were warm. We conclude that Hurthle cell neoplasms of the thyroid gland are functional more frequently than currently ap preciated.