Follow-up standards for patients with differentiated thyroid cancer have changed considerably in the last decade. Recent studies (and the upcoming ATA guidelines will endorse this) have shifted their focus to accurate risk-group stratification for predicting locoregional recurrence in patients with thyroid cancer.
Having Hurthle cell carcinoma puts the patient in the intermediate risk for recurrence or death category. In this category we selectively use radioactive iodine remnant ablation when a primary tumor is confined to the thyroid is between 1-4 cm, with or without lymph node mets. Most patients with primary well differentiated PTC between 1 and 4 cm, with less than 3-5 cervical lymph node metastases (< 5 mm in maximum size) do not receive RAI ablation. Similarly, even tall cell variants of papillary thyroid cancer less than 2 cm confined to the thyroid are also usually not treated with radioactive iodine ablation. Worrisome histologies (such as Hurthle cell carcinoma) greater than 2 cm, or patients with extensive lymph node metastases are usually offered radioactive iodine remnant ablation since these have a higher risk of recurrence and the data regarding whether or not RAI remnant ablation is beneficial is conflicting.
For Hurtle cell carcinoma we use RAI ablation- Sometime we discuss clinical cases of patients vith very small tumors , but the RAI ablation is the rule.
I agree with Gibelli, RAI remnant ablation also gives opportunity to an earlier recognition of distant metastasis
In our hospital we also believe that patients with Hurthle cell thyroid carcinoma can benefit from the radioiodine ablation~
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