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43

NCCN Guidelines for Patients

®

:

Thyroid Cancer, Version 1.2017

5

Treatment guide

Follicular and H

ü

rthle cell thyroid cancer

Guide 11

shows the primary treatment options

when an FNA biopsy is read as follicular cell

neoplasm or Hürthle cell neoplasm. A neoplasm is an

abnormal growth of tissue. It is also called a tumor.

There are some benign tumors of the thyroid

that look like follicular or Hürthle cell cancer on

FNA biopsy. Neither of these cancers can be

diagnosed with standard FNA biopsy alone. To

diagnose follicular or Hürthle cell thyroid cancer, the

pathologist has to see vascular (veins and arteries)

invasion or capsular (capsule around the thyroid)

invasion under the microscope. This means cancer

has grown into those areas.

Guide 11. Follicular or Hürthle cell neoplasm found on an FNA biopsy

Primary treatment Consider after treatment Next steps of care

Total

thyroidectomy

ª

• Not cancer

ª

• Levothyroxine to keep TSH normal

ª

• Papillary thyroid cancer

ª

• See papillary treatment guides

ª

• Follicular thyroid cancer

ª

• Care after surgery

ª

• Hürthle cell thyroid

cancer

Lobectomy

with removal

of the isthmus

ª

• Invasive cancer

(extensive vascular

invasion - large spread

of cancer in the blood

vessels)

ª

• Complete

thyroidectomy

ª

• Care after

surgery

ª

• Minimally invasive

cancer (eg, well-defined

tumor)

• (NIFTP)

n

on

i

nvasive

f

ollicular

t

hyroid

neoplasm with

p

apillary-

like nuclear features

ª

• Complete

thyroidectomy

or

• Observe

ª

• Care after

surgery

ª

• Consider

levothyroxine

therapy to

keep TSH

low or normal

ª

• Not cancer

ª

• Observe

ª

• Papillary thyroid cancer

ª

• See primary treatment, then surveillance

and management for papillary