THU675 A Case Report For Hurthle Cell Neoplasm Suspicious For Carcinoma
Authors: Wu Jinjin , Rimal Priya , Ying Shan-Ching , Jasaraj Ranjit , Ali Furkhan , Havrylyan Andriy 
Published: October 2023

Disclosure: J. Wu: None. P. Rimal: None. S. Ying: None. R. Jasaraj: None. F. Ali: None. A. Havrylyan: None.

Hurthle cell carcinoma, also called Hurthle cell thyroid cancer, is an extremely rare type of thyroid tumor. It accounts for approximately 3-4% of all thyroid cancers, [3][19] usually diagnosed when patients present clinically with thyroid nodules or incidental findings on neck imaging. [1][2] In this case, we present a case for suspicious Hurthle cell carcinoma occurring in a 76-year-old male patient. He initially presented with progressive worsening dyspnea. An initial chest CT scan showed multiple pulmonary nodules; meanwhile, it also noted an incidental finding of thyroid nodules on the CT scan. Thyroid function tests, including thyroid-stimulating hormone (TSH) and thyroxine (T4), are mild hypothyroidism, indicating non-thyrotoxic thyroid nodules; ultrasound of the thyroid gland showed one right upper solid isoechoic nodule. Further fine-needle aspiration (FNA) biopsy revealed cells suspicious for hurtle cell neoplasm. The patient was subsequently referred to otolaryngology for thyroid lobectomy or thyroidectomy.Case reports: A 74-year-old male with a past medical history of Hypertension, type2 Diabetes mellitus, Deep vein thrombosis, Atrial fibrillation, Aortic stenosis, and hypothyroidism initially presented with chronic dyspnea caused by severe aortic stenosis, with scheduled aortic valve replacement in August 2022. A pre-procedure chest CT showed multiple 3 -5 mm pulmonary nodules throughout the lungs and an incidental finding of thyroid nodules. The patient was referred to the endocrinology department for his thyroid nodules. The patient was in a clinically euthyroid state, denied compressive symptoms, and denied dysphagia, hoarseness, and past exposure to radiation. The thyroid function test reveals elevated TSH and a high level of thyroid peroxidase antibodies; However, free T4, free T3, and Total T3 are all within normal limits. Subsequently, a thyroid ultrasound revealed one right upper solid isoechoic 2.5 x 1.7 x 2.1 cm nodule (TI-RADS 3). A fine-needle aspiration (FNA) biopsy on 01/23/2023 revealed findings suspicious for hurtle cell neoplasm. This patient was subsequently referred to an otolaryngologist (ENT) for thyroid lobectomy or thyroidectomy to confirm the diagnosis. ENT recommends at least a right thyroid lobectomy. Conclusion: Despite being rare, Hurthle cell carcinoma still affects several patients every year. It is usually diagnosed when patients present clinically with thyroid nodules or incidental findings on imaging of the neck, like in this case. It is characterized by the presence of Hurthle cells in histology. However, FNA cannot distinguish between a benign adenoma and malignant carcinoma. Distinguishing them requires a thyroid lobectomy or thyroidectomy. We hope that highlighting this case report will help clinicians across specialties recognize and diagnose this condition with the appropriate level of care.

Presentation: Thursday, June 15, 2023