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Health condition

Hürthle cell cancer, a distinct thyroid cancer with its own rules.

Reclassified by the WHO in 2022, oncocytic thyroid carcinoma behaves more aggressively than classical follicular cancer. A specialist plan matters from the very first scan.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against the American Thyroid Association, the British Thyroid Association and WHO 2022 classification.

  • 03

    Current for 2026

    Reflects the WHO 2022 reclassification, molecular profiling and targeted therapy options in UK specialist practice.

Key facts

Hürthle cell cancer at a glance.

The essentials, in plain English - what it is, how common it is, and the framework the UK MDT uses to treat it.

  • What it is

    Hürthle cell carcinoma - now called oncocytic thyroid carcinoma - a distinct thyroid cancer per WHO 2022, no longer a variant of follicular.

  • How common

    Around 3 to 10 per cent of thyroid cancers - uncommon, older age at diagnosis than follicular.

  • Why it matters

    More aggressive behaviour, higher metastatic potential and more frequent radioactive iodine resistance than classical follicular cancer.

  • How it presents

    Usually a firm thyroid nodule, sometimes with goitre, cervical lymphadenopathy, hoarseness or dysphagia.

  • How it is diagnosed

    Thyroid ultrasound, FNA cytology (Bethesda), molecular profiling and CT staging - always in an MDT setting.

  • How it is treated

    Total thyroidectomy plus neck dissection, risk-stratified radioactive iodine, TSH suppression and targeted therapy where indicated.

Why this guide matters

A specialist plan, not a generic thyroid pathway.

Hürthle cell tumours are a small slice of thyroid cancer with distinct biology. The three points below shape every decision on this page.

  • A distinct WHO 2022 diagnosis

    Oncocytic thyroid carcinoma is now recognised as its own entity - not a variant of follicular cancer - with its own molecular and clinical fingerprint.

  • Radioactive iodine is not always enough

    Many Hürthle cell tumours are less iodine-avid, so response to RAI has to be assessed carefully and alternative options planned early.

  • Molecular profiling opens targeted options

    RET, NTRK and mitochondrial DNA findings can direct patients to selpercatinib, larotrectinib or trial therapies for RAI-refractory disease.

How the diagnosis is made

From first neck lump to a clear MDT plan.

The steps a UK thyroid team will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and examination

    A structured history of neck lumps, hoarseness, dysphagia and family history, plus examination of the thyroid and cervical lymph nodes.

  2. 02

    Assessing

    Thyroid function tests

    TSH, free T4 and free T3 to check the thyroid is working normally before deciding on further tests.

  3. 03

    Assessing

    Thyroid ultrasound

    A high-resolution scan of the thyroid and neck nodes - see the thyroid ultrasound clinic for the full protocol.

  4. 04

    Confirming

    FNA and Bethesda cytology

    Fine-needle aspiration reported using the Bethesda system, with review by a specialist thyroid cytopathologist.

  5. 05

    Confirming

    Molecular profiling

    Afirma, ThyroSeq and specialist commissioned tumour molecular profiling - including mitochondrial DNA and genomic NGS - refine the diagnosis and treatment options.

  6. 06

    Confirming

    Staging imaging

    CT of the neck and chest, with selective use of PET-CT, defines the extent of disease before any surgery.

  7. 07

    Planning

    Specialist thyroid cancer MDT

    Every case is discussed at a specialist commissioned head and neck endocrine cancer MDT - Kings, Guys, Royal Free and other specialist centres.

Typical timeline: from first ultrasound to an MDT plan in a few weeks.

Symptoms

What Hürthle cell cancer looks like.

Most tumours announce themselves as a slow-growing neck lump. Compression, hoarseness or nodal disease change the urgency of assessment.

  • Thyroid nodule

    A firm, slow-growing lump in the front of the neck, often noticed by the patient or on a scan for another reason.

  • Goitre

    Diffuse or nodular thyroid enlargement - see the guide to goitre for context.

  • Cervical lymphadenopathy

    Enlarged neck lymph nodes signal possible spread and shape the extent of any surgery.

  • Hoarseness

    A persistently hoarse voice may reflect recurrent laryngeal nerve involvement and needs urgent ENT and imaging review.

  • Dysphagia

    Difficulty swallowing suggests either a large mass or invasion into adjacent structures.

  • Compressive symptoms

    Neck pressure, stridor or breathlessness point to airway or oesophageal compression and prompt urgent assessment.

  • Older age at diagnosis

    Hürthle cell carcinoma tends to present in later adulthood than classical follicular cancer, often over the age of 55.

  • Red flag - metastatic disease

    Bone pain, breathlessness or new neurological symptoms may reflect distant metastases and need urgent imaging.

Treatment

How Hürthle cell cancer is treated in the UK.

Surgery first, then risk-stratified radioactive iodine and TSH-suppressive thyroxine. Targeted therapy has changed the outlook in advanced disease.

  • Total thyroidectomy

    Standard first-line surgery, often with central and lateral neck dissection where nodes are involved - see thyroid surgery.

  • Radioactive iodine (I-131)

    Risk-stratified and specialist-led - Hürthle cell tumours are often less iodine-avid than follicular cancer, so response is not guaranteed.

  • TSH suppressive thyroxine

    Long-term levothyroxine at doses tailored to risk, aiming to suppress TSH and reduce recurrence, under specialist endocrinology.

  • External beam radiotherapy

    Reserved for locally advanced or unresectable disease and delivered by a specialist thyroid radiotherapy team.

  • Lenvatinib and sorafenib

    Tyrosine kinase inhibitors for radioactive iodine-refractory disease - see the lenvatinib thyroid cancer clinic.

  • RET-targeted therapy

    Selpercatinib and pralsetinib for RET fusion-positive tumours - see the selpercatinib clinic.

  • NTRK inhibitors

    Larotrectinib and entrectinib for the small subset of tumours with an NTRK gene fusion - identified through molecular profiling.

  • Clinical trials and surveillance

    Specialist commissioned trials, plus long-term thyroglobulin, ultrasound and whole-body scans to detect recurrence early.

What this guide is based on

The sources behind every claim on this page.

UK and international guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your endocrine surgeon, thyroid oncologist and specialist MDT know your pathology and imaging and can tell you which parts apply to you. If in doubt, get seen.

  • American Thyroid Association (ATA). Guidelines on management of differentiated thyroid cancer.

  • British Thyroid Association (BTA). Guidelines on the management of thyroid cancer.

  • WHO Classification of Endocrine and Neuroendocrine Tumours, 5th edition (2022).

  • NICE. Thyroid cancer: assessment and management.

  • Butterfly Thyroid Cancer Trust. Patient information on oncocytic and Hürthle cell thyroid cancer.

Red flags

When Hürthle cell cancer needs urgent attention.

These features change the urgency of assessment and the intensity of treatment - and are the ones we watch for at every clinic visit.

  • Rapidly enlarging neck mass

    Any thyroid or neck lump that grows quickly, especially in an older patient, needs urgent specialist assessment.

  • New persistent hoarseness

    More than two to three weeks of hoarseness in someone with a thyroid nodule points to possible laryngeal nerve involvement.

  • Stridor or breathlessness

    Airway compromise from a thyroid mass is a medical emergency and needs same-day ENT and airway review.

  • Progressive dysphagia

    Difficulty swallowing solids and then liquids can reflect oesophageal invasion and requires urgent imaging.

  • Suspicious lymph nodes

    Firm, fixed or growing cervical nodes with a thyroid nodule should be biopsied under ultrasound guidance.

  • Distant metastases

    Unexplained bone pain, pathological fracture or lung symptoms may signal metastatic Hürthle cell disease.

  • Rising thyroglobulin after surgery

    Serial thyroglobulin rises after total thyroidectomy suggest residual or recurrent disease and need specialist review.

  • RAI-refractory disease

    Progression despite radioactive iodine is a specific indication to consider targeted therapy and clinical trials.

Living with it

A treatable cancer, with a specialist long game.

Four things that make the biggest difference over the years - specialist care, patient surveillance, molecular thinking and community support.

A quiet reminder

Long, careful follow-up is where outcomes are earned.

Hürthle cell tumours can recur late - a steady, specialist-led surveillance plan matters more than any one clinic visit.

  1. 01 MDT

    Insist on specialist care

    Hürthle cell carcinoma is uncommon - being under a specialist commissioned thyroid cancer MDT changes the quality of every decision.

  2. 02 Follow-up

    Plan for long surveillance

    Thyroglobulin, neck ultrasound and imaging over years, not months - late recurrences do happen and are treatable when caught early.

  3. 03 Molecular

    Ask about molecular profiling

    Genomic profiling can open the door to targeted drugs like selpercatinib or larotrectinib - especially in advanced disease.

  4. 04 Support

    Use patient charities

    The Butterfly Thyroid Cancer Trust offers UK-specific support, information and peer contact for oncocytic and Hürthle cell disease.

Frequently asked

Everything we get asked about Hürthle cell cancer.

Quick answers on diagnosis, surgery, radioactive iodine and modern targeted therapy.

  • What is Hürthle cell cancer?

    Hürthle cell carcinoma, now called oncocytic thyroid carcinoma under the WHO 2022 classification, is a distinct type of differentiated thyroid cancer. It is no longer considered a variant of follicular thyroid cancer and tends to behave more aggressively, with a higher risk of metastasis and more frequent resistance to radioactive iodine.

  • How common is Hürthle cell thyroid cancer?

    It accounts for around 3 to 10 per cent of all thyroid cancers, making it uncommon but not rare. It is usually diagnosed at an older age than classical follicular thyroid cancer and slightly more often in women than men.

  • How is Hürthle cell cancer diagnosed?

    The pathway starts with clinical assessment, thyroid function tests and thyroid ultrasound, followed by fine-needle aspiration reported using the Bethesda system. Molecular tests such as Afirma or ThyroSeq, and specialist commissioned genomic and mitochondrial DNA profiling, refine the diagnosis. CT of the neck and chest, and sometimes PET-CT, complete staging before an MDT decision.

  • How is it treated?

    Standard treatment is total thyroidectomy, often with central and lateral neck dissection where nodes are involved, followed by risk-stratified radioactive iodine and long-term TSH-suppressive thyroxine. External beam radiotherapy is used for locally advanced disease, and targeted therapies such as lenvatinib, sorafenib, selpercatinib, pralsetinib, larotrectinib or entrectinib are considered in advanced or RAI-refractory disease.

  • Why is Hürthle cell cancer sometimes resistant to radioactive iodine?

    Hürthle cells often lose the ability to concentrate iodine as effectively as normal thyroid tissue or classical follicular cancer. That means radioactive iodine may not deliver enough dose to residual disease, so response has to be judged carefully and alternative options - including targeted therapy and clinical trials - are considered earlier than in some other thyroid cancers.

  • What is the outlook?

    Outcomes depend on stage, age, extent of surgery, iodine avidity and molecular profile. Localised, completely resected disease with a good response to radioactive iodine has a very favourable outlook, while metastatic or RAI-refractory disease is more challenging - though targeted therapies have meaningfully improved options in recent years.

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