Hürthle Cell Research Articles

Survival and prognostic factors for survival, cancer specific survival and disease free interval in 239 patients with Hurthle cell carcinoma: a single center experience

BackgroundHurthle cell carcinoma makes up 3 to 5% of all thyroid cancers and is considered to be a true rarity. The aim of our study was to analyze clinical characteristics and survival rates of patients with Hurthle cell carcinoma.MethodsClinical data regarding basic demographic characteristics, tumor grade, type of surgical treatment and vital status were collected. Methods of descriptive statistics and Kaplan-Meier survival curves were used for statistical analysis. Cox proportional hazards regression was used to identify independent predictors.ResultsDuring the period from 1995 to 2014, 239 patients with Hurthle cell carcinoma were treated at our Institution. The average age of the patients was 54.3, with female to male ratio of 3.6:1 and average tumor size was 41.8 mm. The overall recurrence rate was 12.1%, with average time for relapse of 90.74 months and average time without any signs of the disease of 222.4 months. Overall 5-year, 10-year and 20-year survival rates were 89.4%, 77.2%, 61.9% respectively. The 5-year, 10-year and 20-year cancer specific survival rates were 94.6%, 92.5%, 87.4%, respectively. When disease free interval was observed, 5-year, 10-year and 20-year rates were 91.1%, 86.2%, 68.5%, respectively. The affection of both thyroid lobes and the need for reoperation due to local relapse were unfavorable independent prognostic factors, while total thyroidectomy as primary procedure was favorable predictive factor for cancer specific survival.ConclusionHurthle cell carcinoma is a rare tumor with an encouraging prognosis and after adequate surgical treatment recurrences are rare.

Cytomorphologic features distinguishing Bethesda category IV thyroid lesions from parathyroid.

Background:Thyroid follicular cells share similar cytomorphological features with parathyroid. Without a clinical suspicion, the distinction between a thyroid neoplasm and an intrathyroidal parathyroid can be challenging. The aim of this study was to assess the distinguishing cytomorphological features of parathyroid (including intrathyroidal) and Bethesda category IV (Beth-IV) thyroid follicular lesions, which carry a 15%–30% risk of malignancy and are often followed up with surgical resection.Methods:A search was performed to identify “parathyroid” diagnoses in parathyroid/thyroid-designated fine-needle aspirations (FNAs) and Beth-IV thyroid FNAs (follicular and Hurthle cell), all with diagnostic confirmation through surgical pathology, immunocytochemical stains, Afirma® analysis, and/or clinical correlation. Unique cytomorphologic features were scored (0-3) or noted as present versus absent. Statistical analysis was performed using R 3.3.1 software.Results:We identified five FNA cases with clinical suspicion of parathyroid neoplasm, hyperthyroidism, or thyroid lesion that had an eventual final diagnosis of the parathyroid lesion (all female; age 20–69 years) and 12 Beth-IV diagnoses (11 female, 1 male; age 13–64 years). The following cytomorphologic features are useful distinguishing features (P value): overall pattern (0.001), single cells (0.001), cell size compared to red blood cell (0.01), nuclear irregularity (0.001), presence of nucleoli (0.001), nuclear-to-cytoplasmic ratio (0.007), and nuclear chromatin quality (0.028).Conclusions:There are cytomorphologic features that distinguish Beth-IV thyroid lesions and (intrathyroidal) parathyroid. These features can aid in rendering correct diagnoses and appropriate management.

Bilateral Hurthle cell adenoma of thyroid: a rare case report

<p class="abstract">Hurthle cell of adenoma of thyroid gland is rare neoplasms of the thyroid. Size more than 4 cm is rare finding and moreover the occurrence of a multifocal Hurthle cell adenoma is not supported by antecedents in literature. Sonography fails to identify its potentials for malignancy while fine needle aspiration cytology couldn’t differentiate it from Hurthle cell carcinoma of thyroid. The management of Hurthle cell adenoma and Hurthle cell carcinoma is quite different and hence diagnostic dilemma should be sorted out early. A 26 year old female presented with bilateral thyroid swelling. Ultrasonography of thyroid gland showed complex solid cystic nodules in bilateral thyroid lobes with right thyroid lobe measuring 4.1×3.4×2.5 cm and left thyroid lobe measure 3.1×1.7×1.6 cm. Fine needle aspiration cytology (FNAC) was suggestive of papillary malignancy with extensive Hurthle cell changes (Class V, Bethesda classification). The patient underwent total thyroidectomy with bilateral parathyroid gland preservation. Histopathology revealed it as Hurthle cell adenoma (HCA) involving bilateral lobe and multifocal in nature. The treatment of choice for Hurthle cell carcinoma is total thyroidectomy with neck dissection depending on the nature of the lesions. However the treatment of Hurthle cell adenoma is only hemithyroidectomy or lobectomy as it is a benign condition. Differentiation of these two entirely different conditions warrants more studies<span lang="EN-IN">.</span></p>

Impact of body mass index on survival outcome in patients with differentiated thyroid cancer

IntroductionIncreased body mass index is known to be associated with the high prevalence of differentiated thyroid cancers; however data on its impact on survival outcome after thyroidectomy and adjuvant therapy is scanty. ObjectiveWe aimed to evaluate the impact of body mass index on overall survival and disease free survival rates in patients with differentiated thyroid cancers. MethodsBetween 2000 and 2011, 209 patients with differentiated thyroid cancers (papillary, follicular, hurthle cell) were treated with thyroidectomy followed by adjuvant radioactive iodine-131 therapy and thyroid-stimulating hormone suppression. Based on body mass index, patients were divided into five groups; (a) <18.5kg/m2 (underweight); (b) 18.5–25kg/m2 (normal weight); (c) 26–30kg/m2 (overweight); (d) 31–40kg/m2 (obese) and (e) >40kg/m2 (morbid obese). Various demographic, clinical and treatment characteristics and related toxicity and outcomes (overall survival, and disease free survival) were analyzed and compared. ResultsMedian follow up period was 5.2years (0.6–10). Mean body mass index was 31.3kg/m2 (17–72); body mass index 31–40kg/m2 was predominant (89 patients, 42.6%) followed by 26–30kg/m2 seen in 58 patients (27.8%). A total of 18 locoregional recurrences (8.6%) and 12 distant metastasis (5.7%) were seen. The 10 year disease free survival and overall survival rates were 83.1% and 58.0% respectively. No significant impact of body mass index on overall survival or disease free survival rates was found (p=0.081). Similarly, multivariate analysis showed that body mass index was not an independent prognostic factor for overall survival and disease free survival. ConclusionAlthough body mass index can increase the risk of thyroid cancer, it has no impact on treatment outcome; however, further trials are warranted.

Metastatic Hurthle cell carcinoma to the skull

Metastatic Hurthle cell carcinoma to the skull

Diagnostic utility of CK19 and CD56 in the differentiation of thyroid papillary carcinoma from its mimics

BackgroundPapillary Thyroid Carcinoma (PTC) is the most common type of malignant thyroid tumors. The main diagnostic clue of PTC is the presence of its characteristic nuclear features. Yet, the focal presence of these features in other thyroid lesions causes a diagnostic dilemma. AimTo evaluate Cytokeratin 19 (CK19) and CD56 immunostains as useful diagnostic markers in distinguishing papillary thyroid carcinoma from other mimicking thyroid lesions. MethodsEighty cases of different thyroid lesions were submitted for immunohistochemical staining of CK19 and CD56. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were analyzed. ResultsCK19 was expressed in 87.8% and 21.2% of the PTC group and the non-papillary carcinoma (NPTC) group respectively, with significant difference (P<0.001). CD56 expression was lost with 81.8% of the PTC group. However, CK19 was negative in only 12.7% of the NPTC group, with significant difference (P<0.001). Comparing papillary carcinoma with papillary hyperplasia, CK19 was the most sensitive immunostain and CD56 was the most specific one, with better diagnostic accuracy in combining both immunostains. Co-expression of CK19/CD56 provided 100% sensitivity and 92% diagnostic accuracy in differentiating follicular variant of PTC from follicular adenoma. Comparing FVPTC with follicular carcinoma, sensitivity and diagnostic accuracy increased to 100% and 91.7% respectively. On distinction between papillary carcinoma (Hurthle cell variant) and Hurthle cell adenoma, sensitivity, specificity, and diagnostic accuracy were 100%, 75% and 83.3% respectively, with CK19/CD56 staining combination. Comparing papillary carcinoma on top of Hashimoto's thyroiditis with Hashimoto's thyroiditis, co-expression of both markers was associated with 100% specificity, as well as increase in PPV and diagnostic accuracy to 91%. ConclusionThe combined use of CK19 and CD56 is helpful in discriminating papillary thyroid carcinoma and its variants from other mimicking thyroid lesions.

Differential Expression of Glycolysis-Related Proteins in Follicular Neoplasms versus Hürthle Cell Neoplasms: A Retrospective Analysis.

Purpose Although currently classified as variants of follicular neoplasms (FNs), Hürthle cell neoplasms (HCNs) exhibit distinct biological characteristics. Hence, the metabolism of both neoplasms may also be different. The aims of this study were to investigate and compare the expression of glycolysis-related proteins in HCNs and FNs and to determine the clinical implications of such expression. Methods Tissue microarrays were constructed with 265 samples of FNs (112 follicular carcinomas (FCs) and 153 follicular adenomas (FAs)) as well as 108 samples of HCNs (27 Hürthle cell carcinomas (HCCs) and 81 Hürthle cell adenomas (HCAs)). Immunohistochemical staining for the glycolysis-related molecules Glut-1, hexokinase II, CAIX, and MCT4 was performed. Results The expression levels of Glut-1, hexokinase II, CAIX, and MCT4 were significantly higher in HCNs than in FNs (p < 0.001). Glut-1, hexokinase II, CAIX, and MCT4 expression levels were highest in HCC, followed by HCA, FC, and FA (all p < 0.001). In HCC, hexokinase II positivity was associated with large tumor size (>4 cm) (p = 0.046), CAIX positivity with vascular invasion (p = 0.005), and MCT4 positivity with extrathyroidal extension (p = 0.030). Conclusion The expression levels of the glycolysis-related proteins Glut-1, hexokinase II, CAIX, and MCT4 were higher in HCNs than in FNs and in HCCs than in HCAs.

Expression of Autophagy-Related Proteins in Hürthle Cell Neoplasm Is Different from That in Follicular Neoplasm.

Purpose We aimed to evaluate expression of autophagy-related proteins in Hürthle cell neoplasm (HCN) and follicular neoplasm (FN) and assess the clinical implications. Methods 265 FNs (112 follicular carcinomas and 153 follicular adenomas) and 108 HCNs (27 Hürthle cell carcinomas and 81 Hürthle cell adenomas) were made into a tissue microarray. Immunohistochemical staining and Western blot for autophagy-related proteins (beclin-1, light chain (LC) 3A, LC3B, p62, and BNIP3) were performed, and the results were statistically analyzed. Results A higher expression rate of beclin-1, LC3B, p62, and BNIP3 was found in HCN than in FN (P < 0.001). The expression rate of beclin-1, LC3B, p62, and BNIP3 was the highest in HCCs followed by HCAs, FCs, and FAs in that order (P < 0.001). HCCs were positive for the largest number of autophagy-related proteins followed by HCAs, FCs, and FAs (P < 0.001), and most of the positive markers identified in HCCs were the high autophagy type (P < 0.001), defined by positive staining for three or more of the five autophagy-related proteins. Conclusion The autophagy-related proteins, beclin-1, LC3A, LC3B, p62, and BNIP3, were more frequently expressed in HCNs than in FNs, and HCCs showed the highest expression rate.

Significance of Hurthle Cells in Thyroid Cytology and its Correlation with Histopathology

Significance of Hurthle Cells in Thyroid Cytology and its Correlation with Histopathology

Synchronous Medullary Carcinoma, Hurthle Cell Carcinoma and Parathyroid Adenoma: A Unique Case Report and Literature Review

Synchronous Medullary Carcinoma, Hurthle Cell Carcinoma and Parathyroid Adenoma: A Unique Case Report and Literature Review

A rare case of Marine-Lenhart syndrome with unilate ral endocrine orbitopathy and Hürthle cell carcinoma

A rare case of Marine-Lenhart syndrome with unilateral endocrine orbitopathy and Hurthle cell carcinoma -

Imaging Surveillance in Patients After a Benign Fine-Needle Aspiration Biopsy of the Thyroid: Associated Cost and Incidence of Subsequent Cancer.

The objective of our study was to determine patterns and cost of imaging tumor surveillance in patients after a benign fine-needle aspiration (FNA) biopsy of the thyroid in a large teaching hospital as well as the rate of subsequent cancer detection. This cohort study was approved by the appropriate institutional review board and complied with HIPAA. All patients who had a benign thyroid FNA biopsy between January 1, 1999, and December 31, 2003, were identified from an institutional pathology database. We gathered information from electronic medical records on imaging tumor surveillance and subsequent cancer detection. Cost was determined using the facility total relative value unit and the 2014 Hospital Outpatient Prospective Payment System conversion factor. Between January 1, 1999, and December 31, 2003, 1685 patients had a benign thyroid FNA biopsy, 800 (47.5%) of whom underwent follow-up imaging. These patients underwent 2223 thyroid ultrasound examinations, 606 ultrasound-guided thyroid FNA biopsies, 78 thyroid scintigraphy examinations, 168 neck CTs, and 53 neck MRIs at a cost of $529,874, $176,157, $39,622, $80,580, and $53,114, respectively, for a total cost of $879,347 or $1099 per patient. The mean length of follow-up was 7.3 years, during which time 19 (2.4%) patients were diagnosed with thyroid cancer at a cost of $46,281 per cancer. Seventeen (89.5%) were diagnosed with papillary carcinoma and two (10.5%) with Hurthle cell carcinoma. Over a 5-year period, about half of the patients who had a benign thyroid FNA biopsy underwent follow-up imaging at considerable cost with a small rate of subsequent malignancy.

Clinicopathological Study of Thyroid Swellings with Some Emphasis on Geographical and Community Distribution: A Hospital Based Analysis

Introduction: Thyroid swellings/goiter are still prevalent in north east part of India. Apart from its sub-Himalayan location the areas along the river Brahmaputra suffer from flooding every year and there is also frequent changing of river course, thought to be another reason for iodine depletion in soil of this region(3).&#x0D; Aim: To determine the incidence of thyroid swellings and distribution among different sections of society and geographical areas, and to evaluate the role of FNAC in the diagnosis and management and find out its accuracy by comparing with histopathology.&#x0D; Materials and methods: In the present study, total 212 patients with thyroid swellings attending department of ENT of a state medical college during the period from January 2013 to December 2015 and undergone FNAC at department of Pathology were taken into consideration.&#x0D; Results: Out of 212 cases major fraction (52.83%) were hailed from areas along the Brahmaputra river followed by patients (33.96%) from tea gardens and adjacent areas. Patients belonging to tribal communities constituted 45.28%, whereas patients from tea workers section of society formed the second majority (34.9%). Female male ratio of cases was 5:1. Majority of patients were from 21-40 years age group with mean age of 37.2 years. Cytology results of 212 cases showed colloid goiter 73.58%, adenomatous goiter 8.49%, thyroiditis 9.9%, hurthle cell neoplasm 1.41%, follicular neoplasm 4.24%, papillary carcinoma 1.41%, papillary carcinoma of follicular variant 0.47% and medullary carcinoma in 0.47% cases. Histopathology was possible in 65 cases and compared with FNAC results with accuracy rate of 89.23%.&#x0D; Conclusion: Frequent flooding and changes of river course may be one of the reasons for high prevalence of thyroid swellings and goiter along the Brahmaputra valley apart from its sub-Himalayan location. Consumption polluted drinking water and goitergenous food stuffs may be another reason of high incidence. FNAC is an easy, rapid, reliable, less invasive, low cost technique for diagnosis of thyroid swellings.

Galectin-3 expression in thyroid tumors

Aim. To evaluate the expression of Galectin-3 in benign and malignant thyroid nodules and to assess its diagnostic value. Methods. Immunohistochemical analysis of Galectin-3 expression was performed on 64 surgically removed thyroid nodules, including 38 carcinomas (13 papillary, 2 tall cell variants, 4 lymph node metastases from papillary carcinoma,6 follicular variants of papillary carcinoma (FVPTC), 4 anaplastic, 5 follicular and 4 Hurthle cell carcinomas), as well as 26 benign lesions (10 follicular adenomas, 5 Hurthle cell adenomas, 11 nodular goiters with surrounding normal thyroid tissue). Results. We found strong and diffuse Galectin-3 expression in all malignant lesions except for one case of FVPTC and one follicular carcinoma. Normal thyrocytes and the majority of the benign lesions were negative for Galectin-3. This molecular marker was expressed in the cytoplasm as well as in the nuclei of follicular cells. Statistical analysis determined sensitivity 94.7%, specificity 69.2%, PPV 81.8%, NPV 90% and accuracy 83% of Galectin-3. Conclusion. Our findings suggest that immunohistochemical expression of Galectin-3 might contribute to differential diagnosis between malignant and benign thyroid nodules, including those with follicular architecture.

Functional polymorphisms in antioxidant genes in Hurthle cell thyroid neoplasm - an association of GPX1 polymorphism and recurrent Hurthle cell thyroid carcinoma.

BackgroundHurthle cells of the thyroid gland are very rich in mitochondria and oxidative enzymes. As a high level oxidative metabolism may lead to higher level of oxidative stress and can be associated with an increased risk for cancer, we investigated whether common functional polymorphisms in antioxidant genes (SOD2, CAT, GPX, GSTP1, GSTM1 and GSTT1) are associated with the development or clinical course of Hurthle cell thyroid carcinoma (HCTC).MethodsA retrospective study was performed in 139 patients treated by thyroid surgery for a Hurthle cell neoplasm. HCTC, Hurthle cell thyroid adenoma (HCTA) or Hurthle cell thyroid nodule (HCTN) were diagnosed by pathomorphology. DNA was extracted from cores of histologically confirmed normal tissue obtained from formalin-fixed paraffin-embedded specimens and genotyped for investigated polymorphisms. Logistic regression was used to compare genotype distributions between patient groups.ResultsHCTC, HCTA and HCTN were diagnosed in 53, 47 and 21 patients, respectively. Metastatic disease and recurrence of HCTC were diagnosed in 20 and 16 HCTC patients, respectively. Genotypes and allele frequencies of investigated polymorphisms did not deviate from Hardy-Weinberg equilibrium in patients with HCTC, HCTA and HCTN. Under the dominant genetic model we observed no differences in the genotype frequency distribution of the investigated polymorphisms when the HCTA and HCTN group was compared to the HCTC group for diagnosis of HCTC or for the presence of metastatic disease. However, GPX1 polymorphism was associated with the occurrence of recurrent disease (p = 0.040).ConclusionsGPX1 polymorphism may influence the risk for recurrent disease in HCTC.

Recurrence rate in regional lymph nodes in 737 patients with follicular or Hürthle cell neoplasms.

BackgroundPreoperative ultrasound (US) evaluation of central and lateral neck compartments is recommended for all patients undergoing a thyroidectomy for malignant or suspicious for malignancy cytologic or molecular findings. Our aim was to find out how frequent was recurrence in regional lymph nodes in patients with follicular or Hürthle cell neoplasm and usefulness of preoperative neck US investigation in patients with neoplasm.Patients and methodsAltogether 737 patients were surgically treated because of follicular or Hürthle cell neoplasms from 1995 to 2014 at our cancer comprehensive center, among them 207 patients (163 females, 44 males; mean age 52 years) had thyroid carcinoma.ResultsCarcinoma was diagnosed in follicular and Hürthle cell neoplasm in 143/428 and 64/309 of cases, respectively. A recurrence in regional lymph nodes occurred in 12/207 patients (6%) during a median follow-up of 55 months. Among patients with carcinoma a recurrence in regional lymph nodes was diagnosed in follicular and Hürthle cell neoplasms in 2% and 14%, respectively (p = 0.002). Recurrence in regional lymph nodes was diagnosed in 3/428 of all patients with follicular neoplasm and 9/309 of all patients with Hürthle cell neoplasm.ConclusionsRecurrence in lymph nodes was diagnosed in 0.7% of patients with a preoperative diagnosis of follicular neoplasm and 3% of patients with a Hürthle cell neoplasm. A recurrence in regional lymph nodes is rare in patients with carcinoma and preoperative diagnosis of follicular neoplasm. Preoperative neck ultrasound examination in patients with a follicular neoplasm is probably not useful, but in patients with Hurtle cell neoplasm it may be useful.

Cytomorphological features of oncocytic variant of papillary thyroid carcinoma with lymphocytic thyroiditis

Cytological diagnosis of hurthle cell lesions of thyroid is a diagnostic dilemma. Presence of hurthle cells on fine needle aspiration (FNA) leads to a wide range of differential diagnosis including benign and malignant entities. The oncocytic variant of papillary thyroid carcinoma (PTC) is one entity of the vast list of differentials of which very few cases have been reported to date. We report a case of oncocytic variant of PTC in a 28-year-old female diagnosed on cytomorphology. The findings of FNA smears of the first aspirate were not sufficient for a definitive diagnosis. Repeat FNA was done to rule out the possibility of autoimmune thyroiditis/thyroid neoplasm. The repeat FNA smears showed oncocytic cells present in papillary and loosely cohesive clusters. Many of the cells displayed nuclear features of PTC and the case was finally diagnosed as PTC; oncocytic variant. Thyroidectomy specimen revealed PTC; oncocytic variant with lymphocytic thyroiditis in the surrounding tissue. Thus, in cytology practice, concurrent autoimmune thyroiditis may pose a problem in diagnosis of PTC; oncocytic variant.

Hurthle Cell Neoplasm of the Thyroid: Still a Dilemma?

The Hurthle cell is a large, polygonal cell characterized by eosinophilic granular cytoplasm and a large, hyperchromatic nucleus with a prominent nucleolus (1). Hurthle cells are seen in many nonneoplastic conditions of the thyroid and are not specific for any disease (2,3). Thyroid nodules containing hurthle cells in cytologic evaluation are composed of many histopathologic entities, including Hashimoto’s thyroiditis (HT), Hurthle cell adenomas (HCA), Hurthle cell carcinomas (HCC), variants of papillary thyroid carcinoma, including tall cell variant, oncocytic variant, and warthin-like variant, and the oncocytic variant of medullary carcinoma (4,5). Hurthle cell neoplasms (HCNs) are rare tumors. They have an unpredictable biology. There are difficulties in distinguishing Hurthle cell adenoma from carcinomas in preoperative and intraoperative period. Few institutions have extensive experience in following up patients with Hurthle cell predominant thyroid nodules. The aim of this review was to examine the features of Hurthle cell neoplasia which would be important in the treatment of patients and could guide clinicians. Hurthle Cell

Impact of specific patterns on the sensitivity for follicular and Hurthle cell carcinoma in thyroid fine-needle aspiration.

To the authors' knowledge, the impact of specific cytologic patterns in thyroid fine-needle aspiration (FNA) for follicular and Hurthle cell carcinoma is not known. The results of all thyroid FNAs performed from 1997 through 2015 with corresponding resections of follicular and Hurthle cell carcinomas were reviewed. A total of 24 follicular carcinomas and 35 Hurthle cell carcinomas were identified. All FNA specimens from follicular carcinomas had a microfollicular component (3 of which were noted only in 3-dimensional groups), but only 18 cases (75%) had cytologic atypia, which most commonly consisted of enlarged nuclei with slightly pale chromatin. Diagnosing cases without cytologic atypia as benign would significantly decrease the sensitivity of the test (P = .02). Five Hurthle cell FNA specimens consisted of only scant Hurthle cells. The remaining Hurthle cell FNA specimens could be divided into those with large cell dysplasia (15 cases), those with small cell dysplasia (10 cases), cases with anisonucleosis insufficient for a diagnosis of large cell dysplasia (4 cases), and cases with Hurthle cells in flat sheets without atypia (1 case). Diagnosing cases with flat sheets without atypia as benign did not appear to affect the sensitivity of the test (P = 1.00). Diagnosing FNA specimens with microfollicles without atypia as benign appears to significantly reduce the sensitivity for follicular carcinoma to 75%; in contrast, diagnosing FNA specimens with Hurthle cells in flat sheets without anisonucleosis as benign does not. Cancer Cytopathol 2016;124:729-36. © 2016 American Cancer Society.

Management of the Central and Lateral Neck in Patients with Differentiated Thyroid Cancer

The incidence of differentiated thyroid cancer, including papillary, follicular, and Hurthle cell histologies, is increasing rapidly in the United States. It is associated with significant risk of locoregional lymph node metastasis; this is especially true for papillary thyroid cancer (PTC), which now accounts for approximately 90 % of all new thyroid cancer diagnoses. Overall, differentiated thyroid cancer is associated with a good prognosis and excellent long-term survival. There is contentious debate about the merits of prophylactic central compartment lymph node dissection for this disease, as there has not been convincing evidence to support it; a randomized controlled trial is unlikely. There are nuances in best practice for management and surveillance of patients with a history of nodal disease, as they are at increased risk for recurrence. This is a comprehensive review of the literature, including the recently published American Thyroid Association (ATA) guidelines for the management of thyroid nodules and differentiated thyroid cancer in adult patients, focusing on the management of nodal disease.