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Follicular thyroid cancer (including Hürthle cell cancer)

Author
R Michael Tuttle, MD
Section Editor
Douglas S Ross, MD
Deputy Editor
Jean E Mulder, MD

INTRODUCTION

Thyroid follicular epithelial-derived cancers include papillary, follicular, and anaplastic cancer. Papillary and follicular cancers are considered differentiated cancers. Follicular thyroid cancer is less common than papillary thyroid cancer. In iodine-sufficient areas, up to 12 percent of all thyroid cancers are follicular cancers, whereas 85 percent are papillary. The molecular pathogenesis, clinical features, diagnosis, and prognostic features of follicular thyroid cancer will be provided here. Papillary thyroid cancer and the management of differentiated thyroid cancer are discussed separately. (See "Papillary thyroid cancer" and "Differentiated thyroid cancer: Overview of management".)

EPIDEMIOLOGY

Follicular thyroid cancer tends to occur in an older population when compared with other differentiated thyroid cancers. Its peak incidence is between ages 40 and 60 years, as compared with papillary thyroid cancer incidence peaking earlier, between the ages of 30 to 50 years. In addition, follicular thyroid cancer is approximately three times more common in women than in men [1]. Iodine may also play a role in the epidemiology of follicular thyroid cancer. In iodine-deficient regions of the world, there is a higher prevalence of follicular cancer compared with iodine-sufficient regions. With the introduction of iodine, some studies showed that the incidence of follicular thyroid cancer decreased, while papillary thyroid cancer increased [2,3].

In a report based upon the Surveillance, Epidemiology, and End Results (SEER) database from 1980 and 2009, there was an increase in follicular thyroid cancer rates among women and men [4]. However, in a report from Poland, rates of follicular thyroid cancer actually decreased between 1982 and 2012, a time during which rates of papillary thyroid cancer were increasing [5]. (See "Papillary thyroid cancer", section on 'Incidence'.)

RISK FACTORS

Risk factors for follicular thyroid cancer are similar to those for papillary thyroid cancer and include a history of radiation exposure during childhood, a history of thyroid cancer in a first-degree relative, or a family history of a thyroid cancer syndrome. Radiation exposure of the thyroid during childhood is the most clearly defined environmental factor associated with benign and malignant thyroid tumors. (See "Papillary thyroid cancer", section on 'Risk factors'.)

MOLECULAR PATHOGENESIS

Most follicular thyroid cancers are probably of monoclonal origin. In addition, oncogene activation is common. (See "Oncogenes and tumor suppressor genes in thyroid nodules and nonmedullary thyroid cancer", section on 'Follicular thyroid cancer'.)

                  
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Literature review current through: Sep 2017. | This topic last updated: May 03, 2017.
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References
Top
  1. https://seer.cancer.gov/statfacts/html/thyro.html (Accessed on March 08, 2017).
  2. Pettersson B, Adami HO, Wilander E, Coleman MP. Trends in thyroid cancer incidence in Sweden, 1958-1981, by histopathologic type. Int J Cancer 1991; 48:28.
  3. Harach HR, Escalante DA, Onativia A, et al. Thyroid carcinoma and thyroiditis in an endemic goitre region before and after iodine prophylaxis. Acta Endocrinol (Copenh) 1985; 108:55.
  4. Aschebrook-Kilfoy B, Grogan RH, Ward MH, et al. Follicular thyroid cancer incidence patterns in the United States, 1980-2009. Thyroid 2013; 23:1015.
  5. Konturek A, Barczyński M, Stopa M, Nowak W. Trends in Prevalence of Thyroid Cancer Over Three Decades: A Retrospective Cohort Study of 17,526 Surgical Patients. World J Surg 2016; 40:538.
  6. Medema RH, Bos JL. The role of p21ras in receptor tyrosine kinase signaling. Crit Rev Oncog 1993; 4:615.
  7. Lemoine NR, Mayall ES, Wyllie FS, et al. Activated ras oncogenes in human thyroid cancers. Cancer Res 1988; 48:4459.
  8. Zhu Z, Gandhi M, Nikiforova MN, et al. Molecular profile and clinical-pathologic features of the follicular variant of papillary thyroid carcinoma. An unusually high prevalence of ras mutations. Am J Clin Pathol 2003; 120:71.
  9. Garcia-Rostan G, Zhao H, Camp RL, et al. ras mutations are associated with aggressive tumor phenotypes and poor prognosis in thyroid cancer. J Clin Oncol 2003; 21:3226.
  10. Fagin JA. Molecular genetics of tumors of thyroid follicular cells. In: Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text, 9th, Braverman LE, Utiger RD (Eds), Lippincott Williams & Wilkins, Philadelphia, PA 2005. p.909.
  11. Marques AR, Espadinha C, Catarino AL, et al. Expression of PAX8-PPAR gamma 1 rearrangements in both follicular thyroid carcinomas and adenomas. J Clin Endocrinol Metab 2002; 87:3947.
  12. Martelli ML, Iuliano R, Le Pera I, et al. Inhibitory effects of peroxisome poliferator-activated receptor gamma on thyroid carcinoma cell growth. J Clin Endocrinol Metab 2002; 87:4728.
  13. Nikiforov YE. Genetic alterations involved in the transition from well-differentiated to poorly differentiated and anaplastic thyroid carcinomas. Endocr Pathol 2004; 15:319.
  14. Führer D, Tannapfel A, Sabri O, et al. Two somatic TSH receptor mutations in a patient with toxic metastasising follicular thyroid carcinoma and non-functional lung metastases. Endocr Relat Cancer 2003; 10:591.
  15. Cerilli LA, Mills SE, Rumpel CA, et al. Interpretation of RET immunostaining in follicular lesions of the thyroid. Am J Clin Pathol 2002; 118:186.
  16. Xing M. BRAF mutation in thyroid cancer. Endocr Relat Cancer 2005; 12:245.
  17. Collini P, Sampietro G, Rosai J, Pilotti S. Minimally invasive (encapsulated) follicular carcinoma of the thyroid gland is the low-risk counterpart of widely invasive follicular carcinoma but not of insular carcinoma. Virchows Arch 2003; 442:71.
  18. D'Avanzo A, Treseler P, Ituarte PH, et al. Follicular thyroid carcinoma: histology and prognosis. Cancer 2004; 100:1123.
  19. Baloch ZW, LiVolsi VA. Prognostic factors in well-differentiated follicular-derived carcinoma and medullary thyroid carcinoma. Thyroid 2001; 11:637.
  20. Baloch ZW, LiVolsi VA. Follicular-patterned afflictions of the thyroid gland: reappraisal of the most discussed entity in endocrine pathology. Endocr Pathol 2014; 25:12.
  21. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid 2009; 19:1159.
  22. Rosai J, Carcangiu ML, De Lellis RA. Tumors of the thyroid gland. In: Atlas of tumor pathology, Armed Forces Institute of Pathology, Washington, DC 1992. Vol Fascicle 5.
  23. Grebe SK, Hay ID. Follicular thyroid cancer. Endocrinol Metab Clin North Am 1995; 24:761.
  24. Machens A, Holzhausen HJ, Dralle H. The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma. Cancer 2005; 103:2269.
  25. Bowden WD, Jones RE. Thyrotoxicosis associated with distant metastatic follicular carcinoma of the thyroid. South Med J 1986; 79:483.
  26. Kasagi K, Takeuchi R, Miyamoto S, et al. Metastatic thyroid cancer presenting as thyrotoxicosis: report of three cases. Clin Endocrinol (Oxf) 1994; 40:429.
  27. Miyauchi A, Takamura Y, Ito Y, et al. 3,5,3'-Triiodothyronine thyrotoxicosis due to increased conversion of administered levothyroxine in patients with massive metastatic follicular thyroid carcinoma. J Clin Endocrinol Metab 2008; 93:2239.
  28. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 1994; 97:418.
  29. Ries LAG, Eisner MP, Kosary CL, Hankey BF, et al. SEER Cancer Statistics Review, 1975-2001. National Cancer Institute. Bethesda, MD, 2004. http://seer.cancer.gov/csr/1975_2001/ (Accessed on October 22, 2005).
  30. Mazzaferri EL. Thyroid carcinoma: Papillary and follicular. In: Endocrine Tumors, Mazzaferri EL, Samaan NA (Eds), Blackwell Scientific, Cambridge, MA 1993. p.278.
  31. Lin JD, Hsueh C, Chao TC. Early recurrence of papillary and follicular thyroid carcinoma predicts a worse outcome. Thyroid 2009; 19:1053.
  32. Kushchayeva Y, Duh QY, Kebebew E, et al. Comparison of clinical characteristics at diagnosis and during follow-up in 118 patients with Hurthle cell or follicular thyroid cancer. Am J Surg 2008; 195:457.
  33. Lai HW, Lee CH, Chen JY, et al. Insular thyroid carcinoma: collective analysis of clinicohistologic prognostic factors and treatment effect with radioiodine or radiation therapy. J Am Coll Surg 2006; 203:715.
  34. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1.