If malignancy is uncertain in a Hurthle cell/follicular neoplasm, what is the recommended treatment?

In cases where there is uncertainty regarding the malignancy of a Hurthle cell or follicular neoplasm, a lobectomy is often the recommended surgical approach. This procedure involves the removal of one lobe of the thyroid gland and is particularly appropriate for indeterminate lesions because it allows for pathological examination of the tissue while preserving some thyroid function.

A lobectomy addresses the immediate concern of potentially malignant growth, and while it does not provide a definitive solution as in the case of a complete thyroidectomy, it strikes a balance between managing the risk of cancer and maintaining thyroid function. If the excised tissue reveals malignancy, further surgical intervention can be planned accordingly.

Complete thyroidectomy might be considered in instances of established cancer, but for uncertain cases, it represents a more aggressive approach that may not be necessary. Radioactive iodine treatment is typically used after surgical procedures when there is confirmed thyroid cancer, and observation without intervention would not be advisable given the potential risk of malignancy. Thus, the lobectomy allows for a diagnostic and therapeutic step while also considering the patient's overall health and thyroid function.