What is the follow-up procedure if carcinoma is identified in permanent section of a Hurthle cell neoplasm?

When carcinoma is identified in the permanent section of a Hurthle cell neoplasm, the preferred follow-up procedure is to perform a completion lobectomy. Hurthle cell neoplasms can occasionally demonstrate malignant potential, and if malignancy is confirmed in the biopsy, the entire lobe containing the neoplasm should be removed to ensure that any malignant tissue is excised, thus reducing the risk of recurrence and enabling further staging if necessary.

Completion lobectomy not only addresses the identified carcinoma but also allows for a more thorough evaluation of the remaining thyroid tissue for any additional signs of malignancy. This is crucial for appropriate management of thyroid cancer, as it impacts follow-up care and treatment options moving forward.

Other options do not provide the comprehensive approach needed in this scenario. For instance, doing nothing would leave the patient at risk for unresolved cancer. A repeat fine needle aspiration may not yield additional helpful information and would delay necessary treatment. Initiating radioactive iodine therapy without a complete surgical resection may not be appropriate if additional malignant tissue is present, as the success of this therapy largely depends on the extent of the disease being adequately addressed beforehand.