Young age - an unusual finding of Hürthle cell carcinoma

Hurthle cell carcinoma is a rare thyroid neoplasm which originates from the follicular epithelium of the thyroid gland and is considered a true rarity in young patients. A 30 year-old woman was admitted to our department with palpable anterior cervical mass due to enlarged thyroid. The ultrasound revealed a large thyroid nodule with central hypoechogenicity, peripheral hyperechogenicity and positive Doppler signal. The patient had no distinguishable lateral cervical lymphadenopathy. The TI-RADS calculation (thyroid image reporting data system) classified the nodule as TR4 (4 points), which indicated a fine needle aspiration biopsy (FNAB), declined by the patient. Total thyroidectomy was performed and the histological findings associated with immunohistochemical study revealed the diagnosis of Hurthle cell carcinoma with capsular and vascular invasion. Because the microscopic vascular invasion was < 4 foci the patient was classified as low-risk group. Even so, due to the young age she was referred to radioactive iodine therapy for completion of curative treatment. This case illustrates the difficulties in the management of thyroid nodules with suspicious features on ultrasound, in the absence of FNAB exploration, and the unusual presence of Hurthle cell carcinoma in a young age patient, knowing the 6th decade is the average age for this rare type of thyroid neoplasm.