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Malignancy risk in indeterminate thyroid nodules with Hürthle cells: role of autoimmune thyroiditis



Hürthle cells are modified follicular thyroid cells, whose development and proliferation have been related to different stimuli inducing cellular stress. Most thyroid aspirates containing Hürthle cells are classified as indeterminate, although the specific risk of malignancy for this subtype of atypia remains unclear. The aim of our study was to assess if the presence of Hürthle cells in indeterminate thyroid nodules correlates with the risk of malignancy. We further evaluated if this risk can be modified by the presence of an underlying Hashimoto’s thyroiditis.

Materials and methods

We retrospectively analyzed all indeterminate thyroid nodules that were surgically treated at our institution between January 2010 and March 2019. For each nodule, we inferred the presence of Hürthle cells in the cytological report. Cytological findings were then correlated with histological reports.


354 indeterminate thyroid nodules were included in the study. The rate of malignancy resulted significantly lower in nodules exhibiting Hürthle cells compared to those negative for this cellular pattern (11.4% vs 22.5%, p = 0.01). Although there was no difference in the rate of malignancy in the whole population according to the presence or absence of Hashimoto’s thyroiditis (21.5 vs 18.5%, p = 0.63), the significantly lower prevalence of malignant lesions in nodules with Hürthle cells was confirmed only in the presence of a histologically documented Hashimoto’s thyroiditis (6.2% vs 32%, p = 0.005).


The finding of Hürthle cells in indeterminate thyroid nodules is associated with a low risk of malignancy in patients with an underlying Hashimoto’s thyroiditis. The clinical management of these lesions may therefore be more conservative.

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Fig. 1

Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.


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Correspondence to Francesca Perticone.

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The local Ethic Committee (San Raffaele Scientific Institute in Milan – Italy) approved the study protocol and written informed consent was obtained from each patient.

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Perticone, F., Maggiore, R., Mari, G. et al. Malignancy risk in indeterminate thyroid nodules with Hürthle cells: role of autoimmune thyroiditis. Endocrine 75, 823–828 (2022).

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  • Thyroid cancer
  • Indeterminate thyroid nodules
  • Malignancy risk
  • Hürthle cells