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8 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Follicular thyroid cancer looks like a benign nodule on a needle biopsy, so the diagnosis is usually made only after surgery. It spreads through the bloodstream rather than to neck nodes, is treated like papillary cancer with surgery and radioactive iodine, and has a good outlook when caught early.
Follicular thyroid cancer is separated from a benign follicular adenoma only by invasion of the capsule or blood vessels, which a fine-needle biopsy cannot show; a follicular result on biopsy therefore leads to diagnostic lobectomy, and molecular tests on the aspirate now help decide who needs it. RAS mutations and the PAX8-PPARG fusion are common, and TERT promoter mutations mark aggressive disease. Minimally invasive tumours are cured by lobectomy; widely invasive tumours receive total thyroidectomy and radioactive iodine, which also treats the lung and bone metastases the disease favours. Oncocytic (Hurthle cell) carcinoma, once a follicular variant, is a separate entity in the 2022 WHO classification and takes up iodine poorly. Iodine-refractory disease is treated as in papillary cancer with lenvatinib or sorafenib.
| Setting | Approach | Guideline |
|---|---|---|
| Indeterminate follicular nodule | Molecular testing of the aspirate; diagnostic lobectomy when suspicious. | not mapped |
| Minimally invasive | Lobectomy alone in most cases; completion surgery and iodine only for high-risk features. | not mapped |
| Widely invasive or metastatic | Total thyroidectomy, radioactive iodine, TSH suppression; bone metastases may need surgery or radiotherapy. | not mapped |
| Iodine-refractory | Lenvatinib or sorafenib; clinical trials of redifferentiation. | not mapped |