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Hürthle cell neoplasms (HCN) of the thyroid gland account for 3% to 10% of all thyroid tumors. Hürthle cell carcinoma (HCC) is more aggressive than other well-differentiated thyroid cancers such as follicular and papillary thyroid carcinoma, with higher rates of recurrence and metastasis. Many surgeons recommend total or near-total thyroidectomy for the treatment of HCC, while Hürthle cell adenomas (HCA) are adequately treated with thyroid lobectomy. Discriminating between HCA and HCC either before or during surgery is difficult. Currently, HCA and HCC can only be distinguished by permanent histology, as neither fine-needle aspiration biopsy nor frozen-section analysis is reliable for differentiation. The purpose of this study was to determine if any pre-operative or intra-operative factors are predictive of malignancy in patients with HCN. Between May 1994 and January 2007, 1199 …