ObjectiveTo summarize the experiences and lessons of diagnosis and treatment of follicular thyroid carcinoma (FTC) with lymph node and lung metastases.MethodThe clinicopathologic data of a case of FTC with metastases of cervical, mediastinum, axillary lymph nodes, and bilateral lungs were analyzed retrospectively.ResultsThe case was a 39 years old male patient, who was diagnosed with the right FTC with multiple metastases. The total thyroidectomy+lymph node dissection in bilateral central and bilateral neck regions+lymph node dissection in the left axillary was intended to perform in the Department of Thyroid and Parathyroid Surgery of the West China Hospital. During the operation, the upper mediastinal lymph node fusion was found, and the tumor was tightly adhered with the recurrent laryngeal nerve, the signal was lost after the adhesion separation. In the right central area, the enlarged lymph nodes penetrated down into the upper mediastinum. More enlarged lymph nodes extended upward into the subclavian area in the left armpit. Considering a longer operation time and about 2 000 mL bleeding amount, the mediastinal and left neck operation was decided to perform in the second stage after consulting with the thoracic surgeon. At more than 6 months after the operation, the patient underwent the mediastinal lymph node dissection+superior vena cava (SVC) restoration+metastatic tumor resection+SVC shunt operation in the Department of Thoracic Surgery of the West China Hospital. The operation was successful, without hypocalcemia, dyspnea, and other complications. At 8 months after the operation, the third operation was performed in the Department of Thyroid and Parathyroid Surgery of the West China Hospital, that was, total residual thyroidectomy+left central and left cervical lymph node dissection+left axillary lymph node dissection (level Ⅱ–Ⅲ). The postoperative pronounce didn’t change, without hypocalcemia and other complications. Three times of iodine ablation therapy were performed in the West China Hospital. The occupy didn’t be found by the neck ultrasound and the pulmonary metastasis was stable by the CT during the regular follow-up.ConclusionsAccording to this case, neck surgery with SVC syndrome, SVC syndrome should be treated preferentially. For patient with complicated condition, unconventional approaches could be selected according to actual condition of patient, and staging surgery might be a good choice.
ObjectiveTo summarize recent advances in the preoperative differential diagnosis, pathological risk stratification, and standardized management of follicular thyroid carcinoma (FTC), aiming to inform clinical decision-making. MethodRecent domestic and international literature regarding the preoperative diagnosis, pathological typing, surgical strategies, radioactive iodine (RAI) therapy, and systemic treatments for FTC was comprehensively reviewed and summarized. ResultsRegarding preoperative diagnosis, the integration of neoplasm-specific ultrasound risk stratification systems, multimodal imaging, radiomics integrated with artificial intelligence models, and molecular biomarkers—including genetic profiling via tissue and liquid biopsies—demonstrates utility in refining the preoperative risk stratification of follicular thyroid neoplasms. Nevertheless, definitive diagnosis of FTC remains contingent upon histopathological examination following surgical resection. Therapeutic strategies emphasize individualized, risk-based management aligned with the 2022 WHO Classification and the 2025 American Thyroid Association Guidelines, stratifying interventions based on tumor invasiveness and vascular involvement. Thyroid lobectomy is recommended as sufficient therapy for low-risk FTC (minimally invasive, non-vascularly invasive tumors), offering a favorable prognosis while minimizing surgical morbidity. For low-to-intermediate-risk FTC (<4 sites of vascular invasion), management necessitates a personalized approach incorporating patient age, tumor dimensions, and informed patient preferences. Total thyroidectomy with adjuvant RAI therapy is advocated for high-risk patients exhibiting extensive vascular invasion (≥4 sites), significant extrathyroidal extension, or distant metastases; subsequent management is tailored based on dynamic risk stratification. Thermal ablation is not endorsed as a primary curative modality for surgically eligible candidates. For progressive, unresectable, or RAI-refractory FTC, upfront molecular profiling and multidisciplinary tumor board review are imperative. Identification of actionable drivers (e.g., BRAFV600E mutation, RET fusion, and NTRK fusion) warrants matched targeted therapies as first-line treatment. In the absence of specific targets, multikinase inhibitors such as lenvatinib or sorafenib remain the systemic therapy mainstay. ConclusionThe clinical management of FTC has gradually shifted from treatment decisions based on a single indicator to a whole-course individualized management model encompassing preoperative risk stratification, standardized surgery and pathological examination, postoperative dynamic risk stratification surveillance, with molecular subtyping and targeted therapy integrated for advanced disease.