Clinical presentation: A 20-yr-old woman requested evaluation of a goiter which has been discovered by herself for a year.

Palpation: a not firm nodule in the left lobe.

Laboratory test: TSH 1.58 mIU/L.

Ultrasonography. The thyroid was echonormal and had tiny hypoechoic areas in the right lobe. There was a heterogeneous, dominantly echonormal nodule in the left lobe. The lesion has small cystic areas, halo sign and perinodular blood flow.

Three aspirations were performed. On two smears, a benign pattern was seen, while the cytology of the third one disclosed papillary carcinoma.

Histopathology. Gross pathology stood for a follicular tumor. Microscopic analysis has revealed three foci of papillary carcinoma with maximal diameters of 6, 7, and 13 mm. Hyperplastic nodules were found outside the malignant foci.

Comments.

1. It is worth re-analyzing the video record in the light of the histopathological diagnosis.

2. The nodule belongs to EU-TIRADS 4 subgroup.