Clinical data: A 80-year-old man was referred for aspiration cytology. He has been operated for clear-cell kidney cancer metastatic to the lung for 17 years. Recently, on evaluation of weight loss, multiple suspicious lesions were detected all over the body.

Palpation: There were very firm lesions in the right lobe and in the isthmus. Multiple firm nodes were palpated lateral to the left lobe.

Functional state: hypothyroidism on daily 75 microgram levothyroxine with TSH 11.9 mIU/L.

Ultrasonography. A large hypoechoic mass occupied almost the entire right lobe. The nodule was lobulated. There was another hypoechoic nodule in the lower part of the right lobe. There were moderately hypoechoic and hypoechoic nodules in the left lobe and in the isthmus. The vascularity of the discrete lesions was irregularly increased. Metastatic lymph nodes in both sides of the neck.

US-guided aspiration was performed from the large nodule in the right lobe, and from both nodes presented in the images. Cytology resulted in all three cases in metastatic carcinoma. Wash out thyroglobulin levels of the thyroid lesion was 0.89 ng/L.