Clinical presentation: A 79-year-old woman was referred for an evaluation of a nodular goiter. Both thyroid lobes have gradually increased in the last 3 years and caused difficulties in swallowing.

Palpation: There was an enlarged multinodular goiter with a moderately firm nodule in the upper part of the right lobe, and an elastic nodule in the lower part of the right lobe. The left thyroid was hard and nodular on palpation.

Functional state: euthyroidism (TSH-level 2.38 mIU/L, FT4 17.0 pM/L).

Ultrasonography. The thyroid was echonormal and contained multiple nodules. The right lobe was composed of an echonormal and a cystic nodule. A large moderately hypoechogenic nodule occupied almost the entire left lobe. It had irregular borders, was lobulated and displayed microcalcifications and intranodular vascularization. There were multiple enlarged lymph nodes in the left side of the neck.

Cytology. Papillary cancer was diagnosed in the nodule in the left lobe and a metastasis of the thyroid cancer into one of the enlarged lymph nodes.

Histopathology. Papillary cancer in the left lobe with metastasis to the lymph nodes, and hyperplastic nodules in the right lobe.

Comment. The identical twin-sister of the patient had been evaluated for two years. There is a startling resemblance between these two cases, including not only the final diagnosis, but also the presentation and location of the nodules. See Case conp 030.