Clinical presentation: A 49-year-old woman was referred for aspiration cytology. She has been treated for hyperthyroidism for 18 months. The patient observed a continuous increase in the left nodule over the past months.

Palpation: There was a large, firm nodule in the left lobe.

Laboratory tests: TSH 0.01 mIU/L, FT4 7.59 on daily 20 mg methimazole.

Ultrasonography. The thyroid was echonormal. There was a hypoechoic nodule in the right lobe. The nodule presented all three signs of a possible extrathyroidal extension. A large, mixed nodule occupied almost the entire left lobe. This lesion had back wall cystic figures and microcalcifications, too. The intranodular vascularization was increased.

US-guided aspiration was performed from both nodules. The cytology resulted in papillary carcinoma and in non-diagnostic report, right and left nodule, respectively.

Histopathology disclosed papillary carcinoma in the right nodule and follicular adenoma in the left nodule.

Comment.

1. Such large nodules are difficult to examine and difficult to present in images.
   
2. The left lobe clearly presented microcalcifications in the solid part.