Clinical presentation: A 44-year-old woman was referred for evaluation of a nodule detected on ultrasound screening. We have already investigated the patient for 15 years and a suspicious lesion in the ventromedial part of the left lobe with a maximal diameter of 8 mm diagnosed. At this time, the patient refused aspiration cytology we suggested a repeat ultrasound in a year.
At present examination we remined her of this previous examination. She told us that she had no complaints and forget our suggestion.

Palpation: a firm lesion in the ventromedial part of the left lobe.

Functional state: euthyroidism (TSH 0.90 mIU/L, anti-TPO 215 U/mL).

Ultrasonography. The thyroid was moderately hypoechogenic and presented small hypoechogenic areas. There were several echonormal discrete areas which corresponded to intact parts of the thyroid not influenced by the underlying thyroiditis. There was a hypoechogenic nodule in the ventromedial part of the left lobe. This lesion presented irregular, blurred margins and microcalcifications. Neither the pattern nor the size of the nodule changed over 15 years.

Cytology was performed from the lesion in the left lobe and resulted in papillary carcinoma.

Total thyroidectomy was performed. Histopathology disclosed papillary carcinoma in the left lobe. There were no other nodules in the thyroid. Chronic lymphocytic thyroiditis was found in the non-nodular part of the organ.

Comment. The nodule in the left lobe presents non-pathological and pathological blur, as well.