Clinical presentation: A 53-year-old woman was referred for aspiration cytology. The patient visited an endocrinologist because of weight gain. The colleague palpated a thyroid nodule.

Palpation: a firm nodule in the isthmus.

Functional state: TSH 1.86 mIU/L, aTPO 597 U/mL.

Ultrasonography. The thyroid was echonormal-minimally hypoechoic and had several tiny hypoechoic areas. There were two moderately hypoechoic nodules, one in the right side of the isthmus and another one in the left lobe. The former presented irregular margins, and all three signs of a possible extrathyroidal extension. The vascularity was scanty.

Cytology was performed from both nodules, and resulted in papillary cancer and Hashimoto's thyroiditis, nodule in the isthmus and in the left lobe, respectively.

Total thyroidectomy and right neck node dissection were performed. Histopathology disclosed papillary carcinoma according to the isthmic nodule and Hashimoto's thyroiditis in the extranodular part. No nodules were found in the left lobe. Minimal degree of extrathyroidal spread was diagnosed (the tumor broke through the thyroid capsule into the strap muscle) but gross extrathyroidal extension was not found. There were no metastatic lymph nodes in the neck.