Clinical data: A 41-year-old man requested a second opinion. On evaluation of a nodule discovered on screening, papillary cancer was diagnosed.

Palpation: no abnormality.

Laboratory tests: TSH 1.83 mIU/L, aTPO above 1300 U/mL.

Ultrasonography. The thyroid was echonormal and presented with numerous hypoechoic areas. The echogenicity index was around 20%. There was an isoechoic nodule in the lower part of the left lobe. The lesion had hypoechoic areas, microcalcifications and presented all three possible ultrasound signs of extrathyroidal spread. Perinodular blood flow predominated but in the lower part of the nodule, increased intranodular vascularity could be also detected. The diameters of the nodule were 13, 9, and 14 mm, width, depth, and length, respectively.

Total thyroidectomy was suggested. Histopathology disclosed a T1b tall cell variant of papillary cancer. The largest diameter of the tumor was 13 mm. Hashimoto's thyroiditis was found in the extranodular tissue. Due to the histological subtype, radioiodine therapy was performed.

Comment. Taking the location and the size of the tumor total thyroidectomy was suggested. There was a chance of extrathyroidal extension, primarily of minimal degree. Although minimal extrathyroidal spread does not worsen the prognosis of the patient but does the chance of lymph node metastasis.