Clinical presentation: A 18-year-old woman was referred for an evaluation of a nodule discovered by a routine examination.

Palpation: a hard nodule in the right lobe.

Functional state: euthyroidism (TSH-level 0.91 mIU/L).

Ultrasonography. The thyroid was minimally hypoechogenic and inhomogeneous. There was a heterogeneous nodule in the right lobe. The lesion contained numerous microcalcifications, had irregular, blurred borders, and presented with a chaotic intranodular blood flow.

Cytological diagnosis: Hürthle-cell tumor. Suspicion of oxyphilic variant of papillary carcinoma.

Histopathology: oxyphilic variant of papillary cancer. Chronic lymphocytic thyroiditis. There were metastatic lymph nodes in the right side of the neck.

Comment. The categorization of the nodule depends on how to define 'normal thyroid'. If it is the extranodular part of the case the reference tissue than the nodule has isoechoic and hypoechoic parts and it is a dominantly isoechoic lesion. If we compare the nodule' echogenicity to a normal, healthy thyroid than the lesion is minimally/moderately hypoechoic and not heterogeneous. The categorization has significant consequences: the nodule should be grouped among intermediate lesions (category 4) e.g. in the Korean-TIRADS.