Clinical data: A 68-year-old woman was referred for an evaluation of a nodular goiter, which was discovered 6 months ago.

Palpation: a hard nodule in the isthmus.

Functional state: euthyroidism (TSH-level 1.08 mIU/L, FT4 12.8 pM/L).

Ultrasonography. The thyroid was echonormal and contained multiple nodules. There was a moderately hypoechogenic, inhomogeneous nodule in the right lobe. There were 3 distinct nodules in the isthmus, including a nodule with microcalcification, another one with blurred borders. There were several small lymph nodes in both sides of the neck.

Cytology. Papillary cancer was diagnosed in all three nodules in the isthmus and a colloid goiter in the nodule in the right lobe.

Histopathology disclosed papillary cancer based on the nodules in the isthmus and hyperplastic nodule according to the nodule in the right lobe. There were metastatic lymph nodes in both sides of the neck.