36 months prior to the present examination (first row of images)

Clinical presentation: A 50-year-old woman was referred for evaluation of a nodular goiter discovered on physical examination.

Palpation: There was a firm nodule in the ventromedial part of the right lobe while a not firm nodule was palpable in the left lobe.

Result of blood test: TSH 1.94 mIU/L.

Ultrasonography. The thyroid was echonormal. There were several discrete lesions in both lobes. The nodule in the ventromedial part of the right lobe was moderately hypoechogenic and presented echogenic granules. There was a moderately hypoechogenic, partly cystic nodule in the central part of the left lobe. The echogenic granules and lines within corresponded the back wall cystic figures.

Aspiration cytology was performed from the lesions described above and resulted in benign and in benign cystic lesion, right and left nodule, respectively.

Present examination (second row of images)

Clinical presentation: The patient had no complaints. She was treated for malignant melanoma which was diagnosed 17 months prior to the current visit. On follow-up PET CT scan, the nodule in the ventromedial part of the right thyroid lobe proved to be positive and therefore a repeat FNA was indicated.

Palpation: unchanged.

Result of blood test: TSH 2.47 mIU/L.

Ultrasonography. Neither the pattern nor the sizes of the nodules had changed.

Cytology of the nodule in ventromedial part of the right lobe: benign colloid goiter.

Comments. It is worth comparing the images gained from the two examinations. The equipment was the same, but the probe used for the examination was better at the second visit. This is not only an aesthetical issue but has even significant effect on the interpretation: let me ask you to compare the echogenic granules at the two videos. At first, they seem to be microcalcifications while at the second occasion it became clear that these are not microcalcifications.