Clinical data: A 39-year-old woman was referred for a routine follow-up ultrasound examination. She has been operated on a T1b papillary cancer for 7 years. I met her first 5 years ago when I found a small, suspicious focus of 6x5x7 mm in the left lobe bed. Cytology did not indicate malignancy, only connective tissue cells were on the smear. Two years later, the size of the lesion did not change, no cytology was performed. Thyroglobulin levels have fluctuated between 0.1 and 2.2 microgram/L since surgery, with no detectable trend.

Palpation: no abnormality.

Laboratory tests: TSH 0.23 mIU/L, FT3 13.8 pM/L on daily 125 microgram levothyroxine. Thyroglobulin was 1.4 microgram/L, anti-hTg less than 20 U/mL.

Ultrasonography. There was a hypoechoic lesion which had microcalcifications in the left thyroid bed. The dimensions were 5x5x7 mm.

Cytology resulted in papillary cancer.

Considering the low and non-increasing level of thyroglobulin, and the absence of growth of the lesion, the patient's endocrinologist decided neither to operate nor to treat the patient with radioioddine.