Clinical presentation: A 53-year-old man was referred for evaluation of thyroid nodule which has been discovered on ultrasound screening.

Palpation: Both lobes were firm. No nodule could be palpated.

Laboratory test: TSH 1.46 mIU/L.

Ultrasonography. The thyroid was hypoechoic and inhomogeneous. There was a deeply hypoechoic lesion in the ventral part of the left lobe. The lesion had ambiguous hyperechoic granules and has irregular borders. The lesion was avascular.

Cytology resulted in Hashimoto's thyroiditis and papillary cancer.

Histopathology disclosed papillary carcinoma and Hashimoto's thyroiditis in the extranodular tissue.

Comment. The ultrasound presentation of the nodule was not very suspicious it could fully correspond to a more active focus of thyroiditis. The irregular borders have very limited role in the differentiation of discrete lesions of Hashimoto's thyroiditis from true nodules. The presence of a few hyperechoic granules was although remarkable but they raised only minimally the suspicion. The most important feature which could be of help that this was almost the only deeply hypoechoic lesion in the lobe. All in all, the lesion could have been a pathological nodule and therefore FNA was clearly indicated.