Clinical presentation: A 37-year-old woman was referred for evaluation of hypothyroidism (TSH 5.01 mIU/L) and a nodular goiter. She was examined because of fatigue and dizziness.

Palpation: no abnormality.

Functional state: euthyroidism (TSH-level 3.08 mIU/L, FT4 14.3 pM/L, aTPO 13 U/mL).

Ultrasonography. The thyroid was echonormal and contained two lesions, one in the right and another one in the left lobe. Both nodules were hypoechogenic and presented microcalcifications. The vascularization was decreased. There was an enlarged lymph node in the left submandibular area of the neck.

Cytological diagnosis: papillary cancer was diagnosed in both nodules and in the lymph node, too.

Histopathology: bilateral papillary cancer with metastasis to both sides of the neck. Focal lymphocytic thyroiditis was also detected.

Comment.

The primary tumor in the right lobe has lobulated or spiculated margins, while the metastatic lymph node does lobulated margins.