Clinical presentation: A 47-year-old man referred for evaluation of a nodule discovered on ultrasound screening.

Palpation. There was a very firm nodule in the left thyroid.

Laboratory test: TSH 1.83 mIU/L.

Ultrasonography. The thyroid was echonormal. There was a dominantly hypoechoic nodule in the left lobe. The nodule had both microcalcifications and macrocalcification and was avascular.

Cytology resulted in papillary carcinoma.

Histopathology disclosed papillary carcinoma.