Clinical presentation: A 73-yr-old woman was referred for evaluation of a thyroid nodule. On evaluation of hemoptysis a tumor spreading into the subglottic area was diagnosed 2 weeks ago.

Palpation: a hard nodule in the left lobe.

Laboratory test: TSH 2.99 mIU/L.

Ultrasonography. The right lobe was intact. A hypoechogenic mass occupied almost the entire left lobe. The mass was composed of several lesions with different echogenicities, which made the appearance of the mass undulated. Several discrete lesions had lobulated margins.

Cytology resulted in carcinoma. Secondary carcinoma with great probability.

Wash-out thyroglobulin level was 2.1 ng/dl.

Additional laboratory tests: calcitonin < 0.59 pM/l, parathormone 43.4 pg/mL (normal value 12-88).

Further examination revealed a laryngeal carcinoma.

Comment. The case demonstrates two types of lobulation, both the non-pathological and the pathological subtype, as well. The former is caused by the presence of multiple lesions next to each other, while the latter can be observed within a single lesion. As a rule, lobulation should be always referred to a single lesion.