Clinical presentation: A 39-yr-old hypothyroid woman came to follow-up examination. She has been diagnosed with a Bethesda III FNA, and a combined ultrasound-cytological report of suspicion of papillary cancer during the 13th gestational week of her pregnancy for 16 months. We suggested that until breastfeeding is completed, surgery can be delayed with certainty.

Palpation: no abnormality.

Laboratory test: TSH 2.03 mIU/L on daily 125 microgram levothyroxine.

Ultrasonography. The right lobe was composed of echonormal and hypoechoic fields. The echogenicity index was above 50%. There was a mass presenting numerous microcalcifications in the ventral part of the left lobe. There were isolated microcalcifications relatively far from this lesion.

Histopathology disclosed Hashimoto's thyroiditis.

Comment.

1. The borders belong to the infiltrative subtype, which is characterized by a central core presenting numerous microcalcifications and isolated microcalcifications in a distance from this core. There were some spiculations on the dorsal part of the nodule. The latter has limited relevance in Hashimoto's thyroiditis, in which the discrete hypoechogenic lesions are characterized by puzzle-like, spiculated borders.

2. This is the only case in my practice which did not prove papillary cancer although the ultrasound pattern seemed to be almost diagnostic of an invasive spread of papillary cancer.