Clinical presentation: A 37-year-old woman requested a second opinion. She has been treated for Graves' disease for four months. She presented with thyroid associated orbitopathy including diplopia. Despite large dose intravenous steroid therapy her eye complaints have worsened.

Palpation: no abnormality.

Laboratory tests: TSH 1.36, FT4 1,25 ng/dL, TSAb 0 U/L.

Ultrasonography. The right lobe was minimally hypoechogenic, while the left was echonormal. Both lobes contained tiny hypoechogenic areas, the echogenicity index was < 5%. There was a hypoechogenic lesion in the ventrolateral part of the right lobe. The lesion presented irregular, lobulated margins and blurred borders, as well. The intranodular blood flow was increased.

Cytology was performed from the lesion in the right lobe and resulted in non-diagnostic report.

A total thyroidectomy with an intraoperative frozen section of the lesion in the right lobe was suggested.

Histopathology disclosed papillary carcinoma in the right nodule with a maximal diameter of 7 mm.

Comment. The tumor presents two types of abnormal borders: the margins are blurred and irregular, spiculated.