First examination (1st and 3rd row of images)

Clinical data: a 56-year-old woman referred for an evaluation of a nodule detected on the carotid Doppler examination.

Palpation: a firm nodule in the left thyroid.

Functional state: euthyroidism (TSH-level 2.11 mIU/L, FT4 15.1 pM/L).

Ultrasonography: there were two insignificant hypoechogenic lesions in the right and a moderately hypoechogenic nodule in the left lobe. The latter exhibited a halo sign and perinodular blood flow. The upper-ventral borders of the nodule were blurred.

Cytological diagnosis: follicular tumor with oncocytic metaplasia.

We advised surgery.

Second examination 3 years later (2nd row of images)

Clinical data: the patient had severe familiar problems therefore she did not undergo on operation. She had no complaints.

Palpation: a firm nodule in the left thyroid.

Functional state: euthyroidism (TSH-level 1.83 mIU/L).

Ultrasonography: the ultrasound presentation of the thyroid was identical to the former except for a significant increase in nodule size. The dimensions were 24x18x32 and 34x26x43 mm, first and present investigation, respectively.

Histopathology: minimally invasive follicular cancer.