Clinical data: a 55-year-old woman followed-up for 10 years because of a multinodular goiter. The thyroid gradually increased in size and spread substernal. Her endocrinologist planned surgery. FNAC was not diagnostic. The patient was sent for FNAC.

Palpation: extremely enlarged left thyroid with muLtiple nodules.

Functional state: euthyroidism (TSH-level 1.09 mIU/L).

Ultrasonography: the right thyroid was intact. The left thyroid was composed of multiple nodules with different echo patterns. A moderately hypoechogenic nodule with microcalcifications was found in the upper part of the lobe. This nodule displayed increased intranodular blood flow.

Cytological diagnosis: papillary cancer.

Histopathology: papillary cancer corresponding to the nodule aspirated. Benign hyperplastic nodules in other parts of the thyroid.