First examination in 1991 (first and second row of images):

Clinical presentation: a 58-year-old woman was referred for an evaluation of a newly discovered nodule.

Palpation: a firm nodule in the left lobe.

Functional state: euthyroidism with TSH-level 2.25 mIU/L.

Scintigraphy: indicated a cold nodule in the left lobe. Ultrasonography was not performed.

Cytological diagnosis: Hürthle-cell tumor.

The patient refused to undergo on surgery.

Second examination in 1995 (third and fourth row of images):

Clinical presentation: the patient told that her nodule increased in size in the last 6 months. She noticed hoarseness for a month and had palsy of the left recurrent nerve.

Palpation: a hard nodule in the left lobe.

Functional state: euthyroidism with TSH-level 1.93 mIU/L.

Ultrasonography: a hypoechogenic nodule in the left lobe with patchy hyperechogenic areas and microcalcifications.

Cytological diagnosis: suspicion of malignancy. Beside a Hürthle-cell tumor, medullary carcinoma has to be considered.

Blood test for calcitonin: serum-level of calcitonin was 6.10 pM/L  (normal value: 0-3.36).

Histopathology: medullary cancer.

Comments. This was our first case of medullary cancer. Naturally, our first cytological diagnosis was false. We had to raise the possibility of a medullary carcinoma even at first examination. The sonographic pictures are out of date, nevertheless the pathognomic pattern of medullary carcinoma is well seen on these old images, as well.