Clinical data: a 37-year-old woman was referred for an evaluation of a hypothyroidism (TSH 5.01 mIU/L) and a nodular goiter. She was examined because of fatigue and dizziness.

Palpation: no abnormality.

Functional state: euthyroidism (TSH-level 3.08 mIU/L, FT4 14.3 pM/L, aTPO 13 U/mL).

Ultrasonography: the thyroids were echonormal and contained two lesions, one in the right and another one in the left lobe. Both nodules were hypoechogenic and presented microcalcifications. The vascularization was decreased. There was an enlarged lymph node in the left submandibular area of the neck.

Cytological diagnosis: papillary cancer was diagnosed in both nodules and in the lymph node, too.

Histopathology: bilateral papillary cancer with metastasis to both sides of the neck. Focal lymphocytic thyroiditis was also detected.