Clinical presentation: a 36-year old man requested an evaluation of a suddenly developed goiter (over six months).

Palpation: both thyroid were enlarged. Numerous hard nodules and enlarged lymph nodes were palpable in both sides.

Functional state: subclinical hypothyroidism with TSH-level 6.81 mIU/L, FT4 14.0 pM/L.

Ultrasonography: both thyroids were enlarged and composed of multiple hypoechogenic nodules. The borders were irregular, the intranodular blood flow was increased. There were numerous enlarged lymph nodes on both sides of the neck. The largest lymph node was 3 cm in maximal diameter.

Cytological report: papillary cancer in both thyroids and metastatic papillary cancer in lymph nodes.

Histopathology: multifocal papillary cancer with bilateral lymph node metastasis.