Clinical data: a 61-year-old woman with an elevated TSH-level detected on screening.

Palpation: a solitary nodule in the left lobe.

Functional state: subclinical  hypothyroidism with TSH-level 5.00 mIU/L.

Ultrasonography: a solitary echonormal nodule within the moderately hypoechogenic left lobe.

Cytological report: suspicion of papillary cancer.

Suggestion: surgery.

Histopathology: microfollicular adenoma and focal lymphocytic thyroiditis.

Comment: in our practice with more than 42,000 FNACs only 5 patients occurred who had carcinoma in an echonormal nodule. Nevertheless, the echo structure of a nodule is influenced by the surrounding normal parenchyma. So, the significance of an echonormal nodule in the case of an underlying Hashimoto thyroiditis (hypoechogenic thyroid) differs from that observed in a patient without thyroiditis, i.e. echonormal thyroid.