Clinical presentation: a 76-year-old woman was referred for an evaluation of a newly discovered nodule. The patient noticed a lump in the left thyroid 4 months earlier. She had no complaints.

Palpation: a hard nodule in the left lobe.

Functional state: euthyroidism with TSH-level 1.40 mIU/L.

Ultrasonography: the thyroid was echonormal. There was a hypoechogenic nodule with microcalcifications in the right lobe, and another hypoechogenic nodule with microcalcifications and cotton-like patches in the left lobe.

Cytological diagnosis.

Second row of images: papillary cancer in the right nodule.

Third row of images: medullary cancer in the left nodule.

Blood test for calcitonin: serum-level of calcitonin was 5.91 pM/L  (normal value: 0-3,36).

Histopathology: papillary cancer in the right and medullary cancer in the left lobe.

Comments.

1. It is very edifying case as regards the presentation of hyperechogenic figures. Considering the histopathology these in the right nodule are very likely microcalcifications. On the other hand they are more close to a non-specific granule.

2. There are larger patch-like hyperechogenic figures in the left, medullary carcinoma focus. These are clearly amyloid deposits. While the relatively smaller and more bright figures are larger than a microcalcification. They are probably also amyloid deposits.