Initial examination (first and second rows of images)

Clinical data: A 41-year-old woman referred for evaluation of weight gain.

Palpation: The left thyroid was tender to the touch, no nodule was palpable.

Functional state: euthyroidism with TSH 0.82 mIU/L, FT4 13,7 pM/L, anti-TPO 1.8 U/mL.

Ultrasonography. The thyroid was echonormal. There was a hypoechogenic area in the dorsolateral portion of the left lobe. The lesion had irregular, blurred borders, contained one focus of microcalcification and presented an irregularly increased intralesional flow.

Cytology of the nodule resulted in benign lesion with signs of inflammation not otherwise specified.

We advised a repeat examination in a year.

Second examination 4 years later (third and fourth rows of images)

Clinical data: The patient had no complaints therefore she visited us only four year after the initial examination.

Palpation:The left thyroid was still tender, no nodule was palpable.

Functional state: euthyroidism with TSH 1.08 mIU/L, anti-TPO 0.3 U/mL.

Ultrasonography. The pattern was basically the same as four years earlier. The hypoechogenic area did not increase in size.

Cytology of the nodule resulted in suspicion of papillary carcinoma.

Histopathology disclosed papillary carcinoma with a maximal diameter of 7 mm in the left lobe. Otherwise neither nodules nor thyroiditis were described.