Clinical data: A 62-year-old woman requested a second opinion. She has noticed a lump in the right side of the neck for three months. On evaluation a moderate degree of hyperthyroidism was detected. The nodule did not take up radioiodine. TSAb and anti-TPO resulted in normal level. Cytology was not diagnostic and surgery was advised.

Palpation: the right lobe was firm and nodular.

Functional state: subclinical hyperthyroidism on daily 15 mg methimazole: TSH 0.13 mIU/L, FT4 11.6 pM/l, FT3 4.07 pM/l.

Ultrasonography. A large hypoechogenic nodule occupied almost the entire right lobe. The nodule presented an incomplete halo and signs of perinodular blood flow. The left thyroid was moderately hypoechogenic and inhomogeneous and contained several relatively small nodules with different echogenicities in the range of 5-15 mm.

An all three attempts of FNAC bloody material was gained and there was no thyroid cell on the smears.

Surgery was advised.

Histopathology disclosed papillary carcinoma corresponding to the nodule in the right lobe. More than 90% of the lesion was necrotized and a focus of papillary carcinoma with a maximal diamater of 15 mm was found at the edge of the lesion. The remaining nodules proved to be hyperplastic.