Clinical data: A 44-year-old woman was referred for evaluation of a nodule which was detected on ultrasound screening. We have already investigated the patient for 15 years and a suspicious lesion in the ventromedial part of the left lobe has been daignosed with a maximal diameter of 8 mm. At this time the patient refused aspiration cytology, therefore we suggested a repeat ultrasound in a year.
At present examination we remined her of this previous examination. She told us that she had no complaints and forget our suggestion.

Palpation: a firm lesion in the ventromedial part of the left lobe.

Functional state: euthyroidism (TSH 0.90 mIU/L, anti-TPO 215 U/mL).

Ultrasonography. The thyroid was moderately hypoechogenic and presented small hypoechogenic areas. There were several echonormal discrete areas which corresponded to intact parts of the thyroid not influenced by the underlying thyroiditis. There was a hypoechogenic nodule in the ventromedial part of the left lobe. This lesion presented irregular, blurred margins and microcalcifications. Neither the pattern nor the size of the nodule has changed over 15 years.

Cytology was performed from the lesion in the left lobe and resulted in papillary carcinoma.

Histopathology disclosed papillary carcinoma in the left lobe. There were no other nodules in the thyroid. Chronic lymphocytic thyroiditis was found in the non-nodular part of the organ.