Clinical data: A 82-year-old woman was referred for evaluation of a thyroid nodule which was detected on physical examination. The patient has noticed a lump in the left side of the neck for 5 months. Otherwise she had no complaints.

Palpation: There was a firm nodule in the right thyroid.

Functional state: euthyroidism with TSH 1.72 mIU/L.

Ultrasonography. The thyroid was echonormal. There was a large cystic nodule in the upper pole of the left lobe. The lesion presented relatively large hyperechogenic granules. There were multiple enlarged lymph nodes lateral to the left lobe, the two largest were cystic.

US-guided aspiration was performed from the nodule. Cytology resulted in papillary carcinoma.

Total thyroidectomy was performed. Histopathology disclosed papillary carcinoma in the left lobe metastatisising to the lymph nodes.