A 60 year old woman presents with a painless neck lump for 3 months. There was no history of recent rapid enlargement, voice changes or discomfort in swallowing. Her medical history is unremarkable and she is not on any medications.
The lump appears to be a hyperechoic upper jugulodigastric node 4.1 x 3.2 cm in size, with a sharp border, peripheral vascularity and punctate calcification, but no intranodal necrosis. No other enlarged lymph nodes are seen.
The superior pole of the right lobe contains a solid, ill-defined, hypoechoic nodule 8 mm in diameter, with punctate calcifications.
Cytology of the lump: suggestive of nodal metastasis of papillary thyroid cancer Cytology of the thyroid nodule: Thy 5 category (definitely malignant)
The serum thyroglobulin level is 10 ng/ml (normal: ≤ 33)