A 50-year-old woman presented with a 3-month history of worsening hoarseness. She denied having dysphagia, odynophagia, cough, or constitutional symptoms. She had a history of hypothyroidism, which was treated with levothyroxine sodium. Physical examination demonstrated paresis of the right true vocal cord and enlargement of the right thyroid gland. Ultrasonography revealed multiple nodules in the right thyroid lobe. A computed tomographic (CT) scan of the neck and chest revealed an enlarged, heterogeneous, right thyroid gland; lymphadenopathy in the right central neck compartment; bilateral pulmonary nodules; and an enlarged, subcarinal lymph node. Fine-needle aspiration (FNA) of the right thyroid nodules and cervical lymph node demonstrated “atypical follicular clusters suspicious for neoplasm.” The results of laboratory investigations were normal.
Herr MW, Sheridan MF. Pathology Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2011;137(5):527. doi:10.1001/archoto.2011.58-a