A 20-year-old, clinically euthyroid African American woman with no significant medical history presented with a 1.4-cm left thyroid nodule. The nodule gradually increased in size and an ultrasonography-guided fine-needle aspiration (FNA) biopsy was performed, which demonstrated large polygonal oncocyte-like cells with abundant granular cytoplasm, ill-defined borders, and small pyknotic nuclei in a background of granular material without colloid. These findings were interpreted as an oncocytic (Hürthle cell) neoplasm or lesion (Figure, A). Molecular testing for BRAF, NRAS61, and KRAS12/13 mutations and RET/PTC1, RET/PTC3, and PAX8/PPAR-gamma translocations were negative.