Thyroid Mass Research Articles

Silent intrathyroid parathyroid carcinoma.

A 59-year-old male presented with an accidental thyroid mass in 2022. Ultrasound and CT scan showed a nodule 5.2 × 4.9 × 2.8 cm (EU-TIRADS 4) in the right lobe of the thyroid gland. Taking into account the results of the fine needle aspiration biopsy (Bethesda V), intrathyroid localization, and absence of clinical symptoms, a malignant tumor of the thyroid gland was suspected. The patient underwent total thyroidectomy using fluorescence angiography with indocyanine green, and two pairs of intact parathyroid glands were visualized in typical localization. Unexpected histological and immunohistochemistry examinations revealed parathyroid carcinoma. Due to the asymptomatic course of the disease and atypical localization of parathyroid tumor, primary hyperparathyroidism was not suspected before the surgery. The diagnosis of asymptomatic intrathyroid parathyroid cancer is a serious diagnostic challenge for a wide range of specialists. Parathyroid cancer is a rare disease that may be asymptomatic. Intrathyroidal localization of parathyroid carcinoma is casuistic and challenging for diagnosis, and the treatment strategy is not well defined. Preoperative parathyroid hormone and serum calcium testing are recommended for patients with solid thyroid nodules (Bethesda IV-V).

S-DETECT SOFTWARE AS A TOOL FOR ULTRASOUND DIAGNOSIS OF THYROID LESIONS

Relevance: Thyroid cancer (TC) is the most common oncological pathology of the endocrine organs.
 According to the International Agency for Research on Cancer (IARC), 567,233 new cases of thyroid cancer were registered worldwide in 2018. According to IARC, in 2018, 486 new cases were detected in Kazakhstan, which accounted for 1.4% of all cases in Asian countries.
 TC ranks 10th in the overall structure of cancer incidence globally; TC accounts for 3.1% of all cases of primary malignant tumors. Despite the relatively low incidence, the problems of pathogenesis have been extremely relevant in recent decades due to the increasing prevalence of thyroid cancer.
 Samsung Medison introduced AI-based S-Detect to improve sensitivity, specificity, and accuracy in the differential diagnosis of thyroid masses.
 The study aimed to explore the S-Detect program capacities in differential diagnostics of thyroid masses.
 Methods: 75 patients with focal lesions in the thyroid gland were examined using the Samsung Medison RS85 ultrasound machine equipped with the S-Detect program; additionally, Doppler and non-Doppler methods were used.
 Results: The S-Detect program made it possible to make a correct diagnosis in 97% of patients (73 of 75), which was confirmed by the results of morphological verification (histology, cytology). The sonoelastography method showed correct results in 91% of patients (68 of 75).
 Conclusion: The use of the S-Detect program for thyroid examination positively affects the diagnostic value of ultrasound in the differential diagnosis of thyroid masses, increasing the sensitivity, specificity, and accuracy of diagnosis, as well as avoiding redundant biopsies.

A Case of Medullary Carcinoma of Thyroid

A 50-year-old diabetic female attended in September, 2021 with a huge swelling in front of her neck, respiratory distress, hoarseness of voice, & generalized weakness for 1 month. All the biochemical tests were inconclusive but S. calcitonin was high(>0.08ng/ml), Fiber optic laryngoscopy revealed left vocal cord paralysis, X-ray chest revealed right sided tracheal deviation, CT-scan of Neck revealed large solid mass in thyroid with mediastinal extension & cervical lymphadenopathy. Patient undergone total thyroidectomy. The specimen sent for histopathology and revealed medullary carcinoma of thyroid gland.
 AKMMC J 2021; 12(2): 104-106

Infected Ruptured Parathyroid Cyst Presenting with Hypercalcemia and Airway Obstruction: A Case Report.

Parathyroid cysts (PC) are infrequently encountered and characterize less than 1% of all head and neck masses. When present, PCs may present as a palpable neck mass and lead to hypercalcemia and rarely respiratory depression. Furthermore, the diagnostics of PCs is difficult as they can masquerade as a thyroid or mediastinal mass given their proximity. PCs are theorized to be a progression of parathyroid adenomas and often routine surgical excision is sufficient for cure. To our knowledge, there is no documented report of a patient with an infected parathyroid cyst that led to severe dyspnea. This case describes our experience of a patient with an infected parathyroid cyst presenting as hypercalcemia and airway obstruction.

Asynchronous thyroid metastases of malignant melanoma: report of a rarity

Thyroid metastasization is a very rare phenomenon with a challenging diagnosis. The incidence is 0.36% in all thyroid malignancies and it is reported it would be up to 2% after surgical specimens’ diagnosis. Thyroid metastasization of a malignant melanoma stands with an incidence of 2% in all thyroid secondarism. We report a 41-years old female with cutaneous malignant melanoma resected four years before the start of compressive symptoms secondary to multinodular goiter. Fine-needle-aspiration showed malignant cells of uncertain origin. A total thyroidectomy was performed. Histopathological examination showed multinodular metastases of malignant melanoma. Thyroid metastasis typically presents as a unifocal thyroid mass or nodule and may occur in the absence of a primary tumor diagnosis, thus leading to a misdiagnosis of thyroid primary tumor. Immunostaining and molecular testing are useful in case of doubt. Although metastases generally indicate disseminated disease, some patients may benefit from aggressive thyroid resection surgery when compared to conservative approaches. Newly-diagnosed thyroid mass in any patient with history of malignancy should raise suspicion for metastasizing. Although the overall prognosis of thyroid metastasis is poor, surgery could be an option in some cases with survival improvement or a palliative role.

No: 3037 Anesthesia management in the patient planned for a thyroidectomy due to a giant thyroid mass

No: 3037 Anesthesia management in the patient planned for a thyroidectomy due to a giant thyroid mass

From diagnosis to treatment: Examining disparities in thyroid nodule evaluation and its impact on patient care

Controversy exists regarding the management of thyroid nodules because of conflicting information regarding the excessive occurrence of thyroid nodules, various occurrence of most cancers stated in the ones surgically excised and the frequency of loss of life from thyroid most cancers. The guidelines suggest an algorithm for evaluation of thyroid masses. 1Workup should start with history and physical examination, proceed to laboratory studies, and then to imaging. Even though FNAC is superior to USG, basically USG is used for evaluation of all thyroid masses initially, followed by FNAC. This study was done to know about the disparities between preoperative investigations and postoperative histopathology report of thyroid swelling. Methods: Study was done in 50 patients with thyroid masses which were subjected to FNAC, TFT and USG neck and their results were later correlated with histopathological examination report (HPR) whenever available. Results: Out of 50, 7 patients had disparities between preoperative and postoperative diagnosis, but it was statistically insignificant. Conclusion: FNAC stands at higher level with respect to P value and significance. Despite the fact is that, there are some patients whose preoperative and postoperative diagnoses were different. They either didn't want the first surgery or they want a second one. 2Detecting malignancy preoperatively allows total thyroidectomy in a single operation without the need for frozen section or a second operation for completion of a thyroidectomy if malignancy is found during the initial thyroid lobectomy. Among them, FNAC was more reliable compared to other investigations in diagnosing malignant conditions preoperatively. Both FNAC and USG over diagnosed colloid goitre.

Aberrant right subclavian artery: A report from Southeast Nigeria

Abstract A 73-year-old woman presented with metastatic lung disease with primary from the thyroid mass and with sepsis complicating gastroenteritis and respiratory tract infection. On a computerized computer tomography scan, an aberrant right subclavian artery was detected. It is a rare abnormality of the aortic arch. There is a need for increased awareness, knowledge of the implications for patient management, and development of cardiothoracic surgery.

A Mass at Laryngopharynx: A Pressure Effect of the Superior Cornu of the Thyroid Cartilage that Resulted from Thyroid Mass

A Mass at Laryngopharynx: A Pressure Effect of the Superior Cornu of the Thyroid Cartilage that Resulted from Thyroid Mass

Protruding Huge Thyroid Mass Concurrent Hemorrhage and Skin Necrosis: A Case Report

Protruding Huge Thyroid Mass Concurrent Hemorrhage and Skin Necrosis: A Case Report

The osteopontin expression and microvascular density in thyroid cancer, comparison of CT and ultrasound in diagnosis of thyroid cancer and correlations of CT features and thyroid cancer.

The aim of this study was to explore the osteopontin expression and microvascular density in thyroid cancer, compare computed tomography (CT) and ultrasound in diagnosis of thyroid cancer and investigate the correlations of CT Features and thyroid cancer. A total of 80 patients with thyroid masses admitted to our hospital from April 2017 to August 2019 were selected, of which there were 40 with benign tumor and 40 with malignant tumor. All patients with thyroid cancer confirmed by pathological tissue biopsy were examined by ultrasound (ultrasound group) and CT (CT group). The expression of osteopontin was detected by PCR while microvascular density was tested by immunohistochemistry. Then univariate analysis and multivariate logistic regression analysis of risk factors were carried out for CT imaging diagnosis of thyroid cancer. The levels of osteopontin and microvascular density in malignant group were significantly higher than those in benign group. The incidence rates of unclear boundary and peripheral lymph node enlargement in CT group were remarkably higher than those in ultrasound group. The diagnostic rate of masses ≥1 cm in diameter was notably higher than that of masses <1 cm in diameter in thyroid cancer patients in CT group and ultrasound group (P<0.05). In addition, the diagnostic rates of follicular carcinoma and papillary carcinoma were higher, whereas those of medullary carcinoma and undifferentiated carcinoma were lower in CT group and ultrasound group. There was no significant difference in the accuracy of thyroid cancer diagnosis between CT group and ultrasound group. Moreover, diameter ≥1 cm, irregular shape, unclear boundary, calcified foci, uneven density/echo and peripheral lymph node enlargement were related risk factors for the CT imaging diagnosis of thyroid cancer, in which irregular shape, unclear boundary, calcified foci and uneven density/echo were independent risk factors for the CT imaging diagnosis of thyroid cancer. The levels of osteopontin and microvascular density were increased in thyroid cancer. CT examination may be of higher diagnostic value in diagnosis of thyroid cancer compared with ultrasound. Irregular shape, unclear boundary, calcified foci, and uneven density/echo were independent risk factors for the CT imaging diagnosis of thyroid cancer.

A CROSS-SECTIONAL STUDY ON EVALUATION OF DIAGNOSTIC APPLICATIONS OF LINEAR SONOGRAPHIC TRANSDUCER IN VARIOUS DISEASES

Introduction: An ultrasonography scan is a medical test that uses high-frequency sound waves to produce live images of the body. Linear transducer is used to create the images of superficial organs. Superficial sonography used for diagnose various pathologies like Large vessel vasculitis, carpel tunnel syndrome, thyroiditis, carotid artery disease etc. The aim of this study is to evaluate the diagnostic application of linear sonographic transducer in various diseases of superficial organs. In the simple sense of word, Transducers are the devices that converts a form of energy into another. These devices have been throughout the history, taking an example of Pythagoras in 550 BC, who sited that pitch and frequency is co-related and this lead to creation of Sonometer, instrument used in music1. A major physics breakthrough occurred in 1880 when the brothers Jacque and Pierre Curie demonstrated the piezoelectric effect, which results in formation of Ultrasound transducer. Over 60 years later, Dr Karl Dussik of Austria in 1940s, becomes the first physician to use the ultrasound in medical diagnosis2.&#x0D; Research Methodology: In this prospective cross-sectional study 40 patients, prescribed for superficial organs ultrasonography (USG) (thyroid {neck}, musculoskeletal, and doppler) were included and stat for result was mean and percentage stats used. This was a quantitative prospective cross sectional study in which high frequency ultrasonography of a maximum of 40 patients with proper indication under taken. Ultrasonography is performed after taking proper history and relevant physical examination performed by the linear transducer (6 – 12 MHz). In this study convenience sampling was used as the sample was taken from a section of the population that was easily accessible or readily available to the researcher.&#x0D; Findings: Total 40 (100%) patient’s data used in this study who undergone the superficial organ examination (Musculoskeletal, Doppler, thyroid {neck}) during the period of study. Out of which 50% (20) patients undergo Thyroid ultrasonography, 25% (10) patients undergo musculoskeletal ultrasonography and 25% (10) patients undergo Doppler imaging ultrasonography. Result of scan collected and master chart is prepared. Author found that in thyroid ultrasonography scan 15% patients have swollen neck and pain was due to cervical varicocele, 12.5% patients have lymph nodes, 2.5% patients have goitre, 2.5% patients have thyroiditis, 2.5% patients have cyst, 2.5 % patients have thyroid mass, and 12.5% patients have normal study. In Doppler ultrasonography scans 5% patients have edema, 2.5% patients have varicocele, 5% patients have varicosities, 2.5% patients have periphery arterial disease and 5% patients have thrombus/plaque and 5% have normal scan with no findings. In musculoskeletal ultrasonography scans 22.5% patients have normal study with no significant findings and 2.5% patients have focal encepahalocele.&#x0D; Conclusion: It is concluded that ultrasound is the best modality to rule out the problems at any stage so that treatment can be started on behalf of reports of Ultrasonography scan in patients of superficial organs with various diseases, as it is fast and safe to patients, it does not include any ionizing radiation so female patients of reproductive age go through scan without any risk. And most common reason of swelling and pain in neck is cervical lymphadenopathy, lymph nodes, mass or goitre, and pain in joints and swelling is varicosities or thrombus in lower extremities and in musculoskeletal cranium study mostly has normal study with no significance but few have focal encepahalocele as per in this study.

A rare primary thyroid mixed germ cell tumour: a case report

Germ cell tumours mostly occur in the gonads. Extragonadal site is rare and mainly located in the mediastinum, retroperitoneum and pineal gland. Germ cell tumour that occurs in the thyroid gland is extremely rare. We present our first description of a patient with a mixed germ cell tumour located primarily in the thyroid gland. A 35 years old gentleman presented with two months history of thyroid swelling associated with compressive symptoms. His neck ultrasound showed multinodular goiter with suspicious nodule (TR4) and FNAC revealed highly suggestive of a malignant lesion. Subsequently, the thyroid mass progressively enlarged in size causing acute upper airway obstruction that made him collapsed at Emergency Department. Core biopsy of TR4 thyroid nodule suggestive of malignant lesion which could be mixed germ cell tumour or poorly differentiated carcinoma. Abnormal laboratory tests showed a high concentration of LDH, Alpha fetoprotein and beta-HCG. He underwent emergency total thyroidectomy, debulking and tracheostomy. Histopathology reported the mass composed of mixed non-seminomatous germ cell tumour with area of necrosis (30%), primarily immature elements (80%), yolk sac tumour (15%) and embryonal carcinoma (5%). He was scheduled for chemotherapy post operatively however he succumbed to the illness due to advanced tumour and sepsis.

A retrospective study of clinical features and prognosis of patients with Graves' disease and ophthalmopathy.

To retrospectively investigate the clinical characteristics of patients with Graves' disease (GD) accompanied by ophthalmopathy (GO) and the prognosis of single 131I therapy. In total, 665 patientswith Graves' disease were enrolled in this study, including 115 patients with GO and 550 patients without GO. On the one hand, the clinical characteristics of the two groups were recorded. On the other hand, the prognosis after more than 6 months of 131I therapy was divided into three groups: recovered, hypothyroidism and unhealed. Compared with GD-alone patients, GD patients with GO were younger, had a higher thyrotrophin receptor antibody (TRAb), heavier thyroid mass and higher dose of single 131I therapy (all P < 0.05). Furthermore, patients were younger in the clinical active score ≥3 group and had higher FT4 level in the mild GO group (all P < 0.05). Among these, age and TRAb were independent risk factors for GO in GD patients (P < 0.05). When age was <52.5 years and TRAb was >24.01 IU/L, GD patients were more likely to develop GO (P < 0.001). After at least 6 months of single 131I therapy, compared with GD-alone patients, the prognosis was poor in GD patients with GO (P < 0.05). Young GD patients with heavy thyroid mass and high TRAb are more likely to have GO. Younger GO patients are more likely to be active stage and the level of thyroid function was inversely correlated with the severity of GO. When the age and TRAb have exceeded the cutoff value, we should pay more attention to the occurrence of GO and shorten the follow-up interval appropriately. Patients with GD combined with GO have a poor prognosis.

Oral lichenoid lesion simultaneously associated with Castleman’s disease and papillary thyroid carcinoma: a rare case report

BackgroundOral lichenoid lesion (OLL) is a term used to describe oral lesions that have clinical and/or histopathological features similar to oral lichen planus (OLP), but it is thought to be caused by specific triggers or systemic conditions and presents higher malignant transformation rate than OLP. To date, OLL simultaneously complicated with Castleman’s disease (CD) and papillary thyroid carcinoma (PTC) has not been reported. Reporting from such disorders is crucial to avoid misdiagnosis and help in timely intervention.Case presentationWe report a rare case of a 39-year-old female with extensive ulcerated lesions on the oral mucosa, diagnosed as OLL by histopathology. Routine oral treatment was scheduled to control the OLL, while the oral lesions remained unhealed. Computed tomography examination was performed after the oral treatment and revealed thyroid and mediastinal masses, which were then surgically removed and pathologically diagnosed as PTC and CD, respectively. Two months after complete excision of the neoplasms, the oral lesions showed obvious alleviation. With subsequent treatment for oral lesions, the patient’s OLL healed.ConclusionsThis is the first reported OLL case simultaneously associated with CD and PTC. This case reminds us to focus on the underlying etiologies of OLL and the multidisciplinary collaboration for oral lesions associated with systemic diseases.

The Diagnostic Value of Artificial Intelligence Ultrasound S-Detect Technology for Thyroid Nodules.

This study aimed to evaluate the consistency of ultrasound TI-RADS classification used by sonographers with different ultrasound diagnosis experience in the diagnosis of thyroid nodules and the diagnostic value of using artificial intelligence ultrasound S-Detect technology in the differentiation of benign and malignant thyroid lesions. 100 patients who underwent ultrasound examination of thyroid masses in our hospital from June 2019 to June 2021 and were further punctured or operated on were included in the study. Pathological results were used as the gold standard to evaluate ultrasound S-Detect technology and the value of TI-RADS classification and the combined application of the two in diagnosing benign and malignant thyroid TI-RADS 4 types of nodules, and the consistency of judgments of doctors of different ages is assessed by a Kappa value. There were 128 nodules in 100 patients, 51 benign nodules, and 77 malignant nodules. For senior physicians, the sensitivity of diagnosis using TI-RADS classification combined with ultrasound S-Detect technology is 93.5%, specificity is 94.1%, and accuracy is 93.8%; for middle-aged physicians using TI-RADS classification combined with ultrasound S-Detect technology for diagnosis, the sensitivity is 89.6%, specificity is 92.2%, and accuracy is 90.6%; for junior doctors, the sensitivity of diagnosis using TI-RADS classification combined with ultrasound S-Detect technology is 83.1%, specificity is 88.2%, and accuracy is 85.1%. Regardless of seniority, the combined application of artificial intelligence ultrasound S-Detect technology and TI-RADS classification can improve the diagnostic ability of sonographers for thyroid nodules and at the same time improve the consistency of judgment among physicians, and this is especially important for radiologists.

Value of thyroid 99mTcO4- imaging ROI ratio for estimating 131I dose in individualized treatment of hyperthyroidism

To investigate the feasibility of using thyroid 99mTcO4- imaging ROI ratio instead of 24 h radioactive iodine uptake (RAIU) for estimating 131I dose in individualized treatment of hyperthyroidism. We retrospectively analyzed the clinical data of 132 patients receiving 131I treatment in our department between January and June, 2019. According to their 3 h/24 h RAIU peak ratio, the patients were divided into peak forward (≥80%) group and no peak forward (< 80%) group. In the former group, the therapeutic 131I dose was calculated based the Marinelli formula (131I dose=thyroid mass×planned amount/24 h RAIU), and in the latter group, the correlation between the ROI ratio and the 24 h RAIU was analyzed, and the 131I dose was calculated using a modified Marinelli formula where 24 h RAIU was replaced by a converted ROI ratio. The two groups of patients were compared for antithyroid drug type and discontinuation time, thyroid hormones and related antibodies, thyroid area, thyroid mass and 131I dose. All the patients were and followed up for one year to analyze the treatment efficacy. The ROI ratios after the treatment were analyzed in the two groups using ROC curves. There was a significant positive correlation between the ROI ratio and 24 h RAUI in the no peak forward group (Y=58.13 + 0.2X, R2=0.118, P < 0.05), and the formula for calculating 131I dose was converted into: 131I dose=thyroid mass× planned amount/(58.13+0.2×ROI ratio)%. Before the treatment, therapeutic 131I dose, thyroid hormone levels, TRAb, 3 h and 24 h RAIU, thyroid area, thyroid mass, and ROI ratio all differed significantly between the two groups (P < 0.05). At 3 months after treatment, thyroid hormone levels, TRAb, TPOAb, thyroid area, thyroid mass, ROI ratio, response rate, hypothyroidism rate, cure rate, remission rate, and nonresponse rate were similar between two groups (P>0.05). At the 1-year follow-up, the composition ratios of hyperthyroidism, hypothyroidism and cured cases remained similar between two groups (P>0.05). ROC curve analysis showed that at 3 months after treatment, the optimal cutoff values of ROI ratio for predicting hyperthyroid recurrence and hypothyroidism were 15.79 and 6.33, respectively. Thyroid 99mTcO4- imaging ROI ratio can be used for calculating 131I dose in individualized treatment of hyperthyroidism and for prognostic evaluation of the patients.

A Rare Presentation of Thyroid Mass- A case report.

The online version contains supplementary material available at 10.1007/s12070-022-03179-x.

ODP497 Multifocal Papillary Thyroid Carcinoma with Anaplastic Dedifferentiation

Abstract A 71-year old male with a two-year history of progressively enlarging right thyroid mass presented with hemoptysis. Chest CT scan showed multiple pulmonary nodules and enlarged right thyroid mass with intrathoracic extension. A fine needle biopsy of the right thyroid mass showed atypia of undetermined significance. Patient underwent total thyroidectomy and complete resection of the intrathoracic component. Histopathology reported multifocal Papillary thyroid carcinoma, right lobe, encapsulated follicular variant (9cm) with extensive and vascular invasion. There was also invasion of the left thyroid lobe, follicular variant, infiltrative (0.6 cm) and conventional (0.6 cm). Extrathyroidal extension to skeletal muscle and lymphovascular invasion was present. The tumor showed areas with more solid growth patterns and some ball-like clustering. Consequently, immunostaining was done which showed the following results: positive for cytokeratin, thyroglobulin and TTF-1 consistent with papillary morphology. The more solid areas with significant nuclear pleomorphism, necrosis and increased mitotic activity (atypical forms) support the focal progression to an anaplastic carcinoma. The final histologic reading showed multifocal papillary thyroid carcinoma with focal (20%) progression to undifferentiated (anaplastic) thyroid carcinoma. Two weeks postoperatively, he developed a 4cm×2cm manubrium mass. There were also several metastases on the brain, pancreas, liver and bones seen on FDG PET scan. One month postoperatively, TSH was 15 uIU/mL Thyroglobulin &amp;gt;500 uIU/mL, anti-thyroglobulin &amp;lt;0.20 ng/dl. Due to the widespread metastases even involving the brain, the multidisciplinary team decided to start treatment with Lenvatinib and check for BRAF V600E gene mutation for a more definitive treatment. He was started on Levothyroxine. He also underwent 27 cycles of radiation therapy to the manubrium mass and was given Denosumab 120mg subcutaneously to stabilize the bone and provide pain relief. BRAF gene mutation analysis result came back negative in two weeks. Close monitoring of his sensorium was done. However, he deteriorated clinically and he succumbed to sudden cardiac death two months after. Presentation: No date and time listed

PSAT293 Uncommon Presentation of Hashimoto Thyroiditis

Abstract Hashimoto thyroiditis (HT) is the most common cause of hypothyroidism in developed countries, which presents with diffuse goiter or atrophic gland. Staii et al. reported a 7.4 per cent prevalence of localized HT diagnosed by fine needle aspiration (FNA) cytology in euthyroid patients during thyroid cancer screening. Although, a transient solitary focal presentation of HT in euthyroid patients has not been described so far. Here we describe a case of localized HT presented with a thyroid mass peripartum, which progressed into diffuse thyroiditis after FNA biopsy. A 27-year-old woman who is 10-day post-partum presents to our endocrine clinic for thyroid mass evaluation noticed by her spouse a few weeks before delivery. The patient has no hypothyroid, hyperthyroid, or mass effect symptoms. On the physical exam: BP 100/64 mmHg, Temp 36.5 C, HR 76 bpm, RR 20 bpm, BMI 24.6 kg/m2. There is a palpated 5-cm non tender right thyroid nodule. Thyroid stimulating hormone (TSH) is 2.04 uiu/ml (N: 0.3-4.2). Thyroid ultrasound (US) shows a 47×25×31 mm right hyperechoic nodule with some septation of hypoechoic areas. It has thin continuous halo, smooth but lobulated margins and Grade 3 doppler. No microcalcification is seen. Left lobe and isthmus are homogenous with no nodules. There is a reactive lymphadenopathy on the right cervical region. An ultrasound guided-FNA cytology shows clusters of follicular cells forming micro- and macro-follicles with background of hemorrhage but no colloid is seen. Cytology is suspicious of a follicular neoplasm, Bethesda IV category. Diagnostic Lobectomy is discussed but the patient opts for repeat biopsy at a different facility. She presents with a similar cytology result after 3 months. She elects follow up as she remains asymptomatic. After 6 months follow up, she has spontaneous reduction of the nodule size and it is not palpated. Neck US shows diffusely heterogeneous gland with hypoechoic areas and significant reduction in size of the right hyperechoic nodule to 22×14×11 mm. Ultrasound findings are suggestive of thyroiditis and further labs are requested. Thyroid peroxidase antibodies &amp;gt;1000 iu/mL (N: &amp;lt;5.61), anti-thyroglobulin antibodies 161.71 iu/mL (N: &amp;lt;4.11), TSH 3.4 uiu/ml (N: 0.35-4.9), free T4 is 10.38 pmol/L (N: 9-19), thyroglobulin 76.76 ng/mL (N: 3.5-77). These findings suggest that HT may present as a localized form in euthyroid phase and should be considered in the differential diagnosis of thyroid nodule. Serologic evidence of HT and serial US follow-up should be recommended instead of other unnecessary procedures. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.