Benign nodule shrinkage: a diagnosis not to be missed

Thyroid nodules presenting ultrasonographic (US) findings suspicious for malignancy should undergo fine-needle aspiration and further cytologic analysis according to the Bethesda 2010 classification. Benign necrotic thyroid nodules may also harbor suspicious US features as follows: ill-defined margins, taller than wide aspect, strong hypoechogenicity, high stiffness index on elastography examination, and reported worrisome cytologic or histologic alterations.

We report the case of a benign thyroid nodule showing shrinkage over time and harboring malignant US features. Fine-needle aspiration cytology examination showed necrosis and no malignant cells.

Precise Doppler US analysis of the nodule and its evolution over time may limit the risk of false-positive diagnosis of thyroid malignancy.