Sandbox:DDx HEENT

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  • 40-60 yo women
  • May have bone pain or respiratory symptoms
  • Painless thyroid nodule


  • Invasion of capsule and surrounding parenchyma/blood vessels on true cut biopsy
  • Thick calcified capsule present
  • Follicular/solid growth pattern with Hürthle cells, nuclear atypia, and increased mitotic activity on FNA


  • Hypoechoic solid solitary mass on U/S
  • Uninodular lymph node involvement
  • RAS oncogene activation
  • PAX8-PPAR gamma 1 genes rearrangement