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On each labeled image, the large right mass is in red and the normal thyroid in yellow. There is another smaller nodule in the isthmus labeled in green on Image D. This nodule has a pattern of many tiny internal vascular channels (called a cribriform pattern) and is isoechoic (same shade of grey) as surrounding thyroid tissue. These features, plus the small size of the nodule, make this one less worrisome. Small isoechoic or hyperechoic nodules with smooth margins and under 1 cm in diameter do not require followup or biopsy, in general. These recommendations must be modified based on clinical factors, like familial history of thyroid cancer, certain genetic syndromes, or prior radiation to the neck. Given these findings, and the hypercalcemia, is there any other imaging that might be helpful?
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