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Eun Kyung Jang Departments of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea

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Dong Eun Song Departments of Pathology, University of Ulsan College of Medicine, Seoul, South Korea

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Gyungyub Gong Departments of Pathology, University of Ulsan College of Medicine, Seoul, South Korea

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Jung Hwan Baek Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

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Yun Mi Choi Departments of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea

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Min Ji Jeon Departments of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea

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Ji Min Han Departments of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea

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Won Gu Kim Departments of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea

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Tae Yong Kim Departments of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea

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Young Kee Shong Departments of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea

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Won Bae Kim Departments of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea

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Introduction Fine needle aspiration (FNA) is a rapid, cost-effective, and safe test, which is widely used for the diagnosis of thyroid nodules [ 1 ]. The positive predictive value of a malignant FNA cytology (FNAC) result is 97-99% according

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Yanping Ma Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China

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Tao Wu Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China

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Zhicheng Yao General Surgery Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China

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Bowen Zheng Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China

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Lei Tan Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China

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Ge Tong Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China

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Yufan Lian Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China

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Jung Hwan Baek Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea

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Jie Ren Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China

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Introduction Thyroid nodules constitute a frequently encountered clinical problem [ 1 , 2 ], and some benign thyroid nodules (BTNs) may require treatment for associated symptoms and/or because of cosmetic problems. As curative surgery

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Daniela Rodrigues Cavaco Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal

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Ana Alves Rafael Department of General Surgery, CUF Academic Center – Hospital CUF Sintra and Hospital CUF Cascais, Lisbon, Portugal

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Rafael Cabrera Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal

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Helena Vilar Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal

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Valeriano Leite Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
NOVA Medical School/New University of Lisboa, Lisbon, Portugal

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total body weight) associated with fatigue to mild effort. Physical examination showed a lobulated diffuse thyroid enlargement and multiple inflammatory lymph nodules in the lateral compartments of the neck. Routine blood tests were normal, including

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X Y Hu Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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J Wu Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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P Seal EFW Radiology, Calgary, Alberta, Canada

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S A Ghaznavi Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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C Symonds Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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S Kinnear Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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R Paschke Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Departments of Medicine, Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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Introduction Thyroid ultrasound (TUS) is the most sensitive and cost-effective modality for the evaluation of thyroid nodules ( 1 ). When thyroid nodules are incidentally discovered on other imaging modalities, current guidelines suggest that

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Helmi Khadra Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA

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Ahmed Deniwar Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA

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Khuzema Mohsin Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA

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Dominique Monlezun Tulane University School of Medicine, New Orleans, Louisiana, USA

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Emad Kandil Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA

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present as thyroid nodules, the American Thyroid Association and the American Association of Clinical Endocrinologists have set recommendations for the systematic evaluation of thyroid nodules [ 2 , 3 ]. Their guidelines for the management of thyroid

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Alexis Lacout Centre d’Imagerie Médicale, Aurillac, France

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Emmanuel Chamorey Unité d’Epidémiologie et Biostatistiques (UEB), Centre Antoine Lacassagne, Nice, France

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Juliette Thariat Department of Radiation Oncology, Baclesse Cancer Research Institute, Caen, France

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Mostafa El Hajjam Department of Radiology, Centre Hospitalier Universitaire Ambroise Paré, APHP, Université de Versailles Saint-Quentin en Yvelines, Boulogne-Billancourt, France

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Carole Chevenet Laboratoire d’Anatomie et de Cytologie Pathologique du CHU Estaing, Clermont Ferrand, France

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Renaud Schiappa Unité d’Epidémiologie et de Biostatistiques (UEB), Département Recherche Clinique Innovation et Statistiques (DRIS), Centre Antoine Lacassagne, Nice, France

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Pierre Yves Marcy Polyclinique Les Fleurs, Service Imagerie Médicale, Ollioules, France

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; MyLab 70; Esaote, Genova, Italy). All thyroid nodules were assessed by the same physician (A.L.), whose thyroidology experience is around 10 years. Optimal settings were always performed in the same order (gain, field of view, magnification) to perform

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Shinsuke Shinkai Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan

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Kenji Ohba Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
Medical Education Center, Hamamatsu University School of Medicine, Shizuoka, Japan

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Kennichi Kakudo Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Osaka, Japan

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Takayuki Iwaki Department of Pharmacology, Hamamatsu University School of Medicine, Shizuoka, Japan

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Yoshihiro Mimura Department of Internal Medicine, American Hospital of Paris, Neuilly sur Seine, France

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Akio Matsushita Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan

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Go Kuroda Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan

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Yuki Sakai Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan

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Nobuhiko Nishino Department of Surgery, Maruyama Hospital, Shizuoka, Japan

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Kazuo Umemura Medical Education Center, Hamamatsu University School of Medicine, Shizuoka, Japan
Department of Pharmacology, Hamamatsu University School of Medicine, Shizuoka, Japan

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Takafumi Suda Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan

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Shigekazu Sasaki Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan

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common somatic mutation in papillary thyroid carcinoma). What Does This Case Report Add? • We identified concurrent BRAF mutation and TSHR polymorphism for the first time in a case of hyperfunctioning malignant thyroid nodule. • The findings

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Tamas Solymosi Endocrinology and Metabolism Clinic, Bugat Hospital, Gyöngyös, Hungary

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Laszlo Hegedüs Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark

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Steen Joop Bonnema Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark

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Andrea Frasoldati Endocrinology Unit of Arcispedale S. Maria Nuova, Reggio Emilia, Italy

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Laszlo Jambor Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

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Gabor Laszlo Kovacs 1st Department of Medicine, Flohr Ferenc Hospital, Kerepestarcsa, Hungary

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Enrico Papini Regina Apostolorum Hospital in Albano, Rome, Italy

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Karoly Rucz 1st Department of Medicine, University of Pecs, Pecs, Hungary

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Gilles Russ Unité Thyroïde et Tumeurs Endocrines – Pr Leenhardt Hôpital La Pitie Salpetriere, Sorbonne Université, Paris, France

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Zsolt Karanyi Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

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Endre V. Nagy Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

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Introduction For more than three decades, the cornerstones in the clinical management of patients with thyroid nodules have been ultrasound (US) and fine-needle aspiration (FNA) cytology [ 1 - 5 ]. Robust evidence demonstrates that the risk of

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Dorothée Bouron-Dal Soglio Department of Pathology, CHU Sainte-Justine, Montreal, Québec, Canada

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Leanne de Kock The Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, Montreal, Québec, Canada
Department of Human Genetics, McGill University, Montreal, Québec, Canada

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Richard Gauci Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Washington, Australia

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Nelly Sabbaghian The Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, Montreal, Québec, Canada

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Elizabeth Thomas Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Washington, Australia
Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Subiaco, Washington, Australia

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Helen C. Atkinson Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, Washington, Australia

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Nicholas Pachter Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, Washington, Australia
King Edward Memorial Hospital, Perth, Washington, Australia

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Simon Ryan Department of General Surgery, Sir Charles Gairdner Hospital, Nedlands, Washington, Australia

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John P. Walsh Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, Washington, Australia
Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Washington, Australia

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M. Priyanthi Kumarasinghe PathWest, QEII Medical Centre, Perth, Washington, Australia

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Karen Carpenter Department of Diagnostic Genomics, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Washington, Australia

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Ayça Aydoğan Department of Molecular Biology and Genetics, Bilkent University, Ankara, Turkey

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Colin J.R. Stewart King Edward Memorial Hospital, Perth, Washington, Australia

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William D. Foulkes The Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, Montreal, Québec, Canada
Department of Human Genetics, McGill University, Montreal, Québec, Canada
Department of Medical Genetics, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada

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Catherine S. Choong Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Subiaco, Washington, Australia
Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, Washington, Australia

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conditions associated with these mutations. Of note is that both syndromes are associated with thyroid nodules in younger individuals, as is recognised in the American Thyroid Association’s recently published management guidelines for thyroid nodules in

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Till Ittermann Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

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Adrian Richter Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
German Rheumatism Research Center, Berlin, Germany

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Martin Junge Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

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Matthias Nauck Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany

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Astrid Petersmann Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
Institute for Clinical Chemistry, Interdisciplinary University Laboratory, University Medicine Göttingen, Göttingen, Germany

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Clemens Jürgens Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

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Harald Below Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany

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Carsten Oliver Schmidt Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

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Henry Völzke Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

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reader variations are particularly essential to evaluate ultrasound (US) techniques such as assessments of thyroid volume and thyroid nodules [ 7 ]. Likewise, US devices as well as laboratory measurement techniques may be prone to variations [ 8 ]. It

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