Incidental C cell hyperplasia (CCH) following thyroidectomy for other indications may rarely be encountered, which may raise concerns about its clinical significance and proper management. CCH can be classified as physiological (reactive) or neoplastic. Reactive CCH has no malignant potential and can be observed in association with many other thyroid diseases (including differentiated thyroid cancer); in contrast, neoplastic CCH should be considered as a preneoplastic stage in the spectrum of C cell disease, ultimately leading to the development of medullary thyroid cancer (MTC). Neoplastic CCH is commonly observed in patients with germ-line mutations in the RET oncogene (commonly in families with a history of hereditary MTC, i.e. familial MTC or multiple endocrine neoplasia type 2 (MEN2)). CCH should be considered in patients with hypercalcitoninemia without nodular thyroidopathy. Total thyroidectomy, which is commonly performed for the majority of thyroid diseases, is an adequate treatment and achieves cure, even in patients with neoplastic CCH. There is no role for cervical lymph node dissection in patients with pure CCH. In conclusion, reactive CCH has no malignant potential, in contrast to neoplastic CCH. Total thyroidectomy achieves cure of patients with CCH.

We present a case with thyroid cancer in a patient with congenital thyroid hemiagenesis (absence of left lobe). This anatomic variation was diagnosed preoperatively by ultrasonography in a patient with nodular thyroidopathy in the right lobe; ultrasound-guided fine-needle aspiration (FNA_ confirmed the diagnosis of cancer. Recognition of this rare anatomical variant is important for the surgeon to avoid aggressive and potentially hazardous surgical manipulations during surgery to find the missing thyroid lobe.

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Thyroid-only metastases from other primary cancers are rare and associated with poor prognosis. Breast cancer typically metastasizes to lymph nodes, liver and lungs, while isolated metastases to the thyroid gland are exceptionally rare and often difficult to suspect and differentiate from thyroid cancer (and most frequently poorly differentiated thyroid cancer), even by using fine needle aspiration. A patient with a history of breast cancer (4 years ago) with thyroid-only metastases is presented. Diagnostic and therapeutic problems are discussed and the relevant literature is briefly reviewed. The novelty of this data is that intrathyroid-only metastases from breast cancer are extremely uncommon and indicate generalized disease, and preoperative diagnosis can be difficult, even by using ultrasound-guided fine needle aspiration.

Thyroid nodules are very common among the general population; suspicion of malignancy is a typical indication for surgery in these patients. Despite that, surgery is typically required in patients with nodules >10 mm, resection should be considered for a selected subgroup of patients with small (≤10 mm) nodules. In this study, among 150 patients who underwent thyroidectomy for thyroid nodules during a 18-month period, 19 (12.7%) had small thyroid nodules. Indication for surgery in these patients was preoperative diagnosis of papillary thyroid cancer, after an aggressive diagnostic investigation (using ultrasound-guided fine-needle aspiration) that was performed due to the recognition of specific risk factors (most commonly suspicious ultrasonographic findings, but also cervical lymphadenectomy and strong positive family history).