Thyroid fine-needle aspiration of an immunocompromised patient: Cytomorphological clues

A 25-year-old female with autoimmune hepatitis, primary sclerosing cholangitis, and ulcerative colitis presented to our clinic. She underwent a deceased donor liver transplant in 2014. The patient had a history of multiple thyroid nodules and was evaluated by our endocrinologists. Her thyroid-stimulating hormone (TSH) was normal. An ultrasound of the thyroid was performed and it showed an indeterminate right thyroid nodule of 1.8 cm, along with a couple of small nodules ranging from 0.3 to 0.5 cm. This indeterminate thyroid nodule demonstrated a heterogeneous appearance with multiple hyperechoic foci and subtle posterior shadowing. The multiple hyperechoic foci raised a suspicion for microcalcifications or inspissated colloid on ultrasound. Therefore, a recommendation for ultrasound-guided fine-needle aspiration (FNA) was made.