title: Synchronous multifocal medullary and papillary thyroid microcarcinoma detected by elastography.
abstract: BACKGROUND
  A few cases of concomitant medullary and papillary carcinoma in the same thyroid nodule have been described in the literature. However, the presence of multiple foci of both types of malignancy in the same gland is very rare.
  
  
  METHODS
  A 39 year-old female with multiple thyroid nodules, elevated serum calcitonin levels and elastographic findings suggestive of thyroid malignancy, underwent total thyroidectomy and central neck dissection. Histology revealed the presence of one focus of medullary and one focus of papillary carcinoma on each thyroid lobe. Subsequently, the patient underwent treatment with radioactive iodine.
  
  
  CONCLUSIONS
  This is the third case of synchronous multifocal medullary and papillary thyroid carcinoma reported in the literature. Several theories for the simultaneous development of these malignant entities have been proposed.
  
  
  CONCLUSIONS
  Ultrasound elastography can be a useful, noninvasive tool in the assessment of thyroid nodules.
authors.affiliation: Department of Otorhinolaryngology, University Hospital of Heraklion, Voutes 71110, Crete, Greece. Electronic address: ekoudounarakis@hotmail.com.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Koudounarakis
authors.affiliation: Department of Otorhinolaryngology, University Hospital of Heraklion, Voutes 71110, Crete, Greece.
authors.forename: Alexander
authors.initials: A
authors.lastname: Karatzanis
authors.affiliation: Department of Otorhinolaryngology, University Hospital of Heraklion, Voutes 71110, Crete, Greece.
authors.forename: Alkiviadis
authors.initials: A
authors.lastname: Chatzidakis
authors.affiliation: Department of Pathology, University Hospital of Heraklion, Voutes 71110, Crete, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Tzardi
authors.affiliation: Department of Otorhinolaryngology, University Hospital of Heraklion, Voutes 71110, Crete, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Velegrakis
keywords: Calcitonin; Elastography; Medullary thyroid carcinoma; Papillary thyroid carcinoma