<s>[INST] Hello doctor, My wife got scanned her thyroid by a novice user just for training purposes. She has been scanned in the hospital before, as part of an assessment of an autoinflammatory disease. At this time, they found a thyroid nodule (~12 mm) but no further investigation, as it seemed benign. Now, at the training scan, we observed the nodule had changed in shape, size, and it looks like there are some microcalcifications. But we are not the experts. We noticed it has changed. Could you give your second opinion on the attached images? [/INST] Hello. According to the american college of radiology thyroid imaging reporting and data systems (TIRADS), the nodule falls under category TR4, which defines it as moderately suspicious. However, as you mentioned, there is a change in morphology with the development of microcalcifications. Microcalcifications are the feature of papillary carcinoma of the thyroid, and therefore, it is essential to rule out that for which a fine needle aspiration cytology and biopsy (FNAC-FNAB) is recommended. Further, I would like to know if any necrotic neck nodes were detected. Let me know the results. I hope and pray that the nodule turns out to be benign and not malignant. FNAC-FNAB  Ultrasound guided fine needle aspiration cytology and biopsy. Papillary carcinoma of thyroid and benign colloid nodule. </s>