This image shows all the hallmarks suggestive of a malignant thyroid lesion:

1. The lucent "halo" around the lesion is gone. The lesion infiltrates the surrounding thyroid tissue. Benign lesions typically have a sonolucent well defined "halo" which is crearly defined

2. Visible microcalcifications

3. The lesion is hypoechoic compared to the normal parenchyma

4. the lesion is as tall as broad. Benign lesions are typically broader than tall.

This was a confirmed papillary carcinoma on FNA.